We carried out a review of the data available to us about SeeAbility - Devon Support Service on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about SeeAbility - Devon Support Service, you can give feedback on this service.
This comprehensive inspection took place on 4 and 5 April 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit. This was so we could arrange to visit some people in their own homes to hear about their experiences of the service. Also, to ensure the registered manager was available when we visited. We last inspected the service on 3 and 5 November 2015 and found the service was compliant with the standards and there were no breaches of regulations.
SeeAbility - Devon Support Service provides care and support to eight people living a ‘supported living’ setting at Windmill Court, Honiton, so that they can live in their own home as independently as possible. The service specialises in supporting people with sight loss with a learning disability, autistic spectrum disorder or acquired brain injury. The flats offer purpose-built accessible accommodation located around a central communal area, where people can meet up and socialise with neighbours and staff if they wish. All flats had two entrances, via a front door from the outside grounds, or via a door from within the communal area.
People’s care and housing were provided under separate contractual agreements. CQC does not regulate the premises used for supported living; this inspection looked at people’s personal care and support.
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.
The service had a registered manager who worked across two locations, in Honiton and Exeter. 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 2017, Devon County Council undertook a review of people in supported living services across Devon. The review was to check individuals were actually getting the support they needed. Also, to clarify any shared support arrangements to make sure they were transparent and fair for everybody, represented a quality service and were value for money.
At Windmill Court, the review significantly reduced the one to one and staff support hours each person received and the shared staff hours. The registered manager said these changes were a very difficult and a worrying time for people and staff and meant people had to adjust to having less staff support hours than they had previously. In order to accommodate the funding changes, the service underwent major organisational change and introduced new ways of working. The registered manager confirmed since the changes were introduced in April 2017, gradually all but two of the original 26 staff team who worked at Windmill Court have left. People, relatives and professionals all commented on how the high turnover of staff had impacted on people.
One person spoke movingly about their sense of loss, when staff they knew well who had worked with them for years left. They said, “They were not just colleagues, they were my extended family.” Another person speaking about the changes said, “For me, it hasn’t been easy.” A relative of a person said, following the changes, it took them a while to settle at night, so they discussed and agreed for the person to have increased staff monitoring at night. When we visited people and staff were still working through those changes. A number of new staff had been recruited, although not all had stayed and there was a significant increase in the use of agency staff. Six staff were undergoing induction when we visited, with four more staff due to start. The registered manager anticipated they would have a full staff team by the end of April.
People felt safe and had their care needs met and there were no missed visits. However, the number of new staff and high agency use was adversely affecting some people’s experiences of care, although others had positively benefitted from staff changes. To minimise risk and improve continuity of care for people, several agency staff worked regularly at Windmill Court. So they had got to know people and about their needs.
Rotas were only available one or two weeks in advance and didn’t include named staff for all support visits planned, with people having less continuity of care staff. Speaking about progress in building a stable staff team, one person said, “The staff team are getting more settled, we are not there yet but we are getting there.” A relative said, “We are hoping things will settle down now.”
The risk of abuse was minimised because staff demonstrated a good understanding of what constituted abuse and knew how to report concerns within the service and to external agencies. Safe recruitment practices were followed before new staff were employed to work with people. People had a range of ways through which they could raise concerns. People’s concerns were listened and responded to.
People’s rights were protected because the service followed the appropriate legal processes. People received their medicines safely and on time.
People receive effective care from staff with the relevant qualifications, training and skills to meet their individual needs. New staff received a thorough induction and all staff had regular supervision and opportunities for further training and professional development. People were supported to see appropriate health and social care professionals regularly to meet their healthcare needs.
People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.
People ate a well-balanced diet and received staff supported them to plan, shop and cook meals of their choice, according to their ability. Where there were any concerns about nutrition or hydration, staff sought professional advice appropriately and followed that advice.
Staff were considerate and caring in their manner with people and knew people’s needs well. People were partners in their care and were fully involved in decisions about their care and treatment. People and relatives said staff treated them with dignity and respect.
People received personalised care that responded to their changing needs. People's care records were detailed about their individual needs including their sensory needs related to their visual impairment. For example, to speak with the person as they approached, that a person was sensitive to bright lights. Information was provided for people in Braille, audio and easy read formats.
People were supported to live as independently as possible and were supported do their own cooking, shopping, laundry and housework, according to their ability. People had a wide range of hobbies and interest and were part of their local community.
The service was well led by the registered manager and deputy manager, who led by example. Robust quality monitoring systems were used to monitor and continually improve. People, relatives and staff were regularly consulted and involved in developing the service. Staff used evidence of what works best to continually review and improve their practice.
The inspection took place on the 3 and 5 November 2015 and was announced. We told the provider two days before that we would be coming. This was so we could arrange to visit some people in their own homes to hear about their experiences of the service and ensure the registered manager was available when we visited. We last inspected the service on 19 December 2013 and found the service was compliant with the standards inspected and there were no breaches of regulations.
SeeAbility - Devon Support Service provides personal care services for people with a visual impairment and a learning disability. It is a supported living service, where people live in their own flat at Windmill Court, Honiton and receive care and support in order to promote their independence. People have a tenancy agreement with a landlord and a separate agreement to receive their care and support from the service. As the housing and care arrangements are entirely separate, this means people can choose to change their care provider without losing their home.
At Windmill Court people’s flats were located around a central communal area, where they could meet and socialise with neighbours and staff. The communal area also housed staff offices and a sleep-in room. Each flat could be entered via the person’s front door or from the communal area. The building was designed to meet the needs of people with a visual impairment and to be accessible to people with physical disabilities.
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 received care that was personalised and responsive. Staff knew people well, understood their needs and cared for them as individuals. People were relaxed and comfortable with staff that supported them and who knew what mattered to them. Staff knew about people’s lives, their families and what they enjoyed doing. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with each person’s wishes and preferences.
Staff supported people to improve their independence and lead busy and fulfilling lives. This included increasing their skills and confidence through supporting some people to undertake voluntary work.
The service had enough staff to support each person’s individual needs and organised people’s care around their wishes and preferences. People had their needs meet by staff who had an in-depth knowledge of their care and health needs. The service had a comprehensive training programme to ensure staff had the right knowledge and skills.
People’s care records were detailed, easy to read and understand how each person needed to be supported. Each person had a care and support plan which had been developed with the person, a relative or others who knew them well.
Staff used a variety of methods to support people to communicate and provide each person the information they needed to make choices. For example, photographs, information in ‘easy read’ formats with pictures, Makaton (a form of sign language) for one person and objects of reference for others. Objects of reference are used with people with sensory impairment and with profound and multiple learning difficulties.
The Mental Capacity Act 2005 (MCA) provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. Staff promoted choice and sought people’s consent for all day to day support and decision making. Where people appeared to lack capacity, mental capacity assessments were completed. Care records included details about how staff could support people with decision making. Staff involved people who knew the person well such as family, other professionals, and staff in making decisions in the person’s ‘best interest’.
People were supported to improve their health through good nutrition. Staff encouraged people to eat a well-balanced diet and make healthy eating choices. Staff encouraged each person to remain active, and maintain their mobility. Each person had an individual mobility plan which included a regular exercise programme and details of any specialist equipment they needed. Staff worked closely with local healthcare professionals such as the GP, community nurse and members of the local learning disability team. A health professional said staff were proactive and sought advice appropriately about people’s health needs and followed that advice.
Staff had completed safeguarding training and demonstrated a good awareness of the signs of abuse and knew how to report concerns. Staff said they would have no hesitation in reporting any concerns to a senior member of staff. Detailed risk assessments were in place for each person with clear actions identified to reduce risks as much as possible. People received their medicines safely and on time. Accidents and incidents were reported and included measures to reduce risks for people.
The provider had a written complaints policy and procedure. Written information about how to raise concerns or complaints was given to people in a suitable format. People and relatives said they wouldn’t hesitate to speak to senior staff or the registered manager with any problems.
The culture at the service was open and honest and encouraged staff to see beyond each person’s disability. The provider had a range of quality monitoring arrangements in place. These included audits of care records and medicines management and regular health and safety checks.
We spoke with three people who were supported by the service, the service manager, administrative assistant, a volunteer at the service, and support staff, including an agency worker. We also spoke with two relatives, one on the phone and one visiting their relative.
When we asked people if they were happy with the support they received all three said 'yes'. A relative we spoke to told us 'The atmosphere is wonderful. They're each individually catered for; they live the lives they want to live.' Another told us 'Windmill court is excellent. The manager and deputy manager have been fantastic; I can't speak highly enough of them. They listen to everything and read everything and have taken our feelings, thoughts, and experience on board.' A volunteer who had been helping at the service for five years told us 'Everyone's so nice, very welcoming, they're lovely, so good at what they do.'
We found that people had comprehensive care plan files, which were personalised and contained lots of photos and instructions for support workers about how people preferred to communicate, and how they wanted to be supported. This meant support staff could be clear about what type of support a person needed, and what their choices and wishes were in the way it was offered.
Whilst at the service we heard and saw staff talking with people and offering them choice and support in a patient and respectful way. Staff told us that many of them had supported the same people since they had first moved into their flats, and we saw that this had allowed them to build a good relationship and communicate effectively with the people they were supporting.
There were eight people living at Windmill Court at the time of our inspection. We saw people were able to move freely about their own homes and communal space and were comfortable in each others company as well as with the staff who supported them.
We found that the provider had suitable arrangements in place to ensure people's privacy and dignity. We saw that people were consulted and involved about the care and support offered to them.
We saw that people received safe and appropriate support that met their needs in line with their agreed care plans. Staff demonstrated a good knowledge of people's individual needs. We saw staff had effective skills to manage the changing moods of people they supported. People's records were well maintained and appropriate in describing their needs and activities.
People's safety was managed effectively and staff received appropriate support in ensuring that people living in the establishment were safeguarded from abuse.
The provider had effective systems in place to routinely audit and monitor the services in order to reduce the risks to people using the service.