Archived: Choices Housing Association

Choices Housing Association is a care at home service providing personal care to 154 people at the time of the inspection. The service supported people across 13 extra care and supported living settings across Staffordshire, Shropshire and Stoke some of whom were living with dementia, mental and physical health needs, and learning disabilities.

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 experience of using this service and what we found

Right Support: 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's medicines were managed safely. However, we did identify the need for some improvements in the management of time-specific medicines, rotation of pain patches and medicines care plans, to ensure these reflected best practice. People were protected from the risk of abuse. The provider took a proactive approach to assessing and mitigating risks to people's safety. The provider was meeting the requirements of the Mental Capacity Act 2005. There were systems in place to identify when things went wrong.

Right Care: Care was person-centred and promoted people's dignity, privacy and human rights. There were enough staff on duty to meet people's needs. There was a system to monitor and assess the care provided. People achieved good outcomes from their care. The service worked collaboratively with other agencies to ensure people received the care they needed.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Management used questionnaires and meetings to take suggestions from people and acted on feedback. There was a culture of continuous learning. The management team understood their responsibilities under the duty of candour and was meeting these.

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 12 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about management of medicines. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.

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 is Good.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Choices Housing Association on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Choices Housing Association is a care at home service providing personal care to 106 people at the time of the inspection. The service supported people across 12 extra care and supported living housing across Staffordshire, Shropshire and Stoke some of whom were living with dementia, mental and physical health needs and learning disabilities.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were supported by trained staff to remain safe. People had personalised care plans and risk assessments in place which helped staff understand their needs and learn about their preferences. People were supported to remain healthy and could access health care professionals should they require this.

Staff were recruited safely and had access to needs led training. This ensured they could meet people's changing needs. People were supported by regular carers who offered flexible support.

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 were supported by compassionate staff who respected their privacy and dignity. People were involved in regular reviews of their care and encouraged to offer feedback. People were supported to receive their medicines safely.

The management team completed quality monitoring audits to continuously improve the standard of care. Staff were involved in learning forums to share best practice and ensure a high quality of care to people.

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 21 December 2016)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Choices Housing Association provides personal care and support for people in their own homes and for those living in supported living schemes or extra care housing. Supported living schemes enable people to be independent with support arranged to meet people’s individual requirements. Extra care schemes enable people to live in their own flats or apartments with support available on site should they require it. At the time of our inspection 102 people were receiving personal care and support.

There was a registered manager in place. It is a requirement that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 felt safe with the support offered from staff. Staff understood their responsibilities to protect them from abuse and avoidable harm. Risks to people’s health and well-being were assessed to give staff guidance about how to support people to reduce the likelihood of harm. Where an accident or incident did occur, the provider took action to prevent reoccurrences wherever possible. The provider had plans in place to support people to remain safe during emergencies such as a fire.

People and their relatives were satisfied with the number of staff available to offer them care and support. The number of staff the provider employed was enough to provide the care that was planned for each person. Prospective staff were suitably checked before they worked for the provider so that people were protected from those who should not work in the caring profession.

Where people required support to take their prescribed medicines, this was undertaken in a safe way by staff who had received guidance. Staff knew what to do should a mistake occur when assisting people with their medicines.

People received support from staff who had the necessary skills and knowledge. Staff received regular guidance and training relevant to their role. For example, staff received training in epilepsy. People’s food and drink was monitored where this was required to make sure they had enough. Staff knew people’s food and drink preferences. People had access to healthcare services to promote their well-being.

People were asked for their consent when care and support was offered and were supported to make decisions in line with the Mental Capacity Act 2005. Staff understood their responsibilities under the Act including what might constitute restrictions to people’s freedom.

People received support from staff who showed kindness. Their privacy and dignity was protected when receiving care and support. Staff knew the people they offered support to and they were supported to be as independent as they wanted to be. For example, staff encouraged people to do as much for themselves as they could.

People were involved and contributed to the planning and review of their support so that this was centred on them as individuals. The provider told us they were looking to improve the regularity of reviews of people’s support to check that people’s care and support continued to meet their requirements. Where people required additional support to make decisions, advocacy support had been made available to them.

People mostly received care and support from regular staff and at agreed times. The provider was reminding staff to contact people if they were running late. This was identified as an area of improvement when people had offered their feedback to the provider. Staff knew the people they were supporting including their preferences and routines that were important to them.

People and their relatives knew how to make a complaint. The provider had a complaints policy in place that had been made available to people. The provider took action when a complaint had been made.

People felt that the service was well-led. Staff felt supported and received good support from the registered manager. People, relatives and staff had opportunities to give feedback about the quality of the service. For example, questionnaires were sent to people and staff attended meetings with a manager. Where suggestions were received, the provider took action.

The provider had aims and objectives for the service that were known by staff. This included placing people at the centre of their care and support. Staff understood their responsibilities including reporting the poor practice of their colleagues should they have needed to.

The registered manager was aware of their registration responsibilities including notifying CQC of significant incidents that occurred. The provider checked the quality of the service. For example, checks of people’s care records took place as well as on the health and safety of the care and support provided. The provider took action where required.

' Is it safe?

The provider had a system in place to monitor the quality of the service and ensure that people received safe care. Systems ensured that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations.

Risk assessments and risk management plans were in place to ensure people's safety. We saw that they had been followed. People made choices and remained in control of decisions about their care.

Changes had been made to staff rosters and people had greater continuity from a core of staff that they knew. This helped to ensure that people's needs were always met.

There was a system in place to ensure that people's medicines had been administered to them safely and appropriately.

' Is it effective?

People confirmed to us that they had been involved in assessments and creating their care plans. They had given written consent relating to some aspects of care such as medication, but they had not signed their plans. It is important that people sign care plans where they are able to confirm agreement with their care and treatment.

Reviews of care and support plans had been carried out after the service had been in place for six weeks and then every twelve months, although we were not able to see evidence of some reviews we were told had taken place.

Some people used an independent advocacy service to seek advice and to ensure that complex decisions were made in their best interests.

' Is the service caring?

People we visited at home told us that staff were helpful, caring and respectful towards them when providing personal care. One person confirmed that their privacy was respected at all times by visiting staff.

People using the service and their relatives completed an annual satisfaction survey. They had reported high levels of satisfaction with the service across a range of activity. Where shortfalls or concerns had been raised these were taken on board and dealt with.

People's preferences, interests and diverse needs had been recorded in care records. Care and support had been provided in accordance with people's wishes.

' Is the service responsive?

People knew how to make a complaint if they were unhappy. A copy of the provider's complaints procedure was available in each person's home. A person told us they had not made a formal complaint but raised some concerns that had been taken seriously and addressed by the service.

When people's health care needs changed, health care professionals had been contacted. Their advice had been recorded and treatment plans had been put into place and followed.

' Is the service well-led?

Quality assurance systems were in place. The quality of the service had been monitored closely. We saw that there had been recent reviews and changes to the way the service had been delivered. A new staff structure had been put into place that would improve the service people received.

Staff were clear about their roles and responsibilities and felt supported with training and supervision by senior staff and the manager. Staff felt confident in their ability to meet people's needs. This ensured that people received a good quality service at all times.

People's relatives told us they were very happy with the care provided. One person said, 'I have nothing but praise for the agency". Another said, "They understand my relative. I can tell they are happy with the staff team".

People's needs were assessed and care plans were in place to ensure that their needs were met, to their satisfaction.

People told us they received their planned care in a professional and unrushed manner. This was because there were enough suitably trained staff to meet people's individual needs.

We saw that there were systems in place to support people who made a complaint. Complaints procedures provided people and staff with information about how complaints were managed and addressed.

We checked to see if people were able to be involved in making decisions and received the support they wanted.

We looked at care and support records and spoke to people who used the service or their relatives to establish their views on the quality of the service they received. One person told us, "I'm very satisfied, I have the same staff all the time", a relative said, "My relative has had been happy with the level of support they receive and I'm very grateful for the assistance provided".

We looked at the recruitment arrangements in the service to ensure that new staff were vetted to ensure they were suitable to work with vulnerable adults. We also checked to see if staff received the support and training they needed. We saw that suitable arrangements were in place.

We saw that there was an effective complaints system in place to support people using the service. People we spoke with confirmed that they had received information about how to make a complaint.