Rathbone Outreach

The Rathbone Centre (Outreach Service) is a domiciliary care and supported living service providing personal care to people in their own homes and in supported living settings. At the time of the inspection there were 7 people receiving personal care support.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Risks to people's health and wellbeing were managed well and people were included in the risk management processes. The provider supported people to take their medicines safely. There were infection control processes in place. Staffing levels were sufficient to maintain people's safety and ensure their health and social needs were met.

Right Care: People were treated with kindness and compassion and they received person-centred care from well trained staff that knew them well. People were supported to identify and attend activities in line with their personal preferences and interests. People’s independence was promoted.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people lead confident, inclusive and empowered lives. The provider worked in partnership with other health and social care professionals to review people's care and support. There were processes in place to gather feedback from people, their relatives and professionals. We received positive comments from relatives of people receiving care about how the registered manager led the team to provide person-centred care.

Despite many positive examples of person-centred care, we could not be assured people were always supported to have maximum choice and control in all aspects of their lives as people’s housing and support were not completely separate. We raised our concerns with the provider and they have taken the necessary action to resolve the issues we found.

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 Good (report published 1 November 2018).

Why we inspected

We undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for The Rathbone Centre (Outreach Service) on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Not everyone using the services of The Rathbone Centre receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’. Where they do we also take into account any wider social care provided. There were approximately 70 people using the service at the time of inspection but only a small number were receiving support with ‘personal care’.

The visits were announced and were carried out on 13 August and 4 October 2018. The provider was given notice because the location provides a domiciliary care and supported living service. We needed to be sure that someone would be in at the location office when we visited and we then arranged to go back to meet with people at the Rathbone Centre drop-in service to get their feedback.

The registered manager was about to leave the employment of the service and an acting service manager was in post who was in the process of registering with CQC. 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 our last inspection in January 2016 we rated the service as 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.

People were positive about the care and support provided by The Rathbone Centre. They told us they felt safe and that staff treated them with dignity and respect. They were happy with the support provided which was meeting their individual needs.

Training on the safeguarding of adults had been completed and the staff were aware of their responsibilities for keeping people safe from avoidable harm or abuse. Each person‘s needs had been assessed and any risks associated with their support were identified and monitored.

People were supported by staff who were trained and well supported in their job roles. Appropriate checks were carried out for people wishing to join the staff team. People using the service were involved in the recruitment process and new staff provided with an induction into the service.

People felt there were enough staff members suitably deployed to meet their current support needs. A new more flexible model of support had been introduced with support staff available at a drop-in centre for two days a week. Staff we spoke with were confident that they provided a good service.

Staff had received training in the management of medicines. People were supported to take their medicines as prescribed in a safe way.

People were able 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 were supported to maintain their independence, follow their interests and take part in activities they enjoyed.

People knew what to do if they had a concern and felt confident to raise any issues with staff and managers at the Rathbone Centre.

The Rathbone Centre provides support, including personal care, to people with learning disabilities through domiciliary care and supported living services.

The service has a registered manager in post at the time of the 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 felt safe. The provider identified risks to people and had up to date plans to keep them safe from avoidable harm. Staff understood how to recognise signs of abuse and what they would do if they suspected it. The provider followed robust recruitment procedures to ensure that staff supporting people had the necessary skills, attitude, experience and background to safely do so.

People were asked for their consent to the care and support they received. The provider met the requirements of the Mental Capacity Act 2005. Staff knowledge and skills were subject to on going evaluation and improvement through supervision and training. People’s nutritional needs were met and the service supported people to access health and social care services.

Staff were caring and respectful towards people and their homes. People’s dignity was maintained and choice was promoted. The service supported people to access advocacy services to make choices.

People were supported to participate in a range of activities they choose. The provider established a number of groups and held a number of events to prevent social isolation. People’s care plans detailed how they would like their needs met and people were supported to pursue their interests and hobbies.

The provider sought feedback from people, relatives and staff and acted upon it to improve the quality of care and support people received.

Staff spoke highly about the registered manager and said he was approachable and supportive.

Health and social care professionals were complimentary about the care and support people received from the provider and praised the management of the service.

The registered manager had effective quality monitoring systems in place to ensure the quality of service provision was maintained and improved.

The provider had suitable procedures to manage emergencies and staff had the necessary training to do so.

Care plans and reviews were signed by people using the service to indicate agreement to the care that they received, and staff were trained to ensure people's consent.

The provider cooperated and liaised with other providers as appropriate and maintained relevant contacts and correspondence.

Staff had appropriate induction and training support. They received regular supervision and appraisals and felt well supported by management.

The provider had a variety of systems to monitor the quality of service provided and feedback from people using the service indicated a high level of satisfaction with the care they received. People were contacted regularly to obtain feedback on their care.

People we spoke with were happy with the care and support they experienced. One person using the service told us, "I'm happy, the staff are nice. I have a plan and I always know what I'm doing." The relative of another said, "They're good at finding the right staff ' I can't fault them.'

One person told us, "My support workers always discuss things with me and we work as a team.' Another said, "The support workers are a real godsend and I can't do without their help".

People told us they were involved in the planning of their care. They had discussed their care with the provider when it first started and the provider had since reviewed their needs with them.

People we spoke with said that their support workers understood their needs and carried out their work competently. Those supported in their homes said their support workers turned up on time and they were informed if there was any delay. The support workers stayed for the allocated time.