Westhope Care Limited - 11 Kings Court

Westhope Care Limited - 11 Kings Court provides personal care for people who live in supported living accommodation. The service specialises in supporting people with a learning disability and/or autism. At the time of our inspection the service was supporting seven people in one supported living setting and two people who lived more independently in the community. 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.

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

People were safe. Staff understood how to protect people from abuse or harm. The provider made sure there was current information for staff to follow to minimise identified risks to people's health, safety and wellbeing. Staff followed current practice when providing personal care and when preparing and handling food which reduced hygiene risks. There were enough staff to support people. The provider checked the suitability and fitness of staff they employed.

People and their relatives were involved in planning the care and support people needed. People’s care plans set out how their care and support needs should be met by staff. Staff were given relevant training to help them meet people’s needs. They were supported by the provider to review and continuously improve their working practices so that people would experience high quality care and support

Staff used people’s preferred method of communication to engage with them. This had helped them to develop good understanding of people's needs, preferences and wishes. Staff were warm and friendly and knew people well. They asked people for their consent before carrying out any care or support and respected their wishes and choices about how this was provided. Staff ensured people's privacy was maintained particularly when being supported with their personal care needs.

People were encouraged to be as independent as they could be. With staff’s help people learnt and maintained the skills they needed for independent living. Staff supported people to participate in activities and events of their choosing and to maintain relationships with the people that mattered to them. 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.

Staff helped people stay healthy and well. They supported people to eat and drink enough to meet their needs and to take their prescribed medicines. People accessed healthcare services when they needed to. Staff worked well with other healthcare professionals to ensure a joined-up approach to the care and support people received. People and their relatives were happy with the care and support provided by staff.

The provider had arrangements to investigate accidents, incidents and complaints and kept people involved and informed of the outcome. Improvements were made when needed and learning from investigations was shared with staff to help them improve the quality and safety of the support they provided.

People, their relatives and staff were encouraged to have their say about how the service could improve. The provider used this feedback along with other checks, to monitor, review and improve the quality and safety of the support provided. They worked proactively with other agencies and acted on recommendations to improve the quality and safety of the service for people.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 28 April 2017).

Why we inspected

This inspection was planned based on the previous rating of ‘Good’.

Follow up

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule or in response to concerns.

The service is a domiciliary care agency. The agency provides services that are based in a person's own home and in supported living services in the community. The supported living service is provided to people in order to promote and maintain their independence. People's care and housing are provided under separate agreements; this inspection looked at their personal care and support arrangements. At the time of our inspection, the agency was providing a service for 22 people with a variety of care needs, including people living with a learning disability or who have autism spectrum disorder. Seven people were in receipt of personal care. The agency was managed from an office based in Horsham, West Sussex.

At the time of the inspection, there was a registered manager at the 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.

At the last inspection on 15 February 2016, we identified one breach of Regulation associated with Fit and proper persons employed. Whilst identity and security checks had been completed for new staff, full work histories had not always been obtained and gaps in the employment history of some staff had not been accounted for. At this inspection, we found that the actions had been completed and the provider had met all the legal requirements. Robust recruitment and selection procedures were in place and appropriate checks had been made before staff began work at the service. There were sufficient levels of staff to protect people's health, safety and welfare in a consistent and reliable way.

At the last inspection on 15 February 2016, we recommended the provider seek good practice guidance in relation to recording the administration of medicines in people's own homes. People's medicines were administered by staff that were trained to do so. However, improvements were needed in relation to the recording of medicines. Following the last inspection, the provider wrote to us to confirm that they had addressed these issues. At this inspection, we found policies and procedures were in place to ensure the safe ordering, administration, storage and disposal of medicines. Medicines were managed safely.

At the last inspection on 15 February 2016, we found the delivery of care was tailored and planned to meet people's individual needs and preferences. People told us they were supported to participate in activities of their own choice however; staffing levels had limited the opportunities for some people to participate in activities they had planned for. This was an area of practice that we identified as needing to improve. At this inspection, we found that the good level of person centred care and sufficient numbers of staff meant people led independent lifestyles, maintained relationships and were fully involved in the local community.

Risks to people's wellbeing and safety had been effectively mitigated. We found individual risks had been assessed and recorded in people's support plans. Examples of risk assessments relating to personal care included moving and handling, nutrition, falls and continence support. Health care needs were met well, with prompt referrals made when necessary.

People told us they felt safe receiving the care and support provided by the service. Staff understood and knew the signs of potential abuse and knew what to do if they needed to raise a safeguarding concern. Training schedules confirmed staff had received training in safeguarding adults at risk.

The management team and staff had an understanding of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. They had made appropriate applications to the relevant authorities to ensure people's rights were protected.

People were enabled to choose their own food and drink and were supported to maintain a balanced diet where this was required.

People said staff were caring and kind and their individual needs were met. Staff knew people well and demonstrated they had a good understanding of people's needs and choices. Staff treated people with kindness, compassion and respect. Staff recognised people's right to privacy and promoted their dignity.

Care records contained detailed, person centred information to guide staff on the care and support required and contained information relating to what was important to the person. These were reviewed regularly and showed involvement of people who used the service or their relatives.

Staff felt supported by management, they said they were well trained and understood what was expected of them. Staff were encouraged to provide feedback and report concerns to improve the service.

There was a complaints policy and information regarding the complaints procedure was available. Complaints were listened to, investigated in a timely manner and used to improve the service. Feedback from people was positive regarding the standard of care they received.

The registered manager had developed an open and positive culture, which focussed on improving the experience for people and staff. She welcomed suggestions for improvement and acted on these. Staff were supported and listened to by the registered manager and were clear about their responsibilities.

There was an effective quality assurance system. Audits were analysed to identify where improvements could be made and these were implemented. There was an on-going development plan for the service to ensure it continued to develop and sustain improvements.

We inspected this service on 15 February 2016 and the inspection was announced. This was to make sure there would be someone available in the office to facilitate our inspection.

The service had 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.

Whilst identity and security checks had been completed for new staff, full work histories had not always been obtained and gaps in the employment history of some staff had not been accounted for. Therefore the provider could not be assured these staff were suitable to work with adults at risk.

People’s medicines were administered by staff that were trained to do so. However improvements were needed in relation to the recording of medicines and we have made a recommendation that the provider seeks up to date good practice guidance on this issue.

The delivery of care was tailored and planned to meet people’s individual needs and preferences. People told us they were supported to participate in activities of their own choice however staffing levels had limited the opportunities for some people to participate in activities they had planned for.

People’s independence was promoted and people were supported to take risks. People were encouraged to undertake their own daily living tasks such as menu planning, cooking and cleaning. One person told us “I do my own cooking. I can do ready meals myself but if I’m cooking a meal then the staff watch me”. Some other people had been supported to find employment and voluntary work which they enjoyed and another person told us “I’m looking forward to getting my own flat. I’ve talked to (Staff members name) and my social worker about it”.

People and their relatives or representatives were involved in the development of their risk assessments and support plans. People had named key workers who supported them to co-ordinate their care who they met with on a regular basis to discuss what was working well and make plans for the future.

People looked happy and were relaxed and comfortable with staff. They were supported by staff who understood their needs and abilities and knew them well. One person’s relative told us “The staff clearly are fond of (person’s name) and he of them. Comments included on questionnaires that people completed included ‘I like everything here, nice people, understanding staff who ask how I am feeling.’ And ‘My care and support workers are caring and kind.’

People’s needs and preferences were met when they were supported with their dietary needs and people were supported to maintain good health. People confirmed they were supported to attend medical appointments and one person told us “Staff help us to make appointments. I’ve got an appointment for my teeth next week and staff will come with me because I can’t go on my own”. Another person’s relative commented “They care for his physical health problems, which have recently included difficulties with swallowing, so that he has to have a pureed diet and thickened drinks.”

The provider actively sought and included people and their representatives in the planning of care. There were processes in place for people to express their views and opinions about the service provided. The feedback from people and their representatives in their most recent customer satisfaction survey was positive.

People were protected against the risk of abuse; staff had a good understanding of how to recognise abuse and what action they should take if they suspected it had taken place. Permanent staff were provided with training relevant to their role and felt well supported by management.

The provider and staff understood their responsibility to comply with the requirements of the Mental Capacity Act 2005. Staff knew about people’s individual capacity to make decisions and supported people to make their own decisions.

People spoke highly of the management. Staff comments on the providers’ staff survey included ‘Our manager is excellent and always listens and deals with any issues fairly and sensitively’, ‘All positive, no negatives at all, management and all staff work well as a team’ and ‘I just love my job’.

There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

We found two areas where the provider was not meeting the requirements of the law. You can find what action we have told the provider to take at the back of the full version of the report.

We spoke with six care workers and the manager. Care workers told us that they enjoyed their work. One said, 'I love it, it's nice to know at the end of the day that you've helped people'. Another told us, 'It's a great service to work for'.

We found that people experienced safe and effective care delivered by regular staff who knew them well. The interactions between care workers and people that we observed during home visits were positive. People were offered choices about the care that they received and support was provided in a kind and respectful manner. Everyone that we spoke with told us that they could approach their care workers and the manager if they were unhappy or had ideas to discuss.

We spoke with one relative. They told us that, 'Staff are very nice and very helpful'. They explained how their relative was always happy to go home after a visit with them and said that, 'They seem to be very caring with him'.

We spoke with three care workers. They told us that they enjoyed working at the agency.

We found that people received care and support that met their needs. However, the provider's quality assurance systems had not identified variations in areas including care planning and staff support.