Reach Housing & Enablement Services Limited

This service provides care and support to people living in nine ‘supported living’ settings, so that they can live in their own home as independently as possible. 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.

At our last inspection in August 2015, the service was rated 'Good'. At this inspection we found that the service remained 'Good’ in Safe, Effective and Caring and had improved to ‘Outstanding’ in Responsive and Well-led key questions.

The service had a registered manager in place at the time of our 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 remained safe because staff were aware of their roles and responsibility of how to support people to remain safe. The registered provider had systems and processes in place to support people from the risks of abuse and avoidable harm. Risks associated to people’s needs had been assessed and planned for and were reviewed to ensure staff had up to date information. People were supported to live in a safe environment. People received support from a team of staff that provided consistency and continuity. Safe staff recruitment checks were carried out before staff commenced employment and people who used the service and or relatives, were involved in the recruitment of staff. People received appropriate support with the administration, storage and management of their prescribed medicines. Staff were aware of the importance of infection control measures and had received appropriate training.

People continued to receive an effective service. 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. People were supported by staff that had received an appropriate induction and ongoing support and training. The registered manager used best practice guidance to develop and support staff to provide effective care and support. The principles of the Mental Capacity Act (2005) were followed when decisions were made about people’s care. People were supported to plan, shop and cook meals as fully as possible. Staff were aware of people’s nutritional needs and promoted health eating. Systems were in place to share information with external services and professionals when required. People received appropriate support to maintain their health. Staff worked with external healthcare professionals to achieve good health outcomes for people.

People continued to receive good care. Relatives spoke positively about the approach of staff whom they said were kind, caring and compassionate. People were involved as fully as possible in their care and support and staff respected their privacy and dignity. Independence was promoted and staff had a good understanding of people’s diverse needs, preferences, routines and personal histories. People were supported to access different types of advocacy support when required.

People received an outstanding responsive service. People were involved as fully as possible in their care and support. People’s support plans focussed on their individual needs, creating a person centred approach in the delivery of care and support. Regular meetings were had with people to discuss their care and support and the activities they wanted to participate in. This included an annual holiday of their choice. People were supported to participate in activities, interests and hobbies that were important to them. Staff had been creative and had used innovative approaches to support people with their dreams and aspirations. Staff promoted people’s independence and people were active citizens of their local community. People received opportunities to develop their social and friendship circle. Staff used effective communication methods to support people’s sensory and communication needs. People had access to the registered provider’s complaints procedure that was presented in an appropriate format. Additional and creative ways had been developed for people to share their views about the service. People’s end of life wishes had been discussed with them.

The service was outstanding in being well-led. The registered manager had developed an open and inclusive service, they had a clear vision and set of values based on social inclusion that the staff fully understood and adhered to. Staff felt listened to, supported and involved in the development of the service. People who used the service and relatives received opportunities to share their views, experience of the service and were involved in developing the service further. Audits were carried out and action plans put in place to address any issues which were identified. The service had been successful in achieving the National Autistic Society Autism Accreditation.

Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them and looking at records. We also spoke with the registered manager.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

During our visit we met one person who used the service and spoke with the representatives of three others. We did this because the people who received personal care from the service could not share their views verbally with us. Everyone we spoke with said that their relative was safe and well looked after. They told us how they worked with the staff team to plan and review the service.

We spoke with staff who supported people who used the service and with team managers and the registered manager. They all told us they had the skills and knowledge to offer effective and consistent support.

We saw very detailed care plans were in place to identify how people's needs should be met. Risk assessments supported activities and staff told us how they assessed how people were feeling before any planned activity went ahead. This meant they could reschedule if they had any concerns about how people would cope with it.

We found that there was confusion around some staff roles and responsibilities and this had negatively impacted upon the quality of the service provided. The policy to support professional boundaries was not being followed although staff told us that they were aware of it. This meant that people who received a service could not be clear about what support they could and could not expect.

Is the service effective?

We saw how the service had been developed around the needs of the people they supported. People's health and care needs were assessed with the full involvement of relative and advocates when appropriate. This meant that people's care and support needs could be met in ways that people preferred.

We saw records of how the agency worked with health and social care professionals as required. This meant they could be sure that they were providing consistent care and support.

Everyone that we spoke with was satisfied with the service that their relatives received. One relative told us, "I am extremely satisfied".

Is the service caring?

People who used the service were supported by staff who cared about them. We heard staff speak with people in a calm and reassuring way. They responded to requests for support in a timely manner. Staff told us how they supported people to make choices while not raising their anxiety levels. One relative told us, 'The staff are brilliant. They are all so kind.'

Is the service responsive?

We saw how staff responded to people's changing needs. We saw that they worked with health professionals and relatives to ensure that people's needs were met consistently and appropriately.

We saw the registered manager had taken action when issues had been brought to their attention however the lack of regular monitoring of the service meant that they had not identified issues themselves and so not taken prompt action to reassure and support people who used the service.

Is the service well-led?

People who used the service lived in their own homes with varying levels of support. Some people required a high level of support to meet their personal care needs. These people were supported by a staff team that was managed by an onsite manager. Staff told us that these managers were effective and supportive. Some staff told us the registered manager was supportive however not all staff who worked for the service thought so. A lack of regular visits to services to assess and monitor the quality of the service provided meant that issues had not been identified and managed until they impacted upon people's quality of life. The registered manager had not worked effectively with social care professionals in relation to investigating concerns about the behaviour of named staff who worked for the service. They had not put sufficient safeguards in place to protect staff as professional boundaries were unclear.

Where people did not have capacity to consent to their care the provider had acted in accordance with legal requirements and people received care and support which met their needs.

We found that appropriate arrangements were in place to manage people's medication and ensure they received medication they needed.

We saw there were systems in place to assess and monitor the quality of service provided and views of people who used the service and their relatives had been sought and acted upon.

We found the service to be well led and there were sufficient skilled and experienced staff to support people who used the service. A relative we spoke with told us, 'The staffing levels are fine and if someone extra is needed it is never a problem, nothing is too much trouble. They know (name) so well, they are like a second family.'

We found people gave consent to and were involved in making decisions about their care and support. A person who used the service told us, 'Ten out of ten. I've moved on since I've been with Reach." A close relative said, 'We are totally involved in everything that happens."

We saw that the provider had taken the appropriate measures to help protect people from abuse and staff were aware of their responsibilities in recognising and reporting any concerns.

Staff told us and records we saw showed they (staff) were well supported and trained to provide good quality care to service users.

We found the provider had good systems in place to regularly assess and monitor the quality of the service.