Background to this inspection
Updated
27 May 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 17, 18 and 19 February 2016 and was announced. The provider was given 48 hours’ notice because the service provides domiciliary care, and we needed to be sure staff we needed to speak with would be available.
Before the inspection we looked at notifications and other information that we had received from or about this service. A notification is information about important events which the provider is required to tell us about by law. A Provider Information Review (PIR) had been submitted in February 2016. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We visited people in six supported living locations, with their permission. We spoke with five people supported by the service, and met a further 11 people. They were unable to tell us about their experience of care, so we observed their care and support. We spoke with four people’s relatives after our inspection to capture their views of people’s care. During our inspection we spoke with ten support workers, and eight team leaders and support managers. We also spoke with the registered manager and divisional director.
We reviewed five people’s support plans, including daily support records, and medicines administration records (MARs) for ten people. We looked at four staff recruitment records, and reviewed training records from a central schedule. We viewed the provider’s policies, procedures and records relating to the management of the service. We considered how comments from people, staff and others, as well as quality assurance audits, were used to drive improvements in the service.
We last inspected this service on 9 September 2014, and did not identify any areas of concern.
Updated
27 May 2016
The inspection took place on 17, 18 and 19 February 2016, and was announced. This was to ensure people and staff we needed to speak to were available.
This service supports people with learning disabilities, including autism, sensory impairment and physical or mental health needs, in the counties of Berkshire, Surrey and Hampshire. People were supported with personal and domiciliary care in their own homes. This included supported living housing locations. These are self contained homes in shared tenancy housing, and sometimes include 24 hour care support. At the time of our inspection 55 people were supported with personal care.
Within this report we sometimes refer to staff. This is used to describe all staff roles, including support workers, team leaders and support managers. Each supported living location was managed on a day to day basis by a team leader and/ or support manager. Support managers oversaw several supported living locations for day to day needs, and reported to the registered manager.
The service had a registered manager. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People were protected from potential harm, because staff were trained to recognise and deal with possible abuse. People felt safe with the staff who supported them.
Risks affecting people’s health and wellbeing had been identified. People were supported to manage risks safely without affecting their chosen activities and lifestyle.
There were sufficient staff deployed to support people’s needs safely. Recruitment checks and roster reviews provided assurance that people’s commissioned care was fully met by support workers of suitable conduct.
People were supported to take their prescribed medicines. Support workers were trained and assessed to ensure they administered people’s medicines safely. Records demonstrated that support workers followed the provider’s training and guidance to protect people from potential medicine administration errors.
People were supported by staff who completed and regularly refreshed their training. This ensured they had the skills required to meet people’s needs effectively. Staff had regular supervisory meetings that provided opportunities for skills and development review, as well as discussion of issues. Support workers and their managers were effectively supported to resolve any concerns identified.
People were supported to make decisions about their care and support. Staff understood and implemented the principles of the Mental Capacity Act (MCA) 2005. People’s relatives confirmed that they were involved in best interest decisions where people were assessed as lacking the understanding to make an informed or complex decision. The registered manager understood the requirements of the Deprivation of Liberty Safeguards (DoLS) and had applied to the Court of Protection for these when necessary. DoLS ensure that where people’s liberty is restricted, this is only to protect them from identified potential harm, is as least restrictive as possible, and is applied in accordance with the MCA 2005.
People were supported to maintain a healthy diet. People’s dietary and health needs were managed effectively, because support workers liaised with and followed health professionals’ guidance.
Support workers treated people with compassion and care. They provided reassurance and comfort when this was needed, and took pride in people’s developing independence. They understood people’s wishes and preferences. People’s cultural, religious and gender preferences were recognised and respected. People were able to seek privacy when they wished, and staff treated them in a dignified manner.
People and those important to them were involved in agreeing and reviewing their plan of care. Changes were identified promptly to ensure people’s support plans remained current, and met their needs and wishes.
Feedback was welcomed, and used to influence changes in the service. Complaints were managed and resolved in accordance with the provider’s policy. The registered manager liaised with families to ensure concerns were addressed to their satisfaction.
Staff understood and demonstrated the provider’s values of inclusiveness and empowering people’s independence as far as possible. Despite some concerns regarding changes to people’s commissioned care regarding the change from residential care to supported living, support workers took pride in the quality of care they provided.
Staff spoke positively of the leadership provided by the registered manager and divisional director. People’s relatives told us communication was improving, and they had no concerns about the quality of care people experienced.
The provider’s quality audit framework ensured issues were identified and addressed. Progress towards resolution of issues was monitored by the divisional director to ensure changes were embedded into practice. Learning was shared in management meetings to drive improvements to the service. The service was well-led.