SeeAbility - Exeter Support Service

SeeAbility Exeter provides supported living and personal support and care to people in their own homes. Most of the people SeeAbility supports live in self-contained flats that are part of the same complex. They support people with a variety of needs including visual impairment, autism and brain injury. SeeAbility also provides an outreach service to people who live in their own homes in Exeter. SeeAbility maintains office space and a communal area within the complex.

We checked the service was working in line with ‘Registering the right support’, which makes sure services for people with a learning disability and/or autism receive services are developed in line with national policy - including the national plan, Building the right support - and best practice. For example, how the service ensured care was personalised, discharge if needed, people’s independence and links with their community.

Rating at last inspection

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing 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.

At the time of this inspection there was no registered manager in post. A new manager had been appointed and they were due to begin in post a few days after our inspection. In the interim period between the previous manager leaving and the new manager starting, the regional head of operations and the deputy manager had jointly managed 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. People who used the service, staff and relatives praised the Regional Head of Operations and the deputy manager for the way they had managed the service during this period.

Why the service is rated Good

The staff were passionate about supporting people to lead an independent and fulfilling life. They were exceptionally skilled and resourceful in helping people overcome problems and barriers in their lives. The organisation employed specialist staff who worked closely with each person and their staff team to find solutions to problems, and to help people achieve their goals and dreams. A person told us “My life has changed in lots of ways since I moved here.” Another person told us how their life had changed since they moved to SeeAbility saying, “Life is much more settled now. A vast improvement”. They also told us, “I am in a good environment that enables me to live my life as I want to live it”.

The staff team were highly sensitive, understanding and knowledgeable about each person’s individual support needs. They knew each person very well and understood the things that mattered to them. They helped people achieve their goals, and gain greater independence and fulfilment. A relative told us how the service had supported a person in many ways to help them gain confidence, independence, better health and quality of life. They said, “I don’t know what it would be like without them (staff).”

People were fully involved and consulted in drawing up and reviewing their support plans. Support plans and other relevant documents had been drawn up in a format each person could understand. People were encouraged to have control over all aspects of their daily lives and to have a say in their staff team and how the staff supported them. They led active lives, did the things they wanted to do, and went to the places they wanted to go.

People told us they felt safe. There were good safeguarding procedures in place. Staff and people who used the service were confident they could raise concerns and these would be listened to and addressed. Systems were in place to protect people from the risk of financial abuse.

Risks to people’s health and safety had been carefully assessed and staff knew the procedures they must follow to support people safely. Staff had received training and equipment to ensure they followed safe infection control procedures. The safety and security of people in their own homes has been given high priority. This had included the use of technology such as an electronic door entry system, vibrating door bells and fire alarms, and specialist kitchen equipment such as talking microwaves, liquid level indicators, and one cup water boilers.

Safe recruitment procedures were followed before new staff are appointed. New staff had received induction training at the start of their employment to ensure they provided safe care to people. There were sufficient staff employed and people were confident they would receive the support they needed, and at times they had requested. People knew who would be supporting them each week. The provider had acted promptly to address issues relating to staff morale and a slightly higher than expected staff turnover in the last year through a range of measures such as improving the support to staff, and closer links with senior managers. Comments from staff included, “Senior leaders are very approachable. They have visited the service and staff know them and know how to contact them” and “We have a really strong team here now. Everyone communicates well. It’s a lot more positive. Staff are much more open if there’s a problem.”

Medicines were administered safely by staff who had received training and were competent in this task. Records of medicines administered were regularly checked to minimise the risk of errors being missed.

People were supported by staff who were kind, caring and passionate about giving people the best possible care. Staff knew each person well, and understood and respected their preferences and the way they wanted to lead their lives. Staff received good training, and were supported and supervised to ensure they carried out their roles effectively. Staff were flexible and always willing to change the hours they work to suit the people they support.

People were supported to plan menus, purchase food, and cook their own meals. Staff encouraged and supported people to eat healthy meals and to maintain a healthy weight.

Staff understood people’s right to make choices and decisions about their lives, even if the choices were unwise or risky. Staff worked closely with families, health and social care professionals to make sure people’s rights were upheld. Where people were unable to make decisions about important issues, the staff followed procedures to make sure the person’s best interests were upheld. Staff upheld people’s human rights and treated each person as a respected individual.

People knew how to make a complaint and were confident any complaint would be listened to, investigated and action taken where necessary to address the issues and prevent it happening again.

People who used the service, staff and relatives told us the service was well-led. People praised the management team for making improvements to the service and for their caring and positive leadership. The staff team were positive, enthusiastic, and clearly enjoyed their jobs. The provider had systems in place to check the quality of the service they provided, and to make improvements where needed. People who used the service, staff, families and other stakeholders had been consulted and involved in the service. A member of staff told us “The organisation is absolutely brilliant!”

Further information is in the detailed findings below

SeeAbility Exeter provides supported living and personal support and care to people in their own homes. Most of the people SeeAbility supports live in self-contained flats that are part of the same complex. SeeAbility maintains office space and a communal area within the complex.

There was a new manager in post who is also registered to manage the Honiton location of See Ability. The management arrangements of the two locations have been changed and the provider proposes to have one registered manager covering both locations with two deputy managers, one in each location. An application had not yet been submitted to register the manager for the Exeter branch at the time of this inspection. 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 told us they were entirely happy with the service they received. Comments from some of the people we spoke with included, “I am happy with my service. I have built up a good relationship with the support staff. I have many friends here,” “Staff are all nice,” and “There are good people who run it very well.”

People were safe. The provider followed careful recruitment checks and procedures to ensure only suitable staff were employed. New staff received training, support and supervision to ensure they had the basic skills at the start of their employment to meet people’s needs safely. In the last year the service had been through a period of higher than usual staff turnover. However, new staff had been recruited and at the time of this inspection a full staff team was in place. This meant people could be confident they would receive visits from staff at times they had requested. People told us the service was reliable, and flexible.

Staff understood how to recognise and report any concerns or potential abuse. The provider had systems in place to listen to people’s concerns and complaints and take appropriate actions to address these.

Medicines were administered safely by staff who had been appropriately trained. Records of administration showed staff took care to ensure people received the support they needed to receive their medicines according to the prescriber’s instructions.

Staff received training and supervision on a regular basis. Staff had the skills and knowledge to meet each person’s individual needs, including any special communication needs. The provider employed specialist staff with qualifications and skills in speech and language and supporting people with visual impairment. These staff provided training and support to those staff working directly with people to ensure people were supported effectively.

Staff were caring. We saw staff supporting people in an unhurried and friendly manner, taking time to listen and respond appropriately. Staff offered people choices and supported people’s rights to make decisions about all aspects of their daily lives.

People told us they had been involved and consulted about all aspects of the service they received. Each person had been supported to write their own care plan and make sure it was kept up to date. People held their own care plan files and daily reports in their homes and knew what was written in the files. One person told us, “I really involve myself a lot with my paperwork. I know what is written in my care plan file.” Another person told us their mother and father had supported them in drawing up their care plan. They were pleased with the outcome, saying “I am happy with the wording.”

People were supported to speak out about all aspects of the service and their views were listened to and acted upon. A person told us how they held the position of chairperson of the ‘Speak Easy group’ which was an opportunity for people who used the service to have their say. People’s views were also sought through questionnaires.

The provider and manager had systems in place to regularly monitor all aspects of the service to ensure the service was running smoothly and people’s support needs were being met. People who used the service and staff told us the service was well-managed. Comments included, “There are good people who run it very well” and “This is the best place I have worked.” A member of staff told us “The (management) team are really good at praising staff.”

Both relatives told us that they were satisfied with the support their relative received. One said that the support 'had improved recently, as for a while x got a lot of different support workers and we were concerned about continuity. All of the staff are really good, but everyone does things differently.' The same relative also told us that when their relative first moved in they didn't seem to make much progress, but that recently this had improved and 'support workers seem very good at telling x about activities that were going on for x to choose to join them...it's a nice little scheme' Another relative said that 'staff have been very good; they are doing things above and beyond the hours x has."

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.

SeeAbility provided supported living with personal care and support to the eight people who lived there. In addition they continued to provide the same support to a person who had chosen to leave the complex and move into the wider community. Most people had visual difficulties and other support needs including physical and learning disabilities. Everyone received one to one support and some people received two to one support. The number of hours support varied according to each person's assessed needs.

We found that everyone was very happy with the support they received. They told us "The staff are really nice". "It is quite homely".

We saw that the provider had in place systems that ensured people's welfare and safety were maintained. However we saw that some of the files needed updating and reorganising. We noted that there had been a very high turnover of staff, but that this appeared to be reducing. The manger told us that she had been focusing on supporting staff over the last twelve months.