Archived: Vivo Care Choices Specialist Autism Service

Vivo Care Choices Specialist Autism Service is a supported living service providing personal care to 21 people at the time of the inspection. The service can support up to 22 autistic people and people with a learning disability

People supported live in shared housing which are situated close to each other. These consist of nine dwellings; six of which are bungalows. A further address is located within a short distance of other dwellings.

People’s experience of using this service and what we found

Quality assurance systems were in place. Safeguarding investigations held earlier this year had identified actions to aid quality assurance. These were included on an action plan and was in progress. We have raised a recommendation about completing this plan to enhance quality of support for people. People and their relatives considered the service to be well-led and felt that all staff sought to extend opportunities for people in their daily lives. People felt involved and engaged in the support they received.

People and their relations felt they were safe when being supported. We have raised a recommendation about the whistle-blowing procedure. Staffing levels were maintained. Risk assessments reflected risks faced by people during their support and from their environment. Medication administration had been reinforced and peoples’ well-being was promoted.

People were supported to have maximum choice and control of their lives and staff did always support them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

The service had developed and responded to the need to support people within the Cheshire West area who sought to be more independent with their lives as tenants but receiving appropriate staff support each day. People lived in accommodation located in a cul-de-sac as well as support provided to people at an address in the neighbourhood. Staff support is very person-centred and matches people’s individual needs and preferences. As an example, one person lives in their own accommodation and receives minimal support in line with their wishes but is able to live safely and independently. Staff perceptions of the location is of being neighbours as opposed to being one larger accommodation. The presence of the main office on site does not impact on people’s accommodation and is seen as a focus for support for people and staff alike.

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

Rating at last inspection

The last rating for this service was Good (published 4 September 2019).

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vivo Care Choices Specialist Autism Service on our website at www.cqc.org.uk.

Vivo Care Choices Specialist Autism Service is a supported living service providing personal care to 21 people at the time of the inspection. The service can support up to 22 people who have learning disabilities and who live with autism.

People supported live in shared housing which are situated close to each other. These consist of nine dwellings; six of which are bungalows.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The communication preferences of people were such that it was not always possible to gain their direct experiences verbally. We were able to observe how people communicated non-verbally and used this to inform our judgement. We gained the views of relatives who had regular contact with their relations.

Relatives were consistently positive about all aspects of the support their relations received. They told us that the service had improved over time and provided a safe, caring and supportive environment. They stated that their relations had had their lives enhanced by the support provided and had progressed in all aspects of their lives. Relatives commented on the management of the service considering it to be transparent and supportive.

People who used the service were relaxed and comfortable with the staff team; using them as a point of reference to make their needs known and request support.

People were safe using the service. Reporting systems were in place for the identifying and reporting of incidents that may be considered as abusive. Staff were now fully trained and knowledgeable about the types of abuse and how these could be reported effectively. Accidents and incidents were analysed and learning took place to prevent reoccurrence.

Risks faced by people were regularly updated and covered all hazards they faced through their support and from the wider environment/community. Sufficient staff were available to respond to the needs of people and the recruitment of new staff was robust.

People were encouraged to maintain hygiene standards in their own homes either through support or independently by a staff team who were trained in minimising infection.

People received prescribed medications as appropriate to promote their health.

Staff consistently received the training they needed to support people effectively. This extended to the receipt of regular supervision to monitor care practice. People had their needs appropriately assessed by the service before they received support.

The nutritional needs of people were met with food provided in line with their preferences and health needs. People were supported to make meals either independently or with staff support.

The registered provider acted as an advocate to ensure that standards of accommodation in people’s homes were of a good standard.

People received support in maintaining their health and wellbeing.

People were supported in a dignified and caring manner. People had their privacy and rights upheld by a staff team who were clearly committed to supporting people effectively.

Care plans were person centred and were now more regularly reviewed. People were provided with information they needed to make informed choices in formats appropriate to their needs. People were provided with the opportunities to take part in leisure activities in line with their preferences both on-site or in the local community; or supported in employment.

The management team demonstrated a continued committed approach to ensuring that people received a person- centred level of support. This commitment extended to the staff team. People we spoke with considered that the standard of support in the service had improved for their relations and that the service was well managed and transparent.

The registered provider was keen to gain the views of people about the standard of the support provided and had a range of audits to check that the support provided was effective and had positive outcomes for people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 5 July 2018). The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Vivo Care Choices Specialist Autism Service on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Vivo Care Choices Specialist Autism Service is a supported living service providing care and support to adults who live in their own homes so that they can live in their own home as independently as possible. The service currently supports 22 people who live in shared housing which is situated close to each other. 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.

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 but they were away from the service at the time of our inspection. The service had appointed an interim manager who began managing the service in February 2018. 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 November 2017 the local authority’s quality assurance team inspected the service and found that overall it was non-complaint with their quality standards. The local authority’s report identified a number of areas requiring improvement, ranging from shortcomings in person-centred care planning and record keeping to a lack of up-to-date training and supervision for staff. The service committed to an improvement action plan, which the local authority shared with us prior to our inspection. Overall, during our inspection we saw that the service was making progress against its improvement action plan. The new management team at the service were actively addressing the shortcomings that had been identified and they will require further time to make all of the necessary improvements.

Since the local authority’s visit the service had put in place clear safeguarding and whistleblowing policies and procedures. The staff we spoke with were clear and confident about managing any safeguarding concerns if they arose. Most staff had received training on safeguarding vulnerable adults but around a quarter of staff’s training had expired. We also found that the service had not always notified CQC of any safeguarding incidents that had occurred as is required.

We saw that documentation about accidents and incidents was not always fully completed and there was a lack of evidence to demonstrate what, if any, follow-up action had been taken following any accidents and incidents.

Staff training had not been kept up-to-date since our last inspection and a significant number of staff were not up-to-date in both the service’s mandatory and specific training. We noted that the service had sourced a new training provider and staff training was scheduled to take place shortly after our inspection.

Staff had not been supported with regular supervisions, appraisals and performance management since our last inspection. However, we saw that the new management team had made improvements in this area in the last few months. For example, we saw that staff supervisions were now being held on a regular basis, were recorded and meaningful discussions such as performance management issues were taking place.

People had personal emergency evacuation plans (PEEPs) and the content of these documents was helpful and gave clear guidance about what level of support people would need in an emergency. However, not all of these documents had been signed and dated so it was unclear when these plans were due to be reviewed.

A new care plan structure and documentation had been introduced to replace the older versions which were disorganised and not up-to-date. Approximately 70% of the people supported had new care plans in place and the service was committed to updating and improving all care plans by the end of June 2018.

The new management team had prioritised updating people’s risk assessments. We saw that people had robust and personalised risk assessments in place and these gave staff the information and guidance they needed to help keep people safe.

Staff, who had appropriate training and experience, provided people with appropriate support with their medication. The staff we spoke with told us that they were confident supporting people with their medication and assisted people to take the right medication at the right times. The staff we spoke with were knowledgeable about people’s medication needs and we saw documentation which gave staff the information and guidance they needed to safely administer people’s medication.

We saw that staff were recruited safely and the relevant checks, known as Disclosure and Barring Service (DBS) checks, were carried out to ensure staff were safe to work with vulnerable people.

The manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and had implemented new documentation to guide staff in this area. This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected.

We saw that there was a caring and positive culture amongst staff. We saw that staff had well established and respectful relationships with the people they supported. It was clear that staff knew the people they were supporting and had a good understanding of their support needs.

The manager was open and transparent with us throughout the inspection. They acknowledged the challenges currently facing the service and they were committed to effectively addressing them as soon as possible. Both the action already taken and scheduled to be taken, along with the positive engagement with the local authority and development of a targeted improvement action plan, gave us confidence that senior staff at the service have the skills and capability to improve the service.