Swanton Community Support

Swanton Community Support is a supported living service. The service supports people to live in their own home as independently as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection, the regulated service was supporting 27 people with a mental health need.

At the time of inspection 20 people were supported in flats at Treeview Court on the same site as the agency office, and seven people were being supported in their own homes in the community.

People’s experience of using this service and what we found

Swanton Community Support provides support to people with complex needs who find it difficult to live in other services. The service kept people safe both physically and emotionally. They managed risks associated with people’s mental health to keep people safe and promote their independence. Systems were in place to ensure that appropriate staff were recruited to work in the service. They went through a thorough induction process and received the training they needed to support people. People were supported to receive their medicines as they were prescribed. When incidents occurred, there were systems in place to ensure these were recorded and reviewed by management so that action could be taken to improve things for the future.

There was a robust assessment of people’s needs prior to them moving into the service. The assessment was holistic and considered physical, social and emotional needs. People were supported to cook healthy meals and some people had specific plans in place for staff to follow where they had specific dietary needs. The service worked well with other professionals and supported people to access healthcare. However, there were some concerns amongst professionals that recent changes in management had affected some aspects of the service. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us the staff were kind and caring and got to know them well. They felt in control of their support which focussed around their needs. There had been recent issues in relation to the rotas which meant some people’s support had not always been with the person or at the time they preferred. This was being addressed. Staff promoted people’s privacy and dignity and there was a focus in the service in supporting people to become more independent.

The service was responsive to people’s individual needs. Care plans were regularly updated by keyworkers who knew people well. People were supported to access the community and attend activities of their choice, as well as training or work-based activities. People knew who to speak to if they had concerns and there was a robust complaints system in place. The service was not supporting people at the end of their life but had processes in place to enable them to do this if required.

Overall the service was well led. However recent changes in management and less regular team meetings had an impact on communication within the team and had affected morale of staff. The managers were addressing these concerns. The registered manager had recently returned from maternity leave and new team leaders had been appointed so they anticipated management would return to being more stable in the future. People and staff told us they could talk to managers and felt listened to. They said they were open and honest. There were systems in place to monitor the quality of care and to act to improve things if necessary.

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 4 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swanton Community Support on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Swanton Community Support provides support to people living in their own homes, most of whom need support with a mental health need or learning disability. At the time of this inspection there were 24 people being supported in flats on the same site as the agency office. A number of others were being supported in their own homes in the community.

There was 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.

There were enough suitably recruited, trained and supported staff to meet people needs in an individual manner. Staff had been inducted and had received appropriate support to prepare them for their role. Ongoing training was provided which had effectively provided staff with suitable skills and knowledge to support the people who used the service.

People’s needs had been regularly assessed and reviewed to ensure accurate support plans were in place. People had been involved in the planning of the support they received and staff demonstrated they knew people’s needs well. The service was flexible in meeting these.

Staff demonstrated a respectful and encouraging approach to providing support and understood the importance of people being in control of this. People’s independence was promoted and their privacy and dignity maintained. Staff had developed meaningful and trustful relationships with the people that used the service.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found that the service was compliant with this legislation and that staff had knowledge of its application. They understood the need for consent and regularly gave people information in order for them to make decisions.

The risks to those that used the service had been identified, managed and reviewed. Staff had a good understanding of how to safeguard people and reduce the risk of abuse. The provider had plans in place to manage any adverse incidents that may occur in order to ensure continuity of the service people received.

Accidents and incidents were recorded and appropriate actions taken. However, a more robust system was required in order to analyse these in order to mitigate future risk. The service had recognised this and was working towards achieving this.

People’s healthcare needs were met and staff supported people as necessary to access healthcare services. Staff supported people with meal preparation as required and gave people information in order for them to make decisions about their diet and associated health. Where support was required, staff administered people’s medicines safely and as prescribed.

Processes were in place to monitor and improve the quality of the service and feedback was sought on its implementation. People told us they felt able to express their views and that they would be listened to. People felt confident any concerns they may have would be actioned appropriately.

The culture of the service was open and positive. The management team were accessible and hands-on. They had a clear understanding of the service, its strengths and areas for improvement. An action plan was in place to drive improvement.

All the people we spoke with told us that they would recommend the service. They told us this was due to the success of the support their family members received, the kind and considerate approach of staff and the confidence they had in the management of the service.

The service provides support people in their own homes. At the time of this inspection, twenty four people were supported in flats on the same site as the agency office. A further 15 were supported in their own homes in the community. Most of the people using the service need support with their mental health needs.

There was no registered manager in day to day charge of the service. The registered manager had been transferred elsewhere and this had become a permanent arrangement just before the 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. In the absence of the registered manager, the deputy manager was fulfilling the role of acting manager. It was the provider's intention that the acting manager would register in respect of the service.

People experienced a service that promoted their safety. They received assistance from sufficient numbers of staff to meet their needs safely. There were robust recruitment processes in operation, which contributed to protecting people from the employment of staff who were unsuitable to work in care. Staff were aware of their obligations to report any concerns that people may be being abused and people were supported with advice about risks to their personal safety.

Where people needed support to manage their medicines, staff did this in a safe way and people received their medicines as the prescriber intended.

The service was not wholly effective. Staff had not been properly trained and prepared to understand their obligations under the Mental Capacity Act 2005, about how to support people to make informed decisions where their capacity to do so may be in doubt. However, improvements in this area were in the process of being made to ensure staff were more aware of their responsibilities. Not all staff had received the provider’s core training so that they all had the skills and knowledge to meet people’s needs effectively. However, there were plans in place to improve this.

People were supported to eat and drink enough if this was a part of their care package. People were also supported to access health professionals if they could not do this independently or their health deteriorated.

People were supported by a staff team that was kind, compassionate and who treated people with dignity and respect. People were involved in making decisions about the care they wanted to receive.

Staff understood people's individual preferences for the way they wished their care to be delivered and respected these. They communicated well with one another about people's support and any changes that needed to be followed up. This helped to ensure people were supported in a way that focused on each person's needs.

People were confident that, if they needed to raise a complaint or concern, this would be dealt with properly and action taken to resolve issues as far as possible.

Changes in management arrangements, both within the provider's management team and within the service, compromised the ability of the service to demonstrate consistent, stable and appropriate leadership. The morale of the staff team was also affected. The new arrangements needed time to consolidate to ensure they were working appropriately, taking into account the views of people using and working in the service.

The needs of each person had been assessed and their support plans had been developed based upon this assessment. Each record contained a set of risk assessments which was individualised for each person. For example, we read risk assessments relating to self-medication, choking risk, emergency evacuation, epileptic seizures and vulnerability to financial abuse. One person told us 'I have one-to-one support every day. It's very vital to have one-to-one.'

The provider had safeguarding training courses in place for all staff. One person said that their accommodation was 'very safe.' Staff members we spoke with showed a good understanding of safeguarding issues and of how to raise concerns.

Staff members we spoke with told us that they felt supported by the provider, managers and colleagues. One staff member said 'I feel really well supported.' New staff received an induction course and were given named mentors to support them. The provider undertook a range of service reviews and audits to monitor the quality of the service.

The staff appeared enthusiastic and positive about their work. We saw examples of staff treating people with respect, ensuring that they obtained consent before delivering care and responding to people's requests in a positive manner.

The care plans that we reviewed were detailed and had been produced in co-operation with people who used the service and reviewed regularly. The service had clear policies in place for the management of medicines and for dealing with complaints. These policies were available to the people using this service and to staff.

We noted that there were sufficient staff, with the appropriate skills, qualifications and training, to meet the required care needs of the people using this service. The team was well-established and showed a good knowledge of the people who use the service.

You can see our judgements on the front page of this report.