St Anne's Community Services - Calderdale Supported Living

St Anne’s Community Services – Calderdale Supported Living is a supported living service providing personal care to up to seven people. The service provides support to people with learning disabilities who may also be on the autism spectrum. The people lived in adjoining houses, two were in one and three in the other. People lived in tenancies agreed with the housing provider. The accommodation is split into two houses that connect through the office. 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. At the time of our inspection there were five people using the service.

People’s experience of using this 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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

People’s records were not always complete. The provider recognised the gaps in records and started to address the matter.

The service had a high number of vacancies so were reliant on agency staff to cover shift. We were not assured agency staff had enough training to provide safe care to people with complex needs.

Right Support

Support plans and risks to people’s safety were considered. However, there was not always clear guidance put in place to support staff. The service uses a lot of agency staff to support people. Although staff knew people well, we were not assured people were always supported by staff who had received appropriate training. People were supported to access health and community support. Staff supported people to maintain relationships that were important to them.

Right Culture

The model of care did not always maximise people’s choice, control and independence. People were not always fully considered and involved in the planning of their care, and some choices were at times restricted. Quality checks were not always robust enough to maintain and improve the quality and safety of the service. Staff felt well supported by the registered manager and could raise any issues. External professionals provided positive feedback about the manager’s approach.

Right Care

Staff promoted equality and diversity in their support for people. Staff understood people’s cultural needs and provided culturally appropriate care. Staff had received training on how to recognise and report abuse and they knew how to apply it. Staff were kind, patient and respected people’s privacy and dignity.

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 (published 22 June 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The inspection of Calderdale Supported Living took place on 25 April 2018 and was announced. This was to ensure there would be someone at the property to greet us as people attended community activities on a regular basis.

The service provides personal care and support for people with learning disabilities who may also be on the autism spectrum. There were five people living in adjoining houses, two were in one and three in the other. People lived in tenancies agreed with the housing provider. The accommodation is split into two houses that connect through the office. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values 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.

People told us they felt safe. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence. Robust emergency plans were in place in the event of a fire or the need to evacuate the building.

A system was in place to ensure medicines were managed in a safe way for people and staff had a good understanding of how to safeguard adults from abuse.

Sufficient staff were on duty to provide a good level of interaction and safe recruitment and selection processes were in place.

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.

Staff told us they felt supported and records showed they had received an induction, role specific training and regular supervision and appraisal to fulfil their role effectively.

People’s nutritional needs were met, healthy eating was promoted and people were supported to access a range of health professionals to maintain their health and well-being.

The service worked in partnership with community professionals and used good practice guidance to ensure staff had the information they needed to provide good quality care.

Staff were caring and supported people in a way that maintained their dignity, privacy and diverse needs. Observation of the staff showed they knew people well and could anticipate their needs.

People were supported to be as independent as possible throughout their daily lives and individual needs were assessed and met through the development of detailed personalised care plans which considered people’s equality and diversity needs and preferences. People worked toward individual goals and we saw these were often achieved.

People had access to social and leisure activities in line with their preferences and interests.

Systems were in place to ensure complaints were encouraged, explored and responded to in good time.

The registered provider had an effective system of governance in place and the registered manager had an overview of the service and knew people’s needs well.

People who used the service and their relatives were asked for their views about the service and these were acted on. Information and good practice was shared within and across teams by the registered manager and the registered provider.

Further information is in the detailed findings below.

The service provides personal care and support for people with learning disabilities who may also be on the autism spectrum. There were seven people living in adjoining houses, four were in one and three in the other. People lived in tenancies agreed with the housing provider. The personal care support is separate from the provision of accommodation. The accommodation is split into two houses that connect through the office.

There was a registered manager in post on the day of 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 were safe as staff had a sound understanding of safeguarding and how to protect people whilst not unduly restricting them. There were detailed protection plans in place for people who needed them and staff demonstrated they knew what was in them by their actions and responses throughout the day.

We found risk assessments to be person-centred and focused on individual needs. They contained specific information about each person’s risk factors and what actions were in place to minimise these. The risk assessments were written in a positive-based risk approach, assessing the merits of a person taking such a risk as well the consequences of such actions. This helped to promote people’s independence and encourage choice.

Staffing levels were appropriate to the needs of the service on the day of inspection and medicines were stored, administered and recorded in line with requirements.

People were supported by staff who had received regular supervision and training relevant to their role which was evidenced through their interactions with people throughout the day. The service was adhering to the requirements of the Mental Capacity Act 2005 and its associated Deprivation of Liberty Safeguards as requests had been made to the Court of Protection to ensure people were not being unlawfully restricted.

Nutritional support and health and social care support were available for each person according to their needs.

Staff clearly knew people well and acted with professionalism in their conversations, ensuring people were happy and contented during the day. We saw staff respond to people’s anxiety in a calm and reassuring manner and sought people’s agreement before any assistance was offered or delivered.

People had the option to spend time in their rooms or in the communal areas as they wished and staff showed that they appreciated this was people’s home.

Support was provided in line with each person’s support plan as agreed with their social worker and staff responded to people’s wishes during the day. People were encouraged to go out and join in activities. Complaints were handled in a professional manner, and any concerns noted and responded to promptly.

Calderdale Supported Living had a relaxed and pleasant atmosphere where people were encouraged to do as much for themselves as possible and where staff were supported by a dedicated registered manager, who was supported by an area manager who visited the service regularly.

On the day of our inspection we visited the Brook House 2 location; there were three male clients living in this house. As they had complex communication needs they were unable to talk to us. We found the registered manager for the service was on sick leave. During our visit we spoke with a senior support worker, who was also the acting manager, and three support workers. After the visit we spoke with two relatives by telephone.

We looked around the house and saw it was clean and tidy. We looked in all three client's bedrooms and saw they had been personalised with photographs and other items which reflected clients' preferences. For example one client liked tractors; there were pictures and model tractors on display in their room.

We looked at two sets of care records and saw that client's individual needs were assessed thoroughly. Their care and support was developed from an assessment of their needs. We saw the clients appeared well-dressed and well cared-for.

We saw and heard that staff knew the clients they cared for well. Staff we spoke with told us there were enough staff to meet the clients' needs and they worked together well as a team. They felt the care provided was good. One support worker told us, 'It's a stable staff team with a low turnover. We help each other out; you can always ask the other staff if you're stuck.' Another support worker said, 'Because we work closely with them (the clients) most days we get to know them really well.'

The two relatives we spoke with told us they were happy with the care provided. One relative told us, 'I'm really, really pleased with everything. He's been on two lovely holidays recently and he's absolutely loved it. Especially the trip to Lapland to see Father Christmas. He's also talking much better. ' The other relative said, 'As far as I'm concerned he's doing well. They bring him to see me once a week and he's well behaved and obviously well looked after.'

During our visit we found that medicines at the house were handled and administered appropriately. We also checked the records kept at the house and found that they were fit for purpose, stored securely and available when required.

The care workers we spoke with told us St Anne's was a good company to work for and they felt confident the service provided was good. Care workers received appropriate training for their role and told us they felt well-supported. Both of the care workers we spoke with told us they would be happy for one of their family to be cared for at Brook House. One of them told us 'Brook House is a lovely house to work at'.

The relatives we spoke with told us they felt the home had a good atmosphere. They said the staff were always inclusive in the way they talked with the people living there. One of them told us 'it's a very happy house, a happy group' they also told us that their relative was 'as happy as I've ever known him be' the other told us their relative was 'happy and settled'. They told us they felt their relatives were safe living there and said the care staff were always concerned, affectionate and extremely competent.