Archived: Community Choices

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Manor Lodge was a ‘single house in multi-occupation’ where four younger adults lived together. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom and kitchen facilities. Each person had their own bedroom on the upper floor and shared a living room, dining room, conservatory and kitchen on the ground floor. There was also a small office and staff sleep in facilities. The service was situated in a quiet residential area and had large outdoor space.

Lower Fisherton was a large house currently occupied by one younger adult only. They had full use of the house and staff had office and sleep in facilities. The service was situated in a very rural area with no close neighbours and had outdoor space.

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 comprehensive inspection in April 2016 we rated the service Good. At this inspection we found the evidence continued to support the overall rating of Good. There was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good:

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.

The provider and support workers delivered care and support which took into account people's individual choices and preferences. People were seen to be very happy and content at the service and positive interactions took place with staff. Staff treated people with respect, dignity and respect at all times. Meaningful relationships had been developed with the support workers who looked after them. Families and friends were involved in people’s on going care, support and wellbeing.

People were encouraged to be as independent as possible and develop individual activities, hobbies and interests. They felt safe and trusted the staff who supported them. Two people said, “All the staff are really kind to me … they really respect me here … I like everybody” and “I am very happy here … I’m a lot happier than my last place …I get to go all over.” People were encouraged to establish community links and take part in things that mattered to them.

People were kept safe and supported by care workers who were aware of their safeguarding responsibilities. There had been one recent safeguarding concern which had been investigated and resolved by the local authority safeguarding team. Support workers were safely recruited, trained and supervised in their work. They enjoyed their jobs, felt very passionate about their roles and were complimentary of the staff team. Comments included, “They (people) actually do what they want to do” and “If you enjoy your job you never have to work a day in your life … it’s brilliant here …we are a really good team who are passionate in what we do.”

People and relatives had confidence in the management of the service and the provider’s management skills. They were confident any issues would be dealt with appropriately. One relative commented, “(The provider) is approachable, professional, warm and popular with us and his staff … he provides any required action plans and outcomes are communicated effectively.”

People were supported by adequate staff levels to meet their needs. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes.

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 support this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

People and relative’s views and suggestions were taken into account to improve the service. Regular feedback was sought from them both informally and formally through questionnaires. Health and social care professionals were involved when necessary. People and relatives knew how to make a complaint. There had been no complaints received at the service since our last inspection.

People were supported to eat and drink enough and maintain a balanced diet. Their food choices were reflected in the menus. Medicines were safely managed and procedures were in place, although these could be improved upon.

The provider had a range of robust quality monitoring systems in place which were used to continually review and improve the service.

Further information is in the detailed findings below.

This was the first inspection since the service was registered with the Care Quality Commission in June 2014 as a supported living service. The first person went to live at the service in September 2015.

Community Choices provides a supported living service for four younger people who live with profound and complex needs. The four people live together in one large home called Manor Lodge in Bideford. Supported living is a service where people live in their own home and receive care and support to promote their independence. The legal agreements for the provision of care and accommodation are separate contractual agreements. Therefore, people can choose to change their care provider without losing their home. The service provides a support service to one other person in their own home in Barnstaple. As this was a non-regulated activity, it was not inspected.

At Manor Lodge, each person had their own bedroom on the first or second floor. There were communal areas on the ground floor for them to meet and spend time with others who lived at the home. This included a lounge, conservatory, kitchen and a computer room. There was an activities room located in a summer house in the garden. The home also housed a support worker sleep-in room.

The provider was also the 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 received care which was personalised to their needs. Staff knew people well, understood them and cared for them as individuals. People were relaxed and comfortable with the staff who supported them and knew what mattered to them. Staff knew about people’s lives, their families, pets and what they liked to do.

People were supported by staff who were carefully selected for their mutual interests and hobbies. Staff were well trained, motivated and supported in their work. They had a good understanding of safeguarding and knew how to recognise the different types of abuse. They knew the correct action to take and who to report any concerns to.

People were relaxed and comfortable with staff. Staff had a genuine warmth and affection towards people. They spoke to people in a respectful and kind way. One staff member said, “We treat people with respect and dignity, people are looked after and it’s genuine, not made to look good.” One relative said, “… Have always been impressed by the respect, dignity and individualised support evident between staff and clients. I have always found staff interactive with clients and not gathered chatting to each other – (family member) has benefitted from feeling cared for.” Staff promoted choice and sought people’s consent for all support and decision making. Where people lacked capacity, decisions had been made in people’s ‘best interests’.

Staff supported people to undertake a variety of activities and hobbies in the local community. These reflected their own personal choices but staff encouraged them to also try new things. When people changed their minds about planned activities, staff respected this decision and made alternative arrangements.

People’s care files were detailed and included information for staff to know how to support each person. The care files were regularly updated and reviewed when needed. Health and social care professionals were included in people’s care; staff worked closely with them to make sure they were providing the most appropriate care. People received the care which had been contracted to them by the commissioning service; this included the hours allocated to activities.

Risk assessments were in place for each person. These identified the correct action to take to reduce the risk as much as possible in the least restrictive way. People’s behaviour and moods were monitored if necessary and any factors which might have influenced the behaviour reported. People received their medicines safely and on time. Accidents and incidents were carefully monitored, analysed and reported upon.

Staff used a variety of methods to communicate with people and support them to make decisions for themselves, for example Makaton (a specialist form of sign language) and picture cards. People were encouraged to eat a well-balanced diet and make healthy eating choices. They were involved in the planning and choosing of meals if they wished. People’s weight was monitored where necessary. People were supported to remain active and maintain their independence.

There was a complaints policy and procedure in place with information about how to raise concerns or complaints. Relatives felt any concerns would be listened to as there was good communication between them and the provider. They felt involved and consulted in their family member’s care. One relative said, “We can and do email or telephone (the provider) and he responds in an effective and timely manner.”

The culture at the service was open and honest. Staff felt their opinions mattered and they enjoyed coming to work. One staff member said, “I am settled here … certainly valued … definitely motivated … (the provider) is a hundred per cent supportive to me … we are part of a team.”

There was a range of quality monitoring arrangements in place which the provider used to improve the service. They had clear values about the service which staff promoted.