At our previous inspection in February 2016 we found the provider was meeting the fundamental standards. We rated the service ‘good’ overall but ‘requires improvement’ in one key question. At that time we found the service was not following national guidelines on the information that should be recorded in relation to people's medicines. There was no evidence on the files we reviewed that the rationale for the person taking the medicine had been explained to the person and everyone involved in their care. While staff were aware of the medicines people were required to take and in what dosage, they were not always aware of what the medicine was for. At this inspection we found the service had addressed the issues and had significantly improved. Staff received appropriate training and their competencies were assessed. Staff were aware of why people were prescribed medicines and the side effects of the medicines for the people in their care. Frontier Support Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service for 34 people with a variety of needs including learning disabilities, autism, epilepsy and mental health issues who are living in Croydon, Lambeth, Southwark and Wandsworth. Not everyone using Frontier Support receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The service was developed and designed before the values that underpin the Registering the Right Support and other best practice guidance was established. However the provider embraces the values that include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
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.
People felt safe with the staff who supported them and staff knew how to safeguard people from abuse and neglect. People received person centred care from appropriate numbers of well trained staff.
Risks relating to people’s care were comprehensively assessed and well managed by staff. Staff understood people’s needs well. People received care from staff who were deemed suitable by the provider which carried out robust recruitment checks.
People received their medicines safely. The provider had good systems in place to review accidents and incidents in order to learn lessons where things went wrong.
The service was effective. Needs assessments for people were holistic and personalised ensuring the resulting care plans were outcome focussed and considered all aspects of their lives in addition to their care needs.
Staff received high levels of support and training to ensure they had excellent skills that met the needs of people. Where people had specialist needs staff were provided with additional training to ensure they could meet people’s needs.
Peoples dietary needs and preferences were clearly identified in their support plans that staff followed closely. People’s dietary needs and preferences were met effectively.
Staff supported people to meet their healthcare needs and supported them to access specialist support and services where this was needed. Records showed staff facilitated people to engage with the community and wider support networks. This helped to ensure all organisations involved in providing support to people worked together in a holistic way.
The provider ensured staff understood the Mental Capacity Act 2005 and that people’s best interests were always a priority. Where people lacked capacity to consent to their care and treatment records showed clear best interests decision making processes had been followed.
The service was caring. People and relatives told us that they were supported by very kind, caring and compassionate staff that went the extra mile to provide them with exceptional care. The staff and the management team were passionate about providing people with support that was based on their individual needs, goals and aspirations. We saw that people were at the centre of their care and goals and achievements were celebrated. Each person was treated as an individual and as a result, their care was tailored to meet their exact needs.
People were supported to maintain relationships and social contacts. Relatives told us they were made to feel very welcome indeed and were encouraged to be an active part of their family member’s lives. People were given the privacy and dignity they needed.
The service was exceptionally responsive. Care and support plans were developed with people and their relatives and other professionals. They were individualised, comprehensive and holistic in their detail and were reviewed as people’s needs changed or as necessary. Arrangements for social activities were creative and showed innovation, meeting people’s needs and helping them to lead a full life.
The staff and the management team were always available and listened to people and their relatives, offered them choices and made them feel they mattered. The service empowered people to have as much control over their lives as possible and to achieve their maximum potential. The staff were passionate about the person-centred approach of the service and it was clear it was run with and for people.
Processes were in place to respond to concerns or complaints and the provider’s complaints policy was shared with people and their relatives so they knew how to raise a concern.
The service was well-led by the registered manager and management team. Managers developed their leadership skills and those of others and the registered manager created a positive environment and culture to work where staff felt well supported. Staff worked collaboratively and were motivated by and proud of the service. Systems were in place to recognise and reward staff achievements in the service. The registered manager developed the values of the service through involving people and staff and the values placed people centrally. Governance was well-embedded in the service with a strong framework of performance monitoring. There was an emphasis on continuous improvement and the views of people, relatives and staff were pivotal to this.