Ambler Way Support Services

Our last inspection of this service took place on 16 March 2016. At that time, we found the provider was meeting all legal requirements and the service was rated as good in all areas. At this inspection we found the evidence continued to support the rating of good. 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.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older adults and younger disabled adults. This service also provides care and support to people living in a number of ‘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.

A registered manager was in post and had worked at the service for many years. 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 using the service, relatives and staff provided very positive feedback about the effectiveness of the registered manager and deputy manager. They told us they were approachable, caring, proactive and committed to continuously improving the quality of care.

Staff were kind, caring and treated people with dignity and respect. People could choose which staff worked with them. The matching process was effective and ensured staff developed positive relationships with the people they supported.

The service continued to effectively manage potential risks to people’s health, welfare and safety. Staff provided training to people using the service to help increase their understanding of key areas to keep people safe, maintain their health and protect them from the risk of abuse.

Staff were recruited safely to help ensure they were of suitable character to work with vulnerable people. There were enough staff to ensure a reliable and consistent service was provided to people. Staff received effective support and training to undertake their role.

Medicines were safely managed and people were effectively supported to access healthcare services and received ongoing healthcare support.

People told us staff involved them in planning menus and we saw people received a balanced diet which met their individual needs and preferences.

People continued to receive highly personalised and good quality care. In one case the care delivered was not fully reflected within the persons’ care records. We recommended that the provider ensures all care records accurately reflect the specific actions staff are required to take to ensure people maintain good health and to manage potential risks.

There was an open and inclusive culture. Staff regularly involved people in making decisions about their care and used peoples’ feedback to ensure they provided a personalised and responsive service. Effective systems were in place to log, investigate and respond to complaints.

Staff continuously sought new ways to communicate with people and ensure everyone had the opportunity to consent to the care they received and express their views. Staff worked in line with the requirements of relevant legislation such as the Deprivation of Liberty Safeguards (DoLS).

The provider had clear values which put the people using the service at the heart of everything; staff were true to these values in their day to day work.

A new supported living house had been purchased which provided care to older people. This gave people the option to continue to be cared for by Ambler Way staff as they grew older. The registered manager was working to improve care planning around end of life care and was involving people using the service in this process.

The registered manager operated effective systems to monitor the quality of care provided and ensured people were fully involved in the running and future development of the service.

We found all fundamental standards were being met. Further information is in the detailed findings below.

Our last inspection of this service took place in June 2014. The service was found to be compliant with all of the legal requirements inspected at that time.

Ambler Way Support Services is a specialist supported living and domiciliary care service for adults with learning disabilities. The main office is based in Haworth. Most people who use the service live in private houses with other people with a learning disability within a five mile radius of the main office. The service provides personal care and support so that people with a learning disability are enabled to live in the local community and lead a full life. At the time of our inspection there were 40 people receiving personal care. In addition to personal care, a range of other services are also provided such as support to do shopping, gain qualifications and access community groups and services.

The registered manager has been in post for several years. 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.

We concluded that the people who used the service were at the heart of every aspect of the organisation. Staff actively sought opportunities to involve and empower people to make key decisions and ensured the service continually evolved to meet their changing needs.

The registered manager was passionate about delivering person centred care and enabling people with learning disabilities to achieve their full potential. Staff at all levels of the organisation demonstrated they were committed to delivering the collaborative, inclusive and innovative philosophy of care which the registered manager promoted.

People were involved in making decisions about every aspect their care and daily routine. Staff adopted different communication techniques to ensure everyone who used the service had a strong voice. Staff used the feedback people provided to deliver individualised care and shape improvements to how care was delivered.

People were in charge of planning their own menus and were encouraged to cook and prepare their meals. Staff adopted an innovative approach to help educate and encourage people to consume a healthy diet such as encouraging every person to develop their own individualised healthy eating pledge.

Staff had developed strong working relationships with health and social care professionals and worked in partnership with them to ensure consistently positive outcomes for people’s health and wellbeing.

Staff received a comprehensive programme of mandatory, specialist and accredited training which ensured they had the skills required to care for people. The registered manager used creative ways to ensure staff understood their training. Staff received an annual 360 appraisal where feedback was provided by people they supported, peers and outside agencies. This demonstrated that the opinions of the people who used the service were valued.

Staff were confident in how the key principals of the Mental Capacity Act 2005 (MCA) applied to their role and how they helped to ensure people’s human and legal rights were respected on a day to day basis. They used creative ways to ensure people were involved in making decisions. They accessed alternative communication methods to ensure everyone had a voice and were enabled to express their views.

Risks to people’s health and wellbeing were being effectively assessed, monitored and managed. The provider had appropriate arrangements in place to help protect people from the risk of abuse.

Sufficient staff were employed to ensure people’s individual care needs were met. Care rotas were realistically planned to ensure people received consistency of care and support at the times they needed it most.

Staff ensured that people were supported to take their medicines in a safe and person centred way. The registered manager was in the process of reviewing the protocols for ‘as required’ PRN medicines to ensure they were more robust.

The feedback we received from people who used the service, relatives and health and social care professionals consistently told us the standard of care delivered was excellent. Staff had developed strong links with health and social care professionals, community services and key local contacts and worked in partnership with them to ensure a high quality and inclusive service provision.

Staff treated people with respect, privacy and dignity and encouraged people to express what dignified care meant for them. People were empowered to develop their independent living skills and staff actively encouraged people to set and achieve future life goals. We saw examples where people no longer needed to use the service because staff had nurtured their independence.

The registered manager promoted an open and honest staff culture. They had a positive attitude towards complaints and saw them as an opportunity to learn and improve. Staff were responsive and flexible in their approach to resolving issues and responded to people with empathy and understanding. Staff actively sought opportunities to learn, develop and improve the service. This meant continuous improvement was a key feature of the service.

There were effective systems in place to monitor and improve the quality of the service provided. The quality assurance systems were inclusive and the key driver for improvement was always the views, preferences and needs of people who used the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five key 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?

This is a summary of what we found. The summary describes the records we looked at and what people using the service and the staff told us.

Is the service safe?

At the time of our visit there were 14 people who used the service. We spoke with two people and they all told us they felt safe when staff visited them.

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their support plans showed the actions required to manage these risks. The three staff we spoke with understood the procedures they needed to follow to ensure that people were safe, such as what action to take in the event of a medical emergency.

We found there were appropriate procedures in place to ensure people were safely supported with their medication. Staff told us they felt they had enough training to safely support people with their medicines. People who used the service told us they received their medication as prescribed and when they needed it.

There were enough skilled and experienced staff to ensure people received a consistent and safe level of support.

Is the service effective?

People had an individual support plan which set out their care needs. We found people and/or their representatives were involved in the assessment and planning of their health and care needs. This meant people could be assured their individual care needs and wishes were identified and planned for.

We saw health action plans were in place for everyone who used the service and these were reviewed annually. People had access to a range of health professionals and the service had a good working relationship with other healthcare professionals and followed their guidance and advice. The input of other healthcare professionals involved in people's care and treatment was clearly recorded within care records.

Is the service caring?

Our discussions with people and the records we looked at told us that individual wishes for care and support were taken into account and respected. People said they were provided with a high standard of care. One person told us their relatives received an 'excellent standard of care, are settled and cared for by staff who know them and how best to support them." People told us they felt involved in making decisions about their care and support and that staff helped them to be as independent as possible.

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered.

Is the service responsive?

Care records were reviewed and any changes made either when people's needs changed or as part of the annual review process. We saw evidence of this within the care records we reviewed. We also saw people and their representatives attended care reviews and were given the opportunity to raise any concerns and suggest changes to how their care and support was provided. The staff we spoke with told us they would immediately commence a care review if they noticed a change in people's needs.

People knew how to make a complaint if they were unhappy. People told us the service took complaints seriously and looked into them quickly.

We saw staff supported people to be as independent as possible and to access a range of activities within the local community.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service and any non-compliance with the essential standards of quality and safety.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People who used the service told us if there were any problems they felt able to raise these with staff and were confident they would be listened to.

Overall, people's personal care records and other records, such as staff files, were accurate and complete.

People's comments included:

'They understand his needs and work really hard to achieve independence. They have achieved loads since they started at the service.'

'Very good service, carers are wonderful.'

'The manager works really hard to make it like one big family.'

'I would recommend the service 100% to anybody.'

We found the provider had processes in place to ensure people's consent was sought before assisting with care. Where people did not have capacity to make decisions, other people were involved such as relatives or advocates.

We found people's care was appropriately planned and risks to people's health and safety were assessed.

We found the provider had suitable recruitment procedures in place which ensured staff employed were suitable and of good character.

We found the provider had robust procedures in place to assess and monitor the quality of the service provided. This included mechanisms for capturing people's views and feedback and a range of audits.

Appropriate and accurate records were in place in relation to people who used the service and staff.

People we spoke with were aware of safeguarding procedures and systems on how to raise a concern were in place. People were satisfied that staff or the managers would take action if concerns were raised. One person who used the service said that they felt safe and able to tell staff if they had any issues.

We spoke with one person who used the service during our visit. This person was very satisfied with the care and activities within the service. They told us that they were involved in planning a fun day during the summer. They said 'I am going to Blackpool with staff and friends at weekend. 'This person also told us that they did their own washing and cleaned their own room, and help was available if required.