Archived: Plymouth Support Service

Plymouth Support Services also provides care and support to people living in a 'supported living' setting. Where people live in their own home and receive care and/or support in order to promote their independence. If there is genuine separation between the care and the accommodation, the care they receive is regulated by CQC, but the accommodation is not. The support that people receive is often continuous and tailored to their individual needs. It aims to enable the person to be as autonomous and independent as possible, and usually involves social support rather than medical care.

The service supports some people on a 24 hour basis and others who may require support with personal care needs at specific times of the day and/or night. At the time of this inspection, seventeen people received support with their personal care needs from the agency including people in the shared houses.

The service had 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.

At the last inspection in April 2016 the service was rated Good. At this inspection we found the service Required Improvement.

Why the service is rated Requires Improvement.

We visited and spoke to 15 people in their own homes and observed the interaction between them and the staff supporting them. People were not all able to fully verbalise their views, so staff used other methods of communication, for example visual choices and sign language.

The service was not consistently safe. When asked, people from one shared house said they did not feel safe. They raised concerns about a person who lived nearby. This person and the people living in the shared house had to gain access to their front door via the shared car park/garden area. People did not feel safe leaving their own home, some people missed appointments if the person concerned was outside of their home as they felt too frightened to leave. Staff also felt intimidated either going off duty or if they were leaving with people they were supporting to access the community if this person was outside in the shared car park/garden area. The service manager was currently in talks with the local safeguarding team over this issue.

People and relatives also raised concerns over a second provider currently providing overnight care for people in one of the shared houses. They were not happy with the level of care and one person commented; “Not sure if they are going to turn up.” The provider was due to stop providing care shortly.

Staff highlighted an issue with one person and their current funding level to help keep them safe and well cared for. This person’s care records all clearly showed they required two to one staffing to assist them to the toilet. At times this person was in the shared house with only one member of staff. Staff told us of an occasion that this person had to wait 45 minutes to be taken to the toilet. This could have caused this person a lot of discomfort and the Commission reported this to the local safeguarding team. The service manager overseeing this service said they were in the process of trying to obtain additional money to fund extra hours to support this person whose health had deteriorated over time due to increasing age. However records showed this person had been receiving over 700 minutes of additional care hours currently provided. These additional hours could indicate that this person may need a more suitable placement. Also if they were deemed to lack capacity to make that decision then a best interest meeting may need to be considered. After one of our site visit days a re-assessment of this persons hours had been carried out by the local authority and an additional two hours a day had been allocated. The service manager said they would discuss this with the registered manager as this still fell short of additional hours currently being provided.

Staff raised concerns over the number of staff employed to cover the current work load. For example some staff worked over 60 hours a week and another had completed six waking night duties to help support people have consistent staff working with them. Though some staff felt this was staffs own choice, other staff felt pressured into working extra hours.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to help support positive risk taking, and help reduce risks from occurring. Risks associated with people's care and living environment were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. People's independence was encouraged and staff helped people feel valued by supporting people to engage in everyday tasks, for example helping prepare meals. However some people’s independence was at times restricted due to not feeling comfortable leaving their home due to issues with a person living near a shared house.

People however felt safe with the staff that supported them. Family members provided positive feedback about the management and staff, the safety of people and how staff related to their loved ones. Comments from relatives included; “Safety comes high on their list of priorities.”

People’s medicines were managed safely. People were protected from abuse because staff knew what action to take if they suspected someone was being abused, mistreated or neglected. People had their needs met by suitable numbers of employed staff. Staff were recruited safely and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults.

The service was not consistently well led.

We were assisted during our inspection by two service managers. These two service manager were in day to day control of the service. This included each one overseeing a shared house individually, and jointly overseeing people who received care in their own home. We also had contact with the registered manager of the Plymouth service during the inspection. We then met with another registered manager for the company to provide additional feedback after the inspection in the temporary absence of the registered manager of the service.

The feedback we received from support staff was variable. Some staff told us one of the service managers was very approachable with some saying; “X [the service manager] is working hard to resolve some issues we have with “X [a person who lived close by]” and “Very approachable” and “Very good manager and involved in the home.”

The feedback on the other service manager was less positive; “Unapproachable”, “X [service managers name] doesn’t speak to us (staff) when they are in the home”, “The worst manager I’ve worked with.” We passed this information onto another registered manager for the company in the absence of the registered manager for this Plymouth service.

The provider had systems in place to monitor, assess and improve the service. However, the current checks and audits carried out were not effective in giving the provider and registered manager a clear oversight of the service or alert them to issues raised during our inspection. For example, that some staff were very unhappy with the running of one of the shared houses, that there was a short fall on providing safe care for one person, namely they only had one staff available to them when they may at times require two staff to assist with personal care. Also the number of additional hours which were being provided to one person over and above their allocated funded hours, possibly indicating an increase in their care needs or a more suitable care package.

People and relatives said they found access to the management team easy and approachable. Though some staff were positive and happy in their jobs, other staff said they were looking for work elsewhere and unhappy in their jobs due to lack of support. There was a clear organisational structure in place.

The service was responsive to people's needs and people were given a wide range of choices about their day to day lives.

The service manager had been responsive in contacting the local authorities before our inspection over issues including the problem with a neighbour who the service was finding challenging and the concerns raised by the people, relatives and staff over the second care provider involved in one shared house. During the inspection one person needing additional staffing, for extra support for all transfers and to meet toileting needs, had been referred to healthcare professionals for a re-assessment of extra funding.

However these were still ongoing issues that had not yet been resolved for the people concerned.

People had access to a very wide range of organised and informal activities which provided them with mental and social stimulation. People were supported to access the local community.

People were enabled and supported to lead fulfilling and active lives. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People could make a complaint and relatives were very confident action would be taken to address their concerns. One relative said how the service manage

Plymouth Support Service is a domiciliary care agency providing personal care and support to people with a learning disability who live in their own homes or supported living accommodation. People may also be supported who are living with conditions associated with sensory impairment and mental health needs. The service supports some people on a 24 hour basis and others at specific times during the day and night. On the day of the inspection 17 people were supported by Plymouth Support Service with their personal care needs.

The service had 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.

On the day of the inspection staff within the office were relaxed, there was a calm and friendly atmosphere. Everybody had a clear role within the service. Information we requested was supplied promptly, records were clear, easy to follow and comprehensive.

People spoke highly about the care and support they received, comments included, “I love it here, all my friends are here and the staff are lovely and very helpful”, “Staff are lovely and caring, when I was in hospital they visited me every day” and “Staff are friendly and really nice to me”. Care records were personalised and gave people control over all aspects of their lives. Staff responded quickly to people’s change in needs. People or where appropriate those who mattered to them, were involved in regularly reviewing their needs and how they would like to be supported. People’s preferences were identified and respected.

Staff put people at the heart of their work; they exhibited a kind and compassionate attitude towards people. Strong relationships had been developed and practice was person focused and not task led. Staff had full appreciation of how to respect people’s individual needs around their privacy and dignity.

People’s risks were managed well and monitored. People were promoted to live full and active lives. Staff were highly motivated and creative in finding ways to overcome obstacles that restricted people’s independence.

People medicines were managed safely. People received their medicines as prescribed, on time and understood what they were for. People were supported to maintain good health through regular access to health and social care professionals, such as GPs, social workers, occupational therapists and physiotherapists.

People told us they felt safe. Comments included, “I am safe”, “I feel much safer here than I did in the community, I was neglecting myself. Here I feel so much safer having my support around me” and “I feel really safe, the staff help me feel safe”. All staff had undertaken training on safeguarding vulnerable adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were supported by staff who had a good working knowledge of the Mental Capacity Act (2005). Staff made sure people were involved in decisions about their care and helped ensure people’s human and legal rights were respected.

People were supported by staff teams who had received a comprehensive induction programme, and tailored training that reflected their individual needs. A health care professional commented, that staff followed guidance and provided effective support.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

The service had a policy and procedure in place for dealing with any concerns or complaints.

A complaint that had been made, had been responded to in a timely manner and thoroughly investigated in line with Plymouth Support Services’ own policy. Appropriate action had been taken and the outcome had been recorded and fed back.

Staff had confidence in how the service was managed and were happy in their work. The management of the home were consistent in their approach and led by example. Staff were inspired to provide and maintain a high standard of care. Comments included, “I couldn’t ask for a better job. I would describe my job as incredible and amazing”, “I love working here, it is really nice”, “I love my job, absolutely love it. The people we support are brilliant and we have a good staff team” and “This is a really nice place to work, I really enjoy it”.

There were effective quality assurance systems in place. Incidents of concern were appropriately recorded and analysed. Learning from incidents and concerns raised were used to help drive improvement and ensure positive progress was made in the delivery of care and support provided by the service.

Staff were knowledgeable about people's physical and mental health needs and were aware of the support plans and networks in place for the people that use the service. Where people were being supported by different health professionals or organisations it was clear that staff communicated with each other to make sure that people were safe and supported appropriately.

Staff received the training they needed to enable them to carry out their role effectively and safely. They underwent regular supervision sessions, had annual appraisals and told us they felt supported by the manager of the service.

There were quality monitoring procedures in place and people were aware of their responsibilities in relation to maintain and improving quality.

Records were stored securely, contained up to date, relevant information and were fit for purpose.