Archived: Supporting You in Cornwall

We visited, by agreement, people living in their own homes where supported living support was being provided by this service. We visited a person who shared a house with other people all of whom had their own bedrooms and shared the other parts of the house with Staff supporting them throughout the 24 hour period. We also visited people who lived in their own flats in a purpose built apartment block. At this facility Supporting You had a dedicated area called ‘the hub’ in the complex which is accessible 24 hours a day so that people could request support as they needed it.

At the time of our inspection nine people were receiving a personal care service. The ‘hub’ provided background support to a further 11 people. These services were funded either privately or through Cornwall Council.

We carried out this announced inspection on 19 and 20 September 2017. The inspection was announced a few days advance in accordance with the Care Quality Commission’s current procedures for inspecting domiciliary care services. At the last inspection, in October 2015, the service was rated Good. At this inspection we found the service remained Good.

A manager had been appointed to the service in April 2017. They had submitted their application to us to be the registered manager of the service. The registered manager has responsibilities for the day to day leadership and for overseeing the performance of services.

We visited some people in their homes to gain their views on the service. People told us they felt safe using the service. Comments included, “I feel safe with all the staff” and “They help me so that I can live here. Staff are always nearby if I need them.” Comments from people about the background support that ‘the hub’ provided were positive, one commented “I like coming here to talk to people as I get lonely in my flat.”

Staff told us they had not been provided with identification badges to enable people to confirm the identity of their care staff. The manager stated identification badges were in process. People told us if new staff were coming to their home, current care staff would ensure they met with them to introduce them. The person could then be reassured who was providing their care so they could ensure people’s safety was not compromised.

The service supported some people with shopping for food and other items. The service had financial procedures in place to ensure that people’s finances were kept safe at all times. Each person should have access to their own accounts and the manager was aiming to adopt this as best practise across the whole service. We were given reassurance that this was currently being addressed to ensure all people had sole access to their own monies at all times.

New employees were required to go through an induction which included training identified as necessary for the service and familiarisation with the service and the organisation’s policies and procedures. There was also a period of working alongside more experienced staff until such a time as the worker felt confident to work alone. However, whilst managers and staff told us that induction occurred, we could not find any documentary evidence to support this. We recommend that induction is formally documented to evidence that staff have received, understood and are familiar with the services organisations policies and procedures.

Staff told us that with the appointment of the new manager and restructuring of the service in April 2017 there had been a lot of positive changes. Staff told us that supervision and staff meetings were now occurring, which had previously been lacking. These meetings allowed an opportunity for staff to reflect on their practices, discuss personal development and share information about any observed changes in people’s needs. Staff also felt that that systems were much clearer, for example care plans had been reviewed and amended and a shift plan had been implemented so all staff knew what was expected of them on each shift they worked. Also procedures in respect of finances and medicines were more robust. Staff stated they felt more supported by the manager due to the increased contact they had with them as they were locally based.

There were enough staff employed by the service to cover the visits and keep people safe. Staffing levels were determined by the total number of hours provided to people using the service. The service recruited staff to match the needs of people using the service and new care packages were only accepted if suitable staff were available.

People were supported by dedicated teams and there were suitable arrangements in place to cover any staff absence. An on call rota was in place so that staff knew who to contact outside of office hours. This meant on call staff could answer any queries if people or staff phoned to check details of their visits or if duties needed to be re-arranged due to staff sickness. People told us they were never supported by someone they did not know.

Staff treated people respectfully and asked people how they wanted their care and support to be provided. People spoke positively about staff. Comments included, “Staff are good, they know me and how I need help”, “They are great”, “They are all very kind to me” and “They are fabulous.” Staff also talked about the need to remember they were working in people’s homes and be mindful of this. One said, “This is their home, we must respect that.”

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed. Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were appropriately trained to support people with their medicines when this was needed.

People had a care plan that provided staff with direction and guidance about how to meet people’s individual needs and wishes. Some of the care plans were jointly agreed with other service providers as people had more than one care agency supporting them. These joint care plans detailed which service was responsible for providing what element of care and support the person needed. This meant that the person and the services providing care, knew exactly at what time and how they were to support a person.

These care plans were regularly reviewed and any changes in people’s needs were communicated to staff. Assessments were carried out to identify any risks to the person using the service and to the staff supporting them. This included any environmental risks in people’s homes and any risks in relation to the care and support needs of the person. For example, each person had a Personal Evacuation Emergency plan (PEEP) which provided information to people what to do in the event of a fire. The PEEP was presented in a visual and written format. This meant that people received information that was meaningful to them.

Staff were recruited safely, which meant they were suitable to work with vulnerable people. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected. Staff received appropriate training and supervision.

The service was acting within the legal framework of the Mental Capacity Act 2005(MCA). Management and staff understood how to ensure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

There was a positive culture within the staff team. Staff were motivated and clearly passionate about making a difference to people’s lives. Staff demonstrated a commitment to their work and worked together as a team.

People described the management of the service as open and approachable. A health and social care professional told us that recent changes to the services were positive and communication had improved.

There were effective quality assurance systems in place to help ensure any areas for improvement were identified and action taken to continuously improve the quality of the service provided. People told us they were regularly asked for their views about the quality of the service they received. People had details of how to raise a complaint and told us they would be happy to make a complaint if they needed to.