Archived: Garland Support

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, people’s independence and links with their community.

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Why the service is rated Good

People and their relatives told us the service was safe. Robust systems, processes and practices were in place to protect people from the risks including the risk of abuse, falls, fire and infection. Staff had received training on safeguarding. Risks to people’s health and safety had been assessed and staff had been given information and training about these as well. Staff understood specific health conditions and knew how to recognise signs of illness and when to seek medical intervention. People were supported to manage their medicines safely. The provider had systems in place to ensure that lessons were learnt and improvements made. As a result they had a low level of incidents and accidents.

Care was taken to recruit and select the right staff for the job. Recruitment processes helped the provider choose applicants with the right values and caring qualities for the job. A person told us “They are marvellous. Always kind.” There were enough staff employed to ensure that people always received support at the right times, and by staff they knew. A relative told us “[…] has a steady, regular staff team. Staff have got to know him. Staff have managed his behaviours well.”

People continued to receive a service that was effective. People told us they were very happy with the support they received. Each person received a timetable each week, in a format they could understand, to let them know who would be visiting them and at what times. Staff told us there were effective systems in place to manage their weekly rotas and ensure they knew who they were visiting each week, and when. The service was reliable.

Staff had the skills, knowledge and experience to deliver effective care and support. Staff received induction and ongoing training and updates on a range of topics relevant to the needs of the people they supported. They were also supported to gain relevant qualifications and to attend courses and training sessions to enable them to improve their knowledge and skills. A relative told us they were confident the staff were well trained, saying “I think they are a high calibre of staff.”

Consent to care and treatment was always sought in line with legislation and guidance. The service understood their legal responsibility to ensure they complied with the Mental Capacity Act. People were supported to make choices and decisions about all aspects of their lives, as far as they were able. People receive support from staff who respected and promoted equality and diversity.

People were supported to eat and drink enough to maintain a healthy balanced diet. Where people required support with this task, staff helped them choose the meals they wanted each week, go shopping for the ingredients and to prepare and cook the meals.

People continued to receive a service that was caring. A person who used the service told us, “It’s like a family. Staff are always kind and caring.” A relative said, “They deeply care. They will go the extra mile”. People were supported by small teams of staff who knew them well and understood the things that mattered to them, their likes and dislikes. People and their relatives praised the staff for their caring manner and gave examples of many “little kindnesses”. We heard how each member of staff brought their own special talents and skills to the job, such as a member of staff who always sat with a person to talk about and listen to the person’s stories and memories of their past. A member of staff was described as, “Just magic. A lovely warm personality.” We saw and heard staff smiling, encouraging and supporting people in a caring and friendly manner. People were involved and consulted on the service. Their views on the service had been sought in various ways including questionnaires, regular reviews and through forums held at their activity base known as The Hub for people who use the service.

People received personalised and responsive care from staff who knew and understood their needs. Support plans were drawn up and agreed with people before the service began. The plans were regularly reviewed and updated to ensure staff always had access to up-to-date information about all aspects of the person’s needs. People were given information about the service, including a copy of their support plan, in a format suited to their needs. They had also been given a copy of the complaints procedure in an accessible format. Concerns and complaints were responded and listened to and used to improve the quality of care. The service was pro-active in recognising mistakes, apologising and taking action to improve the service. A relative told us “They are very open. Even if they have made a mistake.”

People were supported to gain independence, learn new skills and achieve their goals and ambitions. People participated fully in the local community. Areas of support included helping people gain employment, attend college, go to places they liked and to do activities they enjoyed. The agency had set up an activity centre called The Hub which people could attend if they wished. The centre offered people a range of activities and outings. A relative told us “He has made new friends. He enjoys The Hub and group activities and outings.”

People told us they continued to receive a service that was well-led. Comments included “They have good values”. At the time of this inspection the registered manager had taken on a new role within the organisation. A new manager had been appointed. A few days after this inspection the new manager’s application to be the registered manager of the service, was approved. People, staff and relatives told us they liked the new manager. Comments included “[…] understands. He has regular meetings with the family and professionals. He has put a lot of time into [person’s] care plan.”

There was a clear management structure in place and staff were well supported. Staff were positive about their jobs and praised the management team. Comments included “This job is brilliant. I love it”.

The provider had quality monitoring processes in place to ensure the service was constantly improving. The views of people who used the service, relatives and staff had been sought in various ways and these were acted upon. A relative told us they had very good communication with the management team, saying “They are constantly seeking to improve things.”

Further information is in the detailed findings below

Garland Support provides personal care for younger adults who have physical or learning disabilities and live in their own homes. This type of service is often referred to as supported accommodation. At the time of this inspection there were two people with visual impairment who received a range of support including personal care. Our inspection focussed on the support given to these two people. The service also provided support to people who did not require personal care. This part of the service is not covered by CQC legislation and therefore was not included in the inspection.

There is a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission 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 who used the service told us they had been fully involved in drawing up and agreeing a plan of their support needs. They held a copy of their support plan and told us they were certain the information was correct. The plans were comprehensive, well laid out and easy to read. They had been regularly reviewed with the person and were up-to-date. Any potential risks to the person’s health or safety had been assessed and regularly reviewed. The support plans provided clear instructions to staff instructions on how each person wanted to be supported.

People received a reliable service. They received a rota in advance which gave them the names of the staff who would be visiting them and the day and the times of the visits. They told us they could rely on staff to arrive on time and stay for the agreed time. They also told us the service was flexible and could provide extra support, or support at a different time and at short notice if necessary.

The registered manager and staff told us one aspect of the service they were particularly proud of was their success in helping people to gain independence and to achieve their goals and aspirations. The service had links with many local resources including education services, social groups, sports and leisure facilities, and employment opportunities. They had consulted with the people who used the service to find out what they wanted to do, and if there were no suitable facilities available they organised their own, for example yoga sessions. People participated in a variety of social activities within the home and in the community. The service had good local links to promote people’s involvement in the community.

People told us the staff were always caring and treated them with respect. Comments included “The staff have the right attitude.” Staff always sought people’s agreement and consent before carrying out any task. One person told us “I feel I am really in control.”

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff had received a range of training and information including safeguarding adults and they were confident they knew how to recognise and report potential abuse. People who used the service told us they felt safe. Comments included “Yes, I feel safe with the agency.”

Staff were well supported. They told us they could contact a manager at any time for advice or support. One-to-one supervision had been mainly through ad hoc meetings and group meetings, but formal one-to-one supervision sessions had been planned for the coming year. Staff meetings were held regularly. Comments included “It’s brilliant. We never let issues rumble on. If we need to discuss anything we will let (the registered manager) know and a meeting is set up.” The staff we spoke with were positive and enthusiastic.

At the time of this inspection people were in full control of their own medicines, although they needed some support from staff to help them take their medicines out of the packaging. Safe systems were in place to record all medicines administered by staff. Staff had received training and information on safe administration of medicines.

Staff respected each person’s right to make decisions about their lives, including matters relating to their health. Staff offered guidance and support to help people manage their own health and well-being. People could request support from staff to help them attend medical appointments. Where people requested support, staff liaised with health and social care professionals on their behalf, and with their full agreement.

People who used the service, staff and professionals told us the service was well-led. Comments included “Yes, the agency is well run. I think (the managers) have done a brilliant job since they started up the company.”

The provider had a range of monitoring systems in place to ensure the service ran smoothly and to identify where improvements were needed. People were encouraged to speak out and raise concerns, complaints or suggestions in a variety of ways. People were asked to complete survey forms seeking their views on all aspects of the service.