SM Voice Advocacy Limited

Updated 1 June 2018

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, looked at the overall quality of the service, and provided a rating for the service under the Care Act 2014. A service provider is the legal organisation responsible for carrying on the adult social care services we regulate.

This unannounced inspection of SM Voice Advocacy took place on 10 and 11 April 2018. When planning the inspection visit we took account of the size of the service and that some people supported by the service could find unfamiliar visitors unsettling. As a result this inspection was carried out by one inspector.

Before the inspection the provider completed a Provider Information Return (PIR). This 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 reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law. We also reviewed information contained within the provider’s website.

During our inspection we spoke with three people using the service, some of whom had limited verbal communication. We used a range of different methods to help us understand the experiences of people using the service who were not always able to tell us about their experience. These included observations and pathway tracking. Pathway tracking is a process which enables us to look in detail at the care received by an individual in the home. We pathway tracked the care of three people using the service and one who had passed away the week before our inspection.

Throughout the inspection we observed how staff interacted and cared for people across the course of the day, including mealtimes, during activities and when medicines were administered. We spoke with the staff including the registered manager, two deputy managers and five care staff.

We reviewed four people’s care records, which included their daily notes, care plans and medicine administration records (MARs). We looked at eight staff recruitment, supervision and training files. We examined the provider’s records which demonstrated how people’s care reviews, staff supervisions, appraisals and required training were arranged.

We also looked at the provider’s policies and procedures and other records relating to the management of the service, such as staff rotas covering February and March 2018, health and safety audits, medicine management audits, infection control audits, emergency contingency plans and minutes of staff meetings. We considered how people’s, relatives’ and staff comments were used to drive improvements in the service.

Following the visit we spoke with four relatives and three friends of people. We also spoke with 10 health and social care professionals, including two independent mental capacity advocates (IMCA) and three Court of Protection appointed deputies. IMCAs are a legal safeguard for people who lack the capacity to make specific important decisions; including making decisions about where they live and about serious medical treatment options. A deputy is appointed by the Court of Protection to manage either the finances and/or health and welfare matters of another person, for example; decisions over where to live or what medical treatment to receive. The Court then monitors the deputy every year to make sure they are carrying out their role properly. These health and social care professionals were involved in the care and treatment of people supported by the service. We also spoke with commissioners of people’s care.

Updated 1 June 2018

The service provides care and support to people living in supported living settings, so they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living. This inspection looked at people’s personal care and support.

The service has been developed and designed in line with values that underpin the Registering the Right Support and other best guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can lead as ordinary life as any citizen.

This comprehensive inspection took place on 10 and 11 April 2018 and was carried out by one inspector. The inspection was announced, which meant the provider and staff knew we would be visiting. We announced the inspection to ensure that people we needed to speak with would be available.

At the time of inspection the service was supporting three people, at two separate addresses. Two of the people were being supported to live with the experience of a learning disability and other associated health needs.

The service had a registered manager in place at the time of our inspection. 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 experienced outstanding care that was extremely flexible and responsive to their individual needs and preferences, from a dedicated staff team who consistently went above and beyond what was expected of them. The personalised care provided consistently achieved exceptional outcomes for people, enriching the quality of their lives and improving their physical and mental wellbeing.

People were fully involved in their care and support and lead active and fulfilling lives. Staff were totally committed to supporting people to achieve their hopes and dreams.

The service worked closely with healthcare professionals to provide outstanding end of life care and support, which ensured people experienced a comfortable, dignified and pain-free death, whilst ensuring their wishes were acknowledged and respected.

People were kept safe from harm by staff who knew what to do in order to maintain their safety. The registered manager supported people to understand what keeping safe means, and how to raise any concerns they may have. Staff promoted people’s independence by discussing any risks to their safety with them and how these could be managed safely. Risks to people were assessed and action was taken to minimise any avoidable harm. Medicines were managed safely and administered as prescribed, in accordance with current and relevant professional guidance.

The provider operated thorough recruitment procedures to ensure staff were safe to work with people living with a learning disability or mental health needs. Risk assessments detailed the number of staff required to support each person and there were always enough staff to provide care and support to meet people’s needs safely.

Staff supported people to safely manage the control and prevention of infection by maintaining high standards of cleanliness and hygiene in their homes, particularly in relation to the safe preparation of food.

Staff raised concerns with regard to safety incidents, concerns and near misses, and reported them internally and externally, where required. The registered manager analysed incidents and accidents to identify trends and implement measures to prevent a further occurrence.

The provider had enabled staff to develop and maintain the necessary skills and knowledge to meet people’s needs effectively. Where required, staff completed additional training to meet individuals’ complex needs.

People were supported to eat and drink enough to meet their nutritional needs. Risks to people with complex needs whilst eating had been identified and were managed safely.

Staff supported people to maintain their health and ensured they were referred promptly to appropriate healthcare professionals whenever their needs changed.

The registered manager and staff clearly understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. People were involved in making every day decisions and choices about how they wanted to live their lives and were supported by staff in the least restrictive way possible. The service tenaciously supported people whilst engaging with other professionals, to ensure their human rights were recognised and protected.

People experienced good continuity and consistency of care from staff who were kind and compassionate. People were relaxed and comfortable in the presence of staff who invested time to develop meaningful relationships with them.

People's independence was promoted by staff who encouraged them to do as much for themselves as possible. Staff treated people with dignity and respect and were sensitive to their needs regarding equality, diversity and their human rights.

The service was responsive and involved people in developing their support plans which were detailed and personalised to ensure their individual preferences were known. People were supported to complete stimulating activities of their choice, which had a positive impact on their well-being.

People were supported by staff to maintain special relationships with friends and relatives to ensure people did not feel lonely and were protected from the risks associated with social isolation.

Arrangements were in place to obtain the views of people and their relatives and a complaints procedure was available for people and their relatives to use if they had the need.

The service was well managed and well-led by the registered manager who provided clear and direct leadership, which inspired staff to provide good quality care. The registered manager was passionate about providing people with the right support, that enabled them to grow and develop. The registered manager had developed an open and inclusive service. They had a clear vision and set of values based on social inclusion that the staff fully understood and delivered in practice. Staff felt listened to, supported and involved in the development of the service.

The safety and quality of support people received was effectively monitored and identified shortfalls were acted upon to drive continuous improvement of the service.