Archived: Somerset LD Services 3 Also known as The Links

The service is registered with the Care Quality Commission (CQC) for the provision of personal care in people’s own homes. This includes assistance or prompting with washing, toileting, dressing, eating and drinking. At the time of the inspection the service supported 94 people with a learning disability or autistic spectrum condition. This included 43 people supported by the Yeovil and Chard area network domiciliary care teams and 51 people in supported living shared occupancy houses. The shared occupancy houses supported by the service were: Churchmoor Farm; Rosedale; Orchardleigh; Bradley View; The Seasons; Vestry Road; Hillcrest Road; and Grove Avenue.

The service also provided other forms of social care support which are not included within CQC’s registration requirements for a supported living service. For example, in addition to personal care, the service assisted people with their housekeeping, shopping, attending appointments and other independent living skills.

The service provided people’s personal care and support under a separate contractual arrangement to people’s housing provision. People’s accommodation was provided by separate housing providers or landlords, usually on a rental or lease arrangement. This meant people could choose an alternative support service provider if they wished. Nevertheless, the service was happy to support people with reporting any faults or maintenance requirements to their respective landlords or housing association.

People who used the service had varying degrees of difficulties and support needs, ranging from mild to severe learning disabilities and autistic spectrum conditions. Some people had complex needs and required 24 hour support, whereas others were relatively independent and just needed assistance for a few hours each week.

There were two registered managers for this service. 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. The registered managers described the service philosophy as “The customer comes first. It is their home and not a work place” and “It is about providing support to individuals to meet their needs and aspirations. Person centred care, individualised as much as possible”.

People who used the service told us they felt safe and secure with the staff supporting them. A person who received support from the domiciliary care team said “They always give me the rotas and let me know who is coming. They all wear ID badges”. Another person said “They help me with my shower. I feel safe, no worries. They also do shopping with me. I know what they buy with my money and no one ever borrows or takes my money”. This showed people knew which staff were coming and when, which meant they were less vulnerable to unexpected callers or strangers. It also showed people were protected from financial abuse.

There were sufficient numbers of staff deployed to meet people’s individual needs and to keep them safe. Before people started to use the service, a detailed assessment of their needs was carried out. This included the staffing support required. Where people’s needs increased the staffing hours were increased. As people became more independent staffing support was reduced. All of the staff we spoke with told us the staffing levels were appropriate to meet the needs and choices of the people they supported. Staff also supported people to access external health and social care professionals when needed. Feedback from an external professional stated “I found that the team is very caring, reflective and receptive to new recommendations, which makes our collaborative work effective”.

Each individual service had its own team of regular staff. This ensured people were familiar with the staff who supported them and the staff understood their needs and preferences. Staff were available to support people with personal care when needed, but the service tried to encourage people to be as independent as possible. This boosted people’s confidence and self-esteem and enabled them to become more self-reliant.

Staff received individualised communication training to enable them to understand and communicate with people who had limited or no verbal communication skills. 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. One of the people in a shared occupancy house said “We are all friends in the house”. A person who received support from the domiciliary care team said “They treat me lovely, nice and kind”. Feedback from people’s relatives included “I find the staff to be polite, patient and above all treat people with dignity and respect”; “Fantastic, attentive and caring staff”; and “Staff constantly go the extra mile”.

Systems were in place to ensure people received their prescribed medicines safely. Most of the people who received domiciliary care were able to self-medicate although occasionally they required assistance or prompting to take their prescribed medicines. Many of the people who lived in the shared occupancy houses had their medicines administered by staff, following a medicines risk assessment.

We found high levels of staff satisfaction across the whole service. Staff said the team leaders, team managers and the registered managers were all very accessible and supportive. The registered managers were visible and visited each service on a regular basis. The service was facing a major transition from local authority control to a new social enterprise company. Staff told us they had been briefed about the future changes and, although this was obviously unsettling, the majority were hopeful and optimistic about the future direction.

The provider had an effective quality monitoring system to ensure standards of service were maintained and improved.

As part of the inspection we met four people who lived at Grove Avenue, one of the supported living services and one person who used the domiciliary service. We also spoke with the Strategic Manager for Learning Disability Services, two team managers, one responsible for supported living homes, the other team for the Yeovil domiciliary service, five staff who worked at Grove Avenue and two staff member from the domiciliary service.

We reviewed care and support plans and other records relating to the management of the service.

Below is a summary of what we found. The summary describes what people using the service and staff told us, what we observed and the records we looked at.

Is the service safe?

We found there were systems in pace which ensured that people were safe. Risk assessments were undertaken which were regularly monitored, reviewed and reassessed with the involvement of the person.

People were encouraged and supported to live as independently as possible. People chose how they lived their lives and remained in control of decisions about their care, support and daily life.

People told us they felt safe and knew who to contact if they had a worry or concern. We saw there were arrangements in place to make sure people knew how to contact someone if they needed help or assistance.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to people in care settings. We found that staff had a good understanding of how to protect people's right under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Best interest checklists were completed and meetings took place which ensured staff acted in accordance with the law and protected people's rights when making decisions on their behalf.

Staff were provided with induction and on-going training which helped ensure they were knowledgeable and skilled in protecting people in their care.

People were encouraged to self-administer their medicine, but where required, staff prompted or reminded people to take medicines at the correct time which minimised the risk of error. Staff were trained to administer medicine and we saw that risk assessments had been undertaken to ensure medicines were taken safely.

Is the service effective?

People were encouraged and supported to live as independently as possible within a safe environment. Staff were available to assist people in daily living tasks such as in cooking, shopping or sorting out financial affairs, and supported people to access social community activities.

People's care and support needs had been assessed with their full involvement. Individual support plans were personalised and illustrated people's preferences, interests, needs and aspirations. Specialist care needs had been identified where required. People were familiar with their support plans which had been produced in suitable written and pictorial formats.

We met five people who used the services and found they lived active, busy lives within the local community. Staff worked flexibly with people to fit around people's requests and needs for support. A member of staff said 'if someone wants to go somewhere we can always be flexible'.

Is the service caring?

We found that staff were kind and caring. People knew the staff well and we observed warm, friendly communications between them. One person told us that the, 'staff are great', another said 'I know I can always call if I need help'. People unable to verbally communicate expressed their appreciation of staff through signing and gesture.

There was a friendly rapport between staff and people. People were happy and relaxed in their company and staff interacted in friendly, yet professional ways. Staff listened carefully to what people said and responded appropriately and considerately.

People were at ease, relaxed and confident in their homes.

Is the service responsive?

We noticed how staff responded appropriately to people's requests for assistance. Staff encouraged and supported people to do things for themselves, that would promote their independence.

We noted that as changes to people's support or care were required the service was able to respond quickly to meet people's needs.

Support plans reflected people's needs and aspirations. Plans were reviewed regularly between the person and staff and where a change was needed this was responded to promptly.

Is the service well led?

There were formal and informal systems in place to monitor the quality of the service provided. The provider encouraged feedback from people who used the services, their relatives, friends and other interested parties. Records showed that where issues were raised these were promptly addressed and where improvement to the service was required this was implemented.

There were clear management structures and lines of accountability. The staff team was stable and staff understood their role and responsibilities. Staff had a good understanding of the ethos of the services and to the quality processes in place.

There were comprehensive reporting systems in place which ensured that procedures were followed, records were in place and that staff received support and training. This demonstrated that the provider took steps and put in place mechanisms that protected people who may otherwise be at risk of inappropriate care.

We found that people could express their views in as far as they were able to do so; and were involved in making decisions about their personal care. A person told us, "I get to choose my own meals and what I would like to eat." We saw that people had their privacy, dignity and independence respected.

We saw that people experienced safe and appropriate care and support. People had copies of their support plans and had been involved in their care planning. A person told us, "They ask us what we want -- We have a file in our home." The service also had arrangements for dealing with foreseeable emergencies.

We found that people were protected from abuse, or the risk of abuse, and that their human rights were respected and upheld. A person told us, "If I was worried about anyone I would tell staff." Another person told us, "The staff are nice, they help me."

We found that people were safe and had their health and welfare needs met by staff who had undergone appropriate pre-employment checks. This was due to the service having appropriate recruitment and selection procedures in place.

We saw that people benefitted from safe quality care and support, due to the service having effective decision making procedures; and by comprehensively monitoring the quality of services people received.

People who used the agency told us they had been fully involved in their plan's and their choices were taken into consideration when their support was arranged. One person told us "Staff only do enough to keep me independent so I do a lot of my own care."

We observed people being supported by staff who delivered care in a way that took into account people's needs and preferences. One person we saw being supported with caring for her young baby said "I like having different staff as I can chat to them about different things".

We asked people if they knew what to do if they were unhappy about the service. One person told us they would ask their relative to speak with the agency. We saw information available that detailed how people could complain and the various agencies they could speak too.

Staff told us they had opportunities to do training on a regular basis. We saw people's records and they confirmed that staff had regular supervision and appraisals.