Supported living Plymouth and Devon

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 that are developed in line with national policy. For example, how the service ensures people care is personalised, maintains their independence and supports links with people’s community.

At our last inspection in July 2016 we rated the service as Good. At this inspection we found the evidence continued to support the rating of good in the areas of safe, effective, responsive and well-led. We found further improvements had been made in relation to caring and this area is now rated as outstanding.

There was a positive, open and inclusive culture within the service. The management team provided good leadership and led by example. Relatives, staff and other agencies were positive about the leadership of the service. Staff said they loved their work and were passionate about providing good care to people.

People were provided with sensitive and compassionate support by a kind, committed and caring staff team. We observed without exception staff treated people with the upmost patience and kindness. When we visited people in their homes we saw staff knew people well and had built positive and trusting relationships. Relatives and other agencies praised the staff and management for their caring and compassionate approach to supporting people. Staff really respected people and recognised they were supporting people in their own homes.

All the staff we spoke with were able to tell us about the values of the organisation and said they were informed of them and their importance during the recruitment process and as part of on-going training and discussion. It was very clear staff had adopted these values in relation to the support they provided. It was reflected in the way staff spoke about the people they supported, in the practices we observed, and in the feedback we received about the way people were cared for and treated.

The service had a culture which recognised equality and diversity amongst the people who used the service and staff. Staff were sensitive and respectful to people’s religious and cultural needs. People were not discriminated against in respect of their sexuality or other lifestyle choices.

Personalised care was central to the service philosophy and staff demonstrated they understood this by talking to us about how they met people’s care and support needs. Staff spoke about their work with commitment and passion and used words like “Individual”, “Independence” and “Rights” when they talked about the people they supported. People’s care records were personalised, which ensured care was tailored to meet their individual and diverse needs. We saw people were supported to live a happy, fulfilled life, to feel safe, enabled to try new opportunities and to maintain their independence as much as possible.

The provider and registered manager recognised the benefits of multi- agency working and external agencies were very positive about the management and care provided to people.

Staff were well trained and training was relevant to their role and kept updated. The registered manager was passionate about developing the skills of the team and also kept themselves updated with best practice. All staff said they felt well supported, and had opportunities to discuss and reflect on their practice and incidents that had occurred. Staff were employed in sufficient numbers to meet people’s needs and to keep them safe. Staff teams were organised in a way that helped ensure consistency.

Relatives and other agencies said they felt people were safe using the service. We observed people were relaxed and comfortable with the staff supporting them. Staff had undertaken training and were clear about how to report any concerns relating to abuse or people’s safety. Recruitment practices helped ensure staff employed by the service were suitable to work with vulnerable people.

Management and staff understood their role with regards to the Mental Capacity Act (2005). People’s consent was sought before care and support was provided. When people were unable to make decisions, discussions took place with relatives and other relevant agencies to help ensure decisions were made in people’s best interest.

People’s health and dietary needs were understood and met. Staff ensured people had access to the food and drinks required to maintain good health. If concerns were highlighted about people’s health or diet advice was sought and appropriate referrals made to relevant health services. Staff supported people to attend hospital and other healthcare appointments.

People continued to receive their medicines safely. Staff who administered medicines had received up to date training, and competency checks were completed to help ensure their skills and knowledge remained sufficient and up to date.

Good governance of the service by both the provider and the registered manager benefitted people because it ensured the quality of care was maintained and enhanced. Regular audits were carried out, which included checks of health and safety, staffing levels, training, and medicines. Checks were carried out by management and support staff to ensure records held in people’s homes were appropriate, accurate and up to date. As a result of audits and reviews of the service recent improvements had been made in relation to staff recruitment, incident reporting and staffing. Staff said the addition of an extra tier of management within people’s staff team had improved communication and consistency of care.

Information gathered about people was used to aid learning and drive continuous improvement across the service. Investigations were carried out when required and systems were in place to identify any trends or patterns, to help make changes when needed. The provider and registered manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. They understood and reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

A registered manager was employed to manage the service locally. 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. There were also service managers and team leaders employed to ensure the service ran smoothly.

People, their relatives and staff were unfailingly positive about the organisation, the management team and the support people received. Comments included, ““Havencare’s (Supported Living) performance has been outstanding and they are truly a person centred organisation”, “They definitely go above and beyond” and “This [service] is a great success story as far as I’m concerned.”

Staff described the management to be very open, supportive and approachable. Staff talked about their jobs in a strong, positive manner and were highly motivated. The registered manager and nominated individual demonstrated a strong ethos of personalised support and empowerment, which was communicated to staff and staff shared this vision. One staff member commented, “I’m so passionate about it.”

People were supported to live active lives based on their wants and desires. Relatives felt that people valued their relationships with staff and placed trust in them. Staff also prioritised building strong relationships with people’s families in order to help understand people better. People’s care plans contained detailed information about how they wanted to be supported and were updated whenever their needs changed.

People were encouraged to develop new skills and further their level of independence. Action plans and steps were created to ensure people received all the support and advice they needed to do this, at a pace that suited them.

People received care from a staff team who were trained to meet their needs and who cared deeply for their wellbeing. Regular activities were carried out to assess any gaps in staff knowledge and resources put in place to improve knowledge in these areas. Staff members were encouraged to develop professionally and used their increased knowledge to the benefit of the people they supported.

Staff were recruited safely and detailed information was collected about people’s likes and dislikes to help ensure staff’s skill suited the person they supported. People were empowered to be in control of who supported them. If people showed they didn’t get on with a particular staff member, this was respected and the staff member did not support them anymore.

People were supported by staff who had an in depth understanding of how to keep them safe and alleviate any anxiety they may have. Staff were skilled in using personalised communication methods to understand people’s needs and wishes; and respected people’s decisions. New technology was embraced in order to gather detailed information to support people to be safe.

Staff had undertaken training on safeguarding adults from abuse, and put their knowledge into practice. Where staff had raised alerts the service managed the concerns promptly and when appropriate, conducted thorough investigations to protect people. Any learning was shared to improve future practice.

People were supported by staff who placed a strong emphasis on the importance of them maintaining a healthy balanced diet. Advice was sought from professionals and family members who knew people well, to help ensure people received the right food for their wants and needs.

People were supported by staff who understood their health needs and recognised minor changes. This meant people received attention from the correct health or social care professional quickly. Risk assessments and guidance were put in place to help ensure staff knew how to keep people safe and healthy. People’s individual preferences were taken into account to help ensure any measures put in place suited them and were successful. Healthcare professionals confirmed staff worked positively with them and followed any guidance given.

There were effective quality assurance systems in place. Action was taken to address areas where practice could be enhanced, and as a result, changes had been made to help ensure the service moved forward and continually improved.

Staff were encouraged to be involved and help drive continuous improvements. This helped ensure positive progress was made in the delivery of care and support provided by the service.

People knew how to raise concerns and make complaints. People and their relatives who had raised concerns confirmed they had been dealt with promptly and satisfactorily.