About the service:

L’Arche Liverpool provides ‘supported living’ services across Liverpool to people in their own tenancies. At the time of inspection, the service was providing support to 40 people with different health needs, mental health conditions, learning disabilities and/or autism.

People’s experience of using this service:

We found and heard some very positive examples, but also identified improvement was needed. We considered everything we looked at in proportion, to achieve a balanced judgement based on people’s experience, which was overall very good.

Staff told us there had been a period of unsettlement, but that over the last few months, due to new arrangements, things had much improved. The provider was aware of improvement needed and were addressing them through a comprehensive management restructuring. We considered that this would help with issues we identified regarding robust planning and review, overview, record-keeping and governance to support consistent safety and quality of care. The service remained caring overall, although in parts more consideration needed to be given to consistently maintain people’s respect, dignity and privacy.

However, at this inspection we also learned of several examples that showed how at times the service was exceptional at responding to people’s needs. For these individuals and their families, the service had truly had a remarkable impact.

The outcomes for people using the service reflected the principles and values of Registering the Right Support, by promoting choice, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. The ‘supported living’ services had been developed out of former care homes, but the provider evidenced how they had changed the setup to real tenancies. We discussed some further considerations with managers around this. Personalised care and support, as well as smaller flat setups mitigated negative impacts on people in slightly larger settings for up to 10 tenants. People were well connected with each other and the wider community.

People felt safe with the support from staff and told us or showed us in their individual ways that they were happy with their care. Staff and relatives told us about the positive, person-centred and inclusive quality of the service. We saw this reflected in the way staff supported people’s unique ways of communicating. The service embraced and promoted equality and diversity. There were enough staff to meet people’s needs and staff support was flexible about individuals’ wishes. Staff felt well supported and told us everyone worked well together to provide a good service for people.

People were supported to be active in ways that were meaningful to them, as well as encouraged to try new things. People, relatives and staff were actively involved in the service and new ways to include them were being developed.

Rating at the last inspection:

At the last inspection we rated the service as overall Outstanding (3 November 2016).

Why we inspected:

This was a planned inspection that was scheduled based on the previous rating. We inspected to check whether the service had sustained its Outstanding rating. The service continued to meet the characteristics of Outstanding under Responsive. We found the service on balance, and with ongoing improvement work, met the criteria of Good in all other areas. Further detail on the changed rating for Caring and Well-Led is in our detailed findings below.

Follow up:

We will follow up on this inspection through ongoing monitoring of the service, through conversations and notifications.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 21 and 23 June 2016. The first day was unannounced, on the second day we visited people in their homes after first arranging a convenient time with them.

L'Arche originated in France in 1964 and is an international movement supporting people with learning disabilities all over the world. L'Arche Liverpool is based upon Christian values; however the organisation welcomes people of all faiths and those with none. People supported by the organisation are called ‘core members’ and staff are referred to as ‘assistants’. The organisation believes this more accurately reflects the relationship between people and is respectful to the people they support.

Due to the nature of their support needs some people did not use speech to communicate with us. However every person we met communicated with us in some way using speech, gestures, actions, guiding us to places and in showing us aspects of their lives and support.

L’Arche Liverpool provided care and support to 32 people who lived in their own homes independently or who shared a home with other people who also received support. When a home was shared, each person usually had separate en suite facilities. Each person held their own tenancy with a housing association. One senior member of staff explained to us that the organisation advocated on people’s behalf with regard to housing as part of their overall support.

Each person we spoke with told us in words or by their actions that they were happy with the support that they received. Staff showed patience and thoughtfulness in their interactions with the people they supported. They were also careful not to have undue influence on people’s decisions and choices. We saw that relationships were respectful and staff demonstrated empathy towards people in their words and actions.

Each person was supported as an individual with their care and support adapted to their needs and wishes. The support people received was centred on their needs, wishes, beliefs, relationships, goals and passions in life. This was reflected in people’s care plans, the plans were meaningful, aspirational and reflected people’s day to day support. People could choose to be supported in every aspect of their lives, to learn new skills, achieve goals and have life enriching experiences. There was a focus on people’s social needs and supporting people to maintain their existing relationships and to make new friends and community connections. We found people’s support was responsive to people’s growth and also their changing needs and wishes.

We saw that people supported were listened to and communicated with constantly, at times in innovative and creative ways. The perspective of people supported was sought in the recruitment of new staff members by meeting candidates before their interview and also at the end of the probation period for new staff. One staff member reasoned, “The staff member is working most of the time in someone’s home, it’s important to gain their perspective”. People’s views on the direction of the organisation had been sought through a series of listening café’s. Action plans and organisational documents had been produced in an easy to read format so people were kept up to date.

Safeguards were in place to ensure people were as safe as possible without being restrictive or risk adverse. Staff received appropriate training in keeping vulnerable adults safe. New staff members had been safely recruited. There were effective and robust systems in place that ensured that peoples medication, money and personal information was kept safe. There were also systems in place that recorded, analysed and learnt from accidents and incidents that had occurred. This had resulted in improvements being made to some people’s support.

Every staff member we spoke with told us they were happy in their role. Staff told us they felt well supported in their role and benefited from an office open door policy, training and trainin

The service provided domiciliary care and support for people living in three houses. On the day that we inspected the service we spent time at the Ark centre where the managers are based and at The Harbour, one of the houses. We spoke to different people to gain a balanced overview of what people experienced, what they thought and how they were cared for and supported. We spoke with a person who lived at The Harbour. We spoke to two carers and two managers. We spent time observing people using the service, to see how they were cared for and how staff interacted with them.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five key questions that we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that care and support was carefully planned to meet service users’ individual needs. This was because people’s needs had been thoroughly assessed and risk assessments had taken place. Care was planned to minimise any risks. There were enough suitably trained staff to meet those needs and to support people in their diverse activities. Measures were in place to safeguard people from abuse and staff received regular training about safeguarding vulnerable adults. When people lacked the capacity to consent, the appropriate steps were taken in line with legislation. The provider had systems in place to regularly monitor the quality of the service provided and assessed safety risks.

Is the service effective?

The service had a community ethos and referred to people who received support as ‘core members’ and staff as ‘assistants’. People told us that the staff had helped them when they needed help and encouraged their independence. A person who was supported to live at The Harbour told us that they were happy living in the house, that it was, “my home.” We saw that information was available for people is a format that included pictures to help people to understand. People and their relatives had been involved in writing their care plans and their preferences and aspirations were taken into account. A person told us, “I can do more for myself now, staff encourage me.”

Is the service caring?

A person using the service told us that the staff were, “Very good. They are all nice to me.” People were supported by kind and attentive staff. We saw that staff interacted with different people throughout the day and they were cheerful and patient, and talked to people pleasantly. The manager showed us that people using the service and relatives were invited to complete questionnaires every year. The manager met with every person using the service after six weeks and carried out a detailed evaluation of the care and support that they received. This included a picture format to help people to understand the questions and to respond if they lacked verbal communication skills. The surveys that we saw showed us that people were happy with the service provided.

Is the service responsive?

We saw that the service was responsive to the needs of people using the service in supporting them to choose activities that they enjoyed. People’s needs were reassessed regularly by staff who knew them, with the involvement of people themselves and relatives. In response to a suggestion by a relative the service had introduced regular meetings with people’s families, either in person or by telephone. The manager monitored incidents and accidents in order to respond by taking steps to make appropriate changes to prevent them re-occurring. We saw that this included both errors by staff and challenging behaviours of people. The manager explained that they had been able to analyse information and make changes such as developing strategies and procedures that all staff could consistently use. This minimised the risk of the same problem reoccurring.

Is the service well led?

The home had a registered manager, who we met. Each house had a locality manager. Carers told us that both of their managers were approachable and dependable. The managers had regular supervision and annual appraisal meetings with all staff. Carers understood the ethos of the home and their own roles and responsibilities. The manager told us that they were constantly working to improve the service and we saw that the provider’s comprehensive quality assurance framework referred to 'a commitment to assuring quality.' We saw that policies and procedure documents were clear, legible, up to date and easy to find. The manager sought advice and guidance from other health and social service professionals when necessary. The service had a robust system in place to monitor the quality of the service that they provided.

People using the service told us they had been treated with respect and involved in decisions about their care, treatment and support.

People told us they felt the information provided to them about the service they could expect from the agency was sufficiently detailed and was written in a way that they could understand

People said the continuity of carers was very good and they usually had the same carers.

One person told us they had been involved in interviewing carers for the agency.

People told us they had received care and support that met their needs.

People commented:

“My carers are the best and they know me well”

“They support me exactly how I want them to”.

People told us they had felt safe using the service and that they would tell staff if they were concerned about their treatment.

People commented:

“I feel safe with my carers and would tell someone if I didn’t”.

“I would know if I had been badly treated”.

People told us they had been contacted regularly by a member of the management team and asked how things had been and if they had any concerns or other comments about the service they had received.

The manager explained that the people they supported were referred to as ‘core members.’ We have used this preferred term throughout our report.

Overall core member's were happy with the support provided and they liked the staff.

Positive comments shared by relatives included: “The support is really good, we are happy with how things are going.” They gave overall positive comments about their relatives support.

Support plans were clear and maintained the dignity and confidentiality of each core member. Support records had been reviewed regularly to make sure the information reflected each core member’s current needs. This meant the staff had the information they needed to provide the care and support required in accordance with individual needs and choices.

The service had developed a lot of their documentation into pictures to help support their core members in accessing any relevant information necessary to them including their complaints procedure. The pictorial complaints format helped support some core member’s to understand their rights to raise their concerns and opinions. We looked at the managers records regarding how they audited complaints. They were well managed and provided a full audit trail regarding how complaints and comments had been managed. This ensured that concerns raised were fully investigated and responded to.