Community Learning Disabilities

CQC only inspects the service being received by people provided with 'personal care'. This includes help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At this inspection there were 41 people using the service out of which nine people were in receipt of a regulated activity.

People's experience of using this service:

We saw good examples of how people were supported to remain safe at times when they were at risk. Robust safeguarding training and policy assisted staff to keep people safe.

Staff were proactive and supported people to take positive risks, ensuring they had maximum choice and control of their lives.

There was a recruitment processes for staff. We noted that some documented pre-recruitment checks were not available at inspection but this issue was resolved after the inspection.

There were environmental safety issues found at two of the assisted living schemes we visited during the inspection. As a result, we have made a recommendation about this in the ‘Safe’ section of this report.

There was a matching process, which ensured that staff were suited to care for people.

Medicines were managed safely and people were supported with their medicines.

There was an open and transparent culture in relation to accidents and incidents and they were used as opportunities to learn and reduce risks.

People's needs were met through robust assessments and support planning.

The service worked with other healthcare professionals to achieve positive outcomes for people and to improve their quality of life.

Staff had good knowledge and skills and the training made available to them ensured people's needs were well met.

We saw good examples of when people had been supported to maintain a healthy and balanced diet

People with complex health needs received care and support that was positive and consistent and which improved their quality of life.

The provider's policies and systems ensured people were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible.

People told us staff were compassionate and kind.

Staff expressed a commitment to ensuring people received high-quality care.

Staff knew people well and supported them to maintain relationships with people that mattered to them.

People were encouraged to learn new skills to enhance their independence and were treated with dignity and respect.

People received care and support that was person-centred.

We saw good examples of how the care and support people received enriched their lives through meaningful activities.

The service was proactive in its response to concerns or complaints and people knew how to feedback their experiences.

The registered manager planned and promoted holistic, person-centred, high-quality care resulting in good outcomes for people.

The values and culture embedded in the service ensured people were at the heart of the care and support they received. Staff told us they received excellent support from management and staff told us they were proud to work for the service.

There was an open and transparent culture and people were empowered to voice their opinions. People told us the service was well-managed.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

At the last inspection, the service was rated outstanding (published 28 October 2016).

Why we inspected:

We carried out this inspection based on the previous rating of the service.

Follow up:

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received we may inspect sooner.

At our previous inspection in April 2014 we found the provider was meeting the regulations in relation to the outcomes we inspected.

Warrington Community Living (WCL) was established in 1991 is a local charity that seeks to support people with learning disabilities, physical disabilities, older people, people with dementia and people experiencing mental health issues to lead their lives in a purposeful, healthy and enjoyable way as full and equal members of their local community. They do this through the provision of residential homes and supported living schemes, provision of short breaks for children and young people as well as other forms of support for individuals in the community.

The head office is in the centre of Warrington located on an upper floor of the Gateway building and is accessible to people via a stairway or a passenger lift.

This inspection focussed on the domiciliary care and supported living network provided by Warrington Community Living. The service provided services to people with severe learning disabilities or autistic spectrum disorder in their own homes. At the time of the inspection the service offered support to 29 people, however only four people received care and support which involved an activity the provider was registered for with the Care Quality Commission.

The service has 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 who used the service and their relatives spoke of the outstanding care delivery. They told us the provider and staff of the service went above and beyond to ensure they received a person centred service. Staff maintained people’s privacy and dignity ensuring any care or discussions about people’s care were carried out in private. We saw interactions both verbal and non-verbal between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion. We observed staff knew and understood the people they cared for and ensured people were provided with choices in all aspects of daily life by way of discussion. Innovative assistive technology had been introduced to enable people who used the service to keep up to date with news and events and to be personally involved with recording their daily diaries.

Staff were recruited through a rigorous procedure. As part of the recruitment process the provider used value based recruitment techniques, a clearly defined culture statement and staff competency assessments. Staffing provision was responsive to people’s changing needs and preferences which enabled people to lead fulfilled lives. People who used the service and their relatives were encouraged to participate in the interviewing process for potential employees. This demonstrated the service’s commitment to the culture of inclusion and participation within the service.

People who used the service, family members and external agencies were most complimentary about the standard of support provided. The registered manager involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests. Relatives and professionals were very positive about the service people received. The service specialised in supporting adults and children with behavioural problems some who had lived in large institutions for a long period of their life or had experienced several failed placements prior being supported by Warrington Community Living.

Positive risk taking was driven throughout the organisation, balancing the potential benefits and risks of taking particular actions over others, in order to support people to live fulfilling lives. In delivering this consistent approach people were supported to try new things and make changes in their lives. The registered manager and staff had an excellent understanding of managing risks and supported people that had previously challenged services to reach their full potential.

An outstanding characteristic for the service was the time spent developing ways to accommodate the changing needs of the people who used the service, using innovative and flexible ways to support people to move forward. The registered provider was seen to constantly adapt and strive to ensure people who used the service were able to achieve their full potential. We saw that over a period of time people had been supported to progress and their support plans and environment adapted and developed to promote their independence.

The registered manager ensured staff had a full understanding of people’s support needs and had the skills and knowledge to meet them. Training records were up to date and staff received regular supervisions and appraisals. There was a well-established management structure in place which ensured staff at every level received support when they needed it. Staff were clear about their roles and responsibilities and how to provide the best support for people.

People were at the heart of the service, which was organised to suit their individual needs and aspirations.

People’s achievements were celebrated and their views were sought and acted on. People were supported by staff that were compassionate and treated them with dignity and respect. Without exception, people who used the service and their relatives we talked with were high in their praise about the staff that supported them.

We saw people had assessments of their needs and care was planned and delivered in a person-centred way. The service had creative ways of ensuring people led fulfilling lives and they were supported to make choices and have control of their lives.

People participated in a range of personal development programmes. Individual programmes were designed to provide both familiar and new experiences for people and the opportunity to develop new skills. People who used the service accessed a range of community facilities and completed activities within the service.

Where necessary people’s nutritional needs were well met and they had access to a range of professionals in the community for advice, treatment and support. Staff monitored people’s health and wellbeing and responded quickly to any concerns.

Care plans had been developed to provide guidance for staff to support in the positive management of behaviours challenged the service and others. This was based on least restrictive best practice guidance to support people’s safety. The guidance supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

There was a strong emphasis on person centred care. Family members and social care professionals told us and all the care records viewed showed people’s needs were continually reviewed. The plans ensured staff had all the guidance and information they needed to enable them to provide individualised care and support. People and their family members were consulted and involved in assessments and reviews. Best practice guidelines were followed and the service was innovative and creative in its approach to support. The management and staff were not afraid to challenge decisions and advocate fully on behalf of the people they supported, often with excellent results. A one page profile was written by the person who used the service to identify their background, achievements and goals. We saw staff had also provided a one page profile of themselves to enable people to have knowledge of them as individuals to include family, interests, knowledge and skills.

People received their medicines as prescribed by their GP. Medicines were managed safely to ensure people received them in accordance with their health needs and the prescriber’s instructions.

The service had a complaints policy; details of which were provided to all the people who used the service and their relatives. People told us they had no reason to complain but if they did ‘they knew what to do’.

The provider regularly assessed and monitored the quality of care to ensure national and local standards were met and maintained. A culture of continuous improvement was in place to promote further enhancement of the service.

There was an extremely positive and strong value based culture within the service, the management team provided strong leadership and led by example, best practice was implemented and followed throughout the service. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Their ethos was “To enable people with learning disabilities to determine the life they live and strengthen their community of family and friends.” Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people. Confidentiality was respected and independence was promoted.

The chief executive and the registered manager were excellent role models who actively sought and acted on the views of people. People, their relatives and health and social care professionals without exception told us they thought the service was extremely well managed. We found all staff were very positive in their attitude to the company and their role and said they were committed to the support and care of the people. Staff said the service was different to others because the management team genuinely cared about all of them and the people who used the service and wanted to make a positive difference to people`s lives.

Systems to continually monitor the quality of the service were effective and

' Is the service well led?

We found that the provider (Warrington Community Living) had taken appropriate action to ensure the service was led and managed by a person who was registered with the Care Quality Commission.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Policies and procedures had been developed by the registered provider (Warrington Community Living) to provide guidance for staff on how to safeguard the care and welfare of the people using the service. This included guidance on the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

We were informed that none of the people using the service had been referred for a mental capacity assessment and no applications had therefore been submitted to deprive a person of their liberty.

Training records highlighted that the majority of staff had completed Mental Capacity Act training but only one staff had completed Deprivation of Liberty Safeguards training. This has been brought to the attention of the provider so that action can be taken to increase staff knowledge and understanding.

The provider had developed guidance on recruitment and selection to provide information to staff on the procedures for recruiting new employees. We looked at a sample of recruitment records for three staff which had been stored electronically. Examination of records and / or discussion with staff confirmed staff had undergone a comprehensive recruitment process prior to commencing work with the provider.

Some records could not be located for one employee. We have received assurances from the provider that action was being taken to recover the missing records and to audit all personnel files to identify any other gaps.

Policies and procedures had been developed for the administration of medication. Staff had completed in house medication training and / or medication and healthcare procedures training prior to administering medication.

We noted that staff had signed one person's Medication Administration Chart (MAR) using a pencil. Furthermore, some medication details had been hand written which had not been signed or countersigned by another suitably qualified member of staff to confirm the details were correct. We have brought this issue to the attention of the provider so that action can be taken to improve records.

Is the service effective?

We spoke with two people using the service by telephone who were both complimentary of the service provided. Comments received included: 'I'm very happy and I'm not moving'; 'The staff help me' and 'The support I receive is great. I've never been so happy.'

Records highlighted that there had been no complaints in the last twelve months and no complaints or allegations were received from people using the service or their representatives during our inspection.

Is the service caring?

We also spoke with the relatives of four people who were supported by the service. All feedback received was positive and confirmed the service was responsive and caring to the needs of the people using the service.

We received comments such as: 'The standard of care provided is exceptional and the service is reliable'; 'They provide a very personalised service in every aspect including the care plans; 'The manager and staff are all lovely people. They genuinely care and have the right ethos' and 'The care provided is outstanding and they understand the needs of my relative.'

Is the service responsive?

Records viewed highlighted that the provider was committed to the inclusion of people in the development and operation of the service. For example, we noted that the provider was exploring options to engage people using the service in staff recruitment.

Furthermore, files viewed contained a range of personalised records that had been developed using signs, symbols and pictures to enable people using the service to participate in the development of person centred planning and to understand the information more easily.

Summary information on each individual's progress with independent living skills, involvement in activities / interests and learning observations had been recorded by support workers. This helps the people using the service to develop and monitor progress and to develop new skills and life experiences.

We could not locate an assessment of need for one person using the service during our visit. We have brought this to the attention of the provider and received an assurance from the acting manager that an assessment tool will be developed to ensure the needs of people using the service are assessed prior to the service commencing (if a care management assessment is not available).

Is the service well led?

The provider has worked well with the Care Quality Commission and is aware of the need to keep us updated on any significant events via statutory notifications.

An acting manager had been appointed who was in the process of applying to register with the Care Quality Commission. We noted that there had been a significant delay in the acting manager progressing his application.

Since completing our inspection we have received a detailed report together with supporting evidence of events contributing to the delay and action taken. This included an action plan to cancel the registration of the previous manager and to ensure the acting manager applies for registration as a matter of urgency.

The service continued to utilise a comprehensive internal quality assurance system and has developed systems to obtain feedback from people using the service and / or their representatives.

The service user spoken with confirmed they were given appropriate information and support regarding their care or treatment. We noted that the service was using electronic tools together with pictures, signs and symbols to assist the person to plan an individualised service and to assist in communication.

The person reported: 'I am very happy living here'; 'I like the staff' and 'I don't want to move'.

Systems had been established to ensure an appropriate response to abuse and ensure the quality of service provided was kept under review.

No concerns, complaints or allegations were received during our visit.