Yarrow Domiciliary Care Agency

Yarrow Housing is a supported living service. It provides care and support to adults with learning disabilities who live in their own homes. At the time of the inspection there were 96 people using the service.

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.

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 felt safe receiving care from the service. Safeguarding systems were in place to investigate and monitor incidents and staff understood their responsibilities to protect people from avoidable harm.

People were protected from the risk of harm and abuse. Staff were recruited safely and there were sufficient staff in place to meet people’s needs and wishes. There were management plans to address risks to people’s wellbeing and also to ensure positive risk taking. Risk plans emphasised the benefits to people of doing activities and promoted people’s independence. There were appropriate plans in place to support people who could be at risk of behaviour which may challenge.

Medicines were safely managed by staff who had the skills and training to do so. The service reviewed when incidents had occurred to make sure that lessons were learned.

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.

Staff understood and provided person-centred care. Staff and managers were clear about their roles and understood the values of the organisation. There were quality assurance systems and processes in place to help the service improve. The service continued to ensure that people were involved in its development and future plans.

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 outstanding (published 13 March 2019).

Why we inspected

We received concerns in relation to the management of safeguarding adults and staffing levels. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service remains outstanding. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Yarrow Housing Limited 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.

Yarrow Housing provides care and support to people living in 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. At the time of our inspection there were 74 people using the service. At our last inspection in March 2016 we rated the service ‘Good’. At this inspection we rated the service ‘Outstanding’.

The service had a registered manager. 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 were empowered by the service. People using the service were supported to develop their independence and be involved in every aspect of running their homes. Person centred planning was well established in the service. People worked with staff to identify their goals and to achieve these, including being able to develop their interests and undertake activities and holidays of their choice. Activities were varied with an emphasis on community involvement and self-expression, including sport, art, video projects and music. People also had individual projects which reflected their own interests and were encouraged to develop these and take ownership.

People and their relatives told us that they were treated with kindness and respect by staff and we saw examples of extremely positive interactions. People had a good rapport with staff and knew them well and were confident in approaching managers for advice or to share news.

People’s goals and achievements were celebrated, and people were encouraged to take their successes a step further. Managers in the service placed a strong and continuing emphasis on co-production, which meant initiatives to improve and develop the service included people and their families throughout. The provider was routinely developing and thinking of new ways to improve and introducing new models for support. People found managers to be visible and approachable.

People were supported to maintain good health. People had chosen to become more active in their chosen way and to eat healthily, and spoke with pride about how their lives had improved as a result. The provider worked with local organisation and people using the service in order to hold events aimed at improving health awareness.

People were safeguarded from abuse and there was a strong culture of speaking up. When people had behaviour which may challenge others, the provider used its in-house expertise to develop plans to address and manage this and promote social inclusion. People were encouraged to look at risks positively to develop their independence and there was a systematic and skilled approach to developing independence and giving people ownership of their daily routines. Medicines were safely managed by staff who had the training and skills to do so, and this was regularly refreshed.

Staffing was available to safely meet people need’s and ensure they could do activities of their choice. Staff members received the training they needed to meet people’s needs and were encouraged to regularly reflect on their training and development needs.

People were able to express their preferences and consent to different aspects of their care, including when they received personal care and the gender of the person providing this. The provider worked in line with the Mental Capacity Act to assess people’s capacity to make specific decisions and to demonstrate how they were acting in people’s best interests.

There was suitable and varied oversight of the service, including through internal audits and checks and assessments from external bodies and other people using the service. The provider regularly invited independent agencies to help them develop services and obtain people’s views on how they would like the service to develop. Managers promoted good communication between staff and people using the service. The provider monitored incidents that had occurred and these were reviewed at board level, with a strong emphasis on learning from these.

Where services are rated ‘Outstanding’ we aim to carry out a further inspection within 30 months of the date of the inspection report. An accessible version of this report is also available on our website.

This inspection was announced. We gave the provider 48 hours’ notice of the inspection, to make sure that key staff would be available. At the time of the inspection the service was providing personal care to 72 people in 24 properties. At the previous inspection in February 2014 we found the provider was meeting the regulations inspected.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 received their personal care and support from staff they trusted and felt safe with. Staff had received training in how to protect people from abuse and knew how to raise any concerns in regards to people’s safety and wellbeing. People’s support plans showed that risks to their safety were identified and plans were put in place to mitigate the risks.

People told us they felt well supported by staff and confirmed that there were sufficient staff to meet their needs. Records showed that there were safe systems in place for the robust recruitment of new staff to ensure they were suitable to work with people who used the service.

Staff had received effective training, supervision and support to meet people’s needs. This included training about the Mental Capacity Act 2005, so that staff understood about supporting people to make their own choices and decisions. People told us they were supported to eat healthily and choose foods that met their dietary and/or cultural need, and to eat out at places of their choice. The provider supported people to meet their healthcare needs through assisting them to attend appointments and follow guidance from healthcare professionals, which was documented in people’s support plans.

People received a caring and compassionate service, which demonstrated some outstanding features. The provider consistently consulted with people and relatives to ensure that their needs and wishes were understood and met. People told us they felt valued as they took part in projects and open days organised by the provider and were supported to make meaningful contributions. The provider keenly sought to celebrate people’s achievements and ensure people understood that their needs were at the core of the organisation. People were treated with dignity and respect and staff protected their confidentiality and privacy.

People received a service that responded to their individual needs and was person centred. People’s needs were properly assessed, and their assessments and support plans were regularly reviewed to ensure they were relevant. The provider responded to people’s aspirations for more independence and their wishes to access community resources, such as regular visits to gyms, cinemas and shopping centres. People were confident about how to make a complaint and relatives said they thought complaints would be dealt with in an open and fair manner.

People received a service that was managed well by the registered manager and other members of the management team. The provider held a clear vision and values that were shaped by people’s contributions to their current strategy plan, and understood by people, relatives and staff. There were systems in place to regularly monitor the quality of the service and identify areas for improvement.

We spoke with the relatives of two people who used the service as people who used the service were able to verbalise their needs. One person told us "I would not say the care is great but it is good. We get on with the staff and my relative is happy." Another persons relative said "The actual support staff are very good, most have been there for a significant period of time. They do a wonderful job."

We spoke with two members of staff who told us that they worked with social workers, people's family members, psychiatrists and psychologists to meet people's needs

The provider had a recruitment and selection procedure in place which provided clear direction on all aspects of the recruitment process.

Arrangements were in place for responding to complaints. One person said that they had made complaints about the service and these had been dealt with.