Peak 15 Ltd

Ashcroft Care services is a supported living service providing personal care to people in five supported living services. They also provided personal care and outreach support to people living in the local community. At the time of inspection, 49 people were receiving personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People and relatives spoke very positively of the care they received and this was matched by compliments received about the service from people, relatives and professionals. People described the freedom and independence they had developed from the care they received. People received a highly personalised service which enabled them to develop their skills and become independent. People routinely took ownership and control over their care needs, find meaningful activities, relationships and employment. There was a personalised approach to risk with a focus on enabling people to take risks in a way that gave them increased choice and control over their lives.

People and staff were well trained and had a good understanding in a variety of areas of care. People’s healthcare needs were met in a holistic and highly personalised way so people were empowered to understand and maintain their own health and wellbeing. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were very committed to the people they worked with and we saw multiple instances of staff standing up for people’s rights and supporting people to speak up where they found discrimination. There was a strong attention to detail evident in the ways staff involved people and found ways to improve their lives and help them to develop.

People had multiple opportunities to engage in meaningful activities and support was targeted based on people’s outcomes. People had entered employment, found new interests, been on holiday and started relationships with a planned and personalised approach to care.

The service embodied strong values which meant there was equality and unity between people, staff and management. People were consistently involved in all areas of the service and the service had strong links with the local community which had achieved positive outcomes for people. There was strong leadership throughout the service and support to staff which made them valued and committed to the people they supported.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, 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.

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

Rating at last inspection

The last rating for this service was Outstanding (published 21 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service ranges from a few support hours several times a week, to 24-hour support for some people in supported living settings. A supported living service is when people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and a separate agreement to receive their care and support from the domiciliary care agency.

Ashcroft Care Services also provide twenty-four-hour emergency on-call assistance to ensure that people living independently can access support at all times. They provide support to people with domestic tasks such as housework. At the time of our inspection the service was providing care and support to 11 people.

The inspection took place on the 11 November and was announced. We told the provider two days before that we would be coming. This was to ensure the registered manager was available when we visited the agency’s office and that we had the opportunity to speak to people who used the service.

The service had two registered managers both were in day-to-day charge of the service. 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 were at the heart of the service, which was organised to suit their individual needs and aspirations. People we spoke with felt the service was excellent and the staff and manager provided above average care and support.

People’s achievements were celebrated and their views were sought and acted on. People were supported by staff that were compassionate and treated them with dignity and respect. Staff were trained to use a range of communication tools suitable to enable the people they supported to express their needs and wishes.

People were active members of their local community and led busy and fulfilling lives. There was evidence of positive outcomes for people, and that people had progressed over time, gained new skills and increased their independence. People were enabled through positive risk taking, to challenge themselves to achieve. Staff were supported to challenge practice and to experiment and try different approaches with people.

The service worked in partnership with other organisations in creative and innovative ways to improve people’s independence. This included working with a variety of organisations to gain opportunities for people to get work experience and gain employment.

The support provided to people was self-directed. People choose when to receive support, who they wished to support them and how they wished to use the support provided to them. Staff treated people with kindness, dignity, respect, and spent time getting to know them and their specific needs and wishes.

Staff had an understanding of abuse and the safeguarding procedures that should be followed to report abuse .The staff we spoke with were able to demonstrate what they would do should they have any concern that abuse was taking place.

Staff were encouraged to raise concerns and report incidents. Incidents were used as opportunities to review what worked well for each person and what needed to be changed. The people we spoke with were aware of the need for risk assessing and were happy with what was in place to support them.

Staffing levels met people's current needs. Staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. People who used the service were encouraged to participate in the interviewing process for potential employees. This demonstrated the service’s commitment to the culture of inclusion and

participation within the service.

People benefitted from a service that was committed to continuous learning and improvement. Staff were enabled to become skilled practitioners through a system of induction, training, and continual professional development. The registered manager promoted evidence based practice and encouraged staff to reflect on their practice through regular supervision and appraisal, team meetings and mentorship. Practice took account of local and national guidance about effective care. The staff we spoke with were confident that the support they received enabled them to do their jobs effectively.

People were supported to receive their medicines when they needed them. We were told by the majority of people we spoke to they did not have any issues with medicines and that they received them when necessary.

People's direct consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 were met. Everyone we spoke with told us that staff members always gained their consent before carrying out any care tasks. Staff were confident and knew how to make

sure people, who did not have the mental capacity to make decisions for them, had their legal rights protected and worked with others in their best interest.

People were able to choose the food and drink they wanted and staff supported them with this. If required, staff supported people to access health appointments. We saw that people had information about their likes and dislikes with food and drinks, and dietary requirements recorded within their files.

There was strong leadership which put people first, set high expectations for staff and led by example. The service had an open culture, a clear vision and values, which were put into practice. Staff were proud to work for the service and felt valued for their work. A positive culture was demonstrated by the attitudes of staff and management when we talked with them about how they

supported people. Many of the staff we met had worked in the service for a long time, knew people well and had developed deep and meaningful relationships with each person they supported.

The service had a complaints procedure in place, where people had made complaints evidence was found that these complaints were recorded and acted upon appropriately. The provider had robust quality monitoring systems to monitor the quality of care. Continuous improvement plans were in place which identified the staff responsible, set deadlines and were regularly monitored and reviewed.

We spoke with people who used the service and their commented were, 'I love living here.', 'staff are good to me and help me with cooking.', 'I do my medication myself.'

Representatives we telephoned told us they were satisfied with the care that their relatives received. One representative told us that 'The care provided is fantastic, I am incredibly happy with the support provided to my relative and staff are proactive.' Another person told us ' I am in regular contact with the manager and can discuss about my relative's care plan any time which I am fully involve and the service enable people to change their lives.'

The agency had a robust recruitment procedure in place; this meant that people were cared by people who had been checked to work with vulnerable people.

We found that the provider had a system in place to monitor the quality of the service they provided and we found that people were generally satisfied with the care and treatment they received.

People were protected against the risks associated with medicines because the provider did have appropriate arrangements in place to manage medicines.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.