Archived: Somerset LD Services 5

Somerset LD Services 5 specialises in providing supported living and domiciliary care services to adults who have a learning disability or autistic spectrum disorder. The agency provides services in Taunton, Bridgwater and surrounding areas. The provider told us they supported 150 people in a range of settings. Some people lived in their own homes and received a domiciliary care service, and others lived in shared houses and bungalows and received support from staff on either a shared or one-to-one basis. During this inspection we visited four shared houses and bungalows in the Taunton, Williton and Bridgewater areas. We also looked at the domiciliary care service, although the registered managers told us this part of the service was in the process of being re-organised and moved to another of the provider’s registered services.

The service provided other forms of social care support which are not included within CQC's registration requirements for a supported living service, such as housekeeping, shopping, attending appointments and other independent living skills. We met some service users while they were attending a day centre run by the provider. People's accommodation was provided by separate housing providers or landlords, usually on a rental or lease arrangement. The housing services are not regulated or inspected by CQC. People could choose an alternative support service provider if they wished while continuing to remain in their current accommodation.

There were two registered managers in post. A third registered manager was in the process of de-registering. They shared the responsibility of managing the supported living service to people living in 13 shared houses and bungalows. 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 told us they felt safe. Comments included, “Yes, I feel safe here” and, “All the staff here are kind. I know this place – all the staff are good.” Staff had received training on safeguarding adults and knew how to identify and report any suspicion of abuse. .

People received reliable and consistent support from a stable and well trained staff team. Each shared house had a team of staff based there. People could choose the staff they wanted to support them. They had been consulted and involved, as far as they were able, to draw up and agree a plan of their support needs. Each person either held, or had access to their support plans and records of their health and personal care needs. Staff were expected to read the support plans and provide support in accordance with the person’s wishes. People told us there were enough staff employed to meet their needs. Risks to each person’s health and welfare had been assessed, regularly reviewed, and staff knew how to support people to minimise the risks

People were supported and encouraged them to learn new skills and gain independence. For example one person was looking forward to moving to new self-contained accommodation in the near future. A relative of another person told us, “She has learned a lot since she moved in there.”

Each person received support to help them manage their medicines safely. Most people held their own medicines in secure storage in their rooms, although a few people had asked for their medicines to be stored securely elsewhere in their house. Staff had received appropriate training on safe administration of medicines and their competence was checked regularly. Records of medicines received, administered or returned to the pharmacy were well maintained.

People were supported by staff who had received a range of training that provided them with the knowledge and skills to meet each person’s health and personal care needs effectively. Staff received regular supervision and support. They were positive and enthusiastic and told us they enjoyed their jobs. Comments included “I am really, really impressed with the set-up. Everything flows really smoothly” and “I cannot say anything against it. It’s wonderful. We work as a team. We get good support. The tenants are at the centre of everything we do.”

Each person was supported by staff to receive regular health check-ups and treatment from doctors and health professionals. Staff knew how to identify potential health problems and supported people to seek medical attention promptly.

Where people lacked the mental capacity to make certain decisions the service ensured their human rights were protected. All of the interactions we observed between people who used the service and the staff were friendly and caring. Staff sought people’s consent before providing support. People were offered choices on all aspects of their daily routines.

People led active lives. Staff had supported each person to help them identify and plan the activities they wanted to participate in each week. People were supported to participate in activities in their local communities, including work, education and leisure activities. They went on group or individual outings and also enjoyed a range of activities in their own homes. We heard about parties, outings and holidays. People were also supported to keep in touch with friends and families. For example, one relative told us, “We visit every five weeks. It’s her home. We ring every Saturday.” Another relative told us “We are always welcomed.” They also said “They bring her to us on a regular basis, once a week.”

The service was well led. A relative praised the management team, saying “(Manager’s name) is amazing. Staff are fantastic. I can’t fault them. We trust them implicitly.” The provider had an effective quality monitoring system to ensure standards of service were maintained and improved. People were involved and consulted about all aspects of the service.

We visited two shared houses where the agency provided 24 hours support to the people who lived there. The majority of the people who lived in one of the houses were able to tell us about their experiences. People living in the second house we visited had very complex physical and mental health needs and were unable to communicate with us. We were however able to observe how staff interacted with people and we spoke with staff about the experiences of the people they supported.

People were offered choices about all aspects of their daily lives. Staff used a range of methods to enable people to make choices. Examples included photographs, objects of reference and signing. The support plans we looked at promoted a very person centred approach to care. People were supported to access to a range of health care professionals.

We looked at three care and support plans. These were personalised to the individuals and gave details about their preferences as well as their physical and mental health needs. This meant that staff could provide care and support in line with people's needs and preferences.

People were supported to develop and maintain independent living skills. Three people told us they were supported with work placements. One person told us they had a job at a nearby hotel. They said 'I get paid and they are all very kind to me there. I like my job.' Another person told us they attended a 'workpower' placement two days a week and also worked in the kitchen at a local day centre. While we were visiting the first house, another person returned after their window cleaning job.

The staff we spoke with had a very good understanding about the needs and preferences of the people they supported. We saw that staff were skilled in recognising and responding to people's needs and wishes where individuals were unable to make their wishes known verbally. This demonstrated that staff knew people well.

We saw people had access to a range of health and social care professionals and that staff supported people to attend appointments where required. Support plans showed that advice from professionals had been appropriately implemented. Examples of this included epilepsy management and the management of certain behaviours. This meant that people's physical and mental health needs had been monitored and appropriately responded to.

Risk assessments had been completed and we saw care plans had been developed to manage any concerns or risks which had been identified. Examples included accessing the local community, cooking and medication. This meant people could be appropriately supported to take managed risks in the least restrictive way.

People who were able to communicate with us told us they felt safe and that they liked the staff. Comments included 'I like all the staff. I have my favourites but they are all lovely' and 'I feel very safe here. I have lived in many places and had bad experiences. I have lived here for 10 years and have never felt this safe.'

We saw people responded positively to staff interactions including those people who were unable to communicate. People appeared very comfortable in the presence of staff and we observed staff interacting with people in a very kind and caring manner.

We observed that staff were competent and professional in their interactions with the people they supported. We saw there was a clear staffing structure in place which meant senior staff were always available to support less experienced staff.

Regular internal audits had been carried out which monitored the on-going health and safety of people. Internal audits included checks on fire systems, environment, care planning and the management of people's medicines. We saw that if any incidents or near misses occurred they were reviewed to see if any lessons could be learnt or trends identified.

We met with 15 people who used the service and 11 members of staff. Two people were supported in individual flats. The remainder lived in two shared houses. The agency provided 24 Hour support to the people we met with. The majority of the people we met with had complex mental health needs and some were unable to engage in conversations with us. We were however able to observe how staff interacted with people and we spoke with staff about the experiences of the people they supported.

People were offered choices about all aspects of their daily lives. Staff used a range of methods to enable people to make choices. Examples included photographs, objects of reference and signing. The support plans we looked at promoted a very person centred approach to care. People were supported access to a range of health care professionals.

The agency followed appropriate procedures for the management and administration of medication. This meant that people received their prescribed medicines when they needed them.

The agency's staff recruitment procedures helped to reduce risks to the people who used the service.

The agency had a complaints procedure which provided people who used the service and their representatives with clear information about how to raise any concerns and of how their concerns would be managed.