Three C's Support

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment under the previous provider we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 55 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

During our visits to the supported living settings staff were approachable and friendly and we observed staff were kind and compassionate. Support staff were kind, caring and compassionate in how they communicated with people. However, the shortage of staff meant that staff were not able to spend the time needed to support people with dignity and in ways that enhanced their quality of life. The long hours worked by some staff also meant they did not have the breaks they needed to provide high-quality, aspirational support to people

We observed interactions between people and staff in each of the supported living settings we visited, and how comfortable people were in their own homes and with the staff supporting them. Some staff had supported people for a very long time, through being employed by the different support provider agencies.

A professional said, “The service is not shaped to meet the needs of individuals. As from 2pm onwards there are only two staff therefore restricting people going out. People do not go out after 2pm – very institutional way of working. there are very few family members that are not involved in people’s care.”

One person told us, “I like [support worker’s name]. She is a very good cook and helps me with my painting.” Another person said, “[My keyworker] helps me.”

Relatives felt the staff were kind, caring and compassionate, a relative told us “When I’ve seen them [staff], they are kind and caring.” Another relative said “Absolutely caring and they really all do their best.” And another relative shared, “Things really changed over the last few years and they’re much better. [Person] seems happy with them to me.”

The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. They took account of people’s strengths, abilities, aspirations, culture and unique backgrounds.

We observed staff interacting with people and they were treated with respect and as individuals. Staff gave examples of people’s cultural and communication needs. A professional told us, “[Staff] knew the person very well and would bring them to their clinic appointment.”

Where people had their own methods of communication, staff knew them well and were able to communicate with them in ways they understood, and in ways they could be understood. All of the support plans we reviewed included information about their preferred communication methods, and some people had additional communication plans that had been developed with guidance from a Speech and Language Therapist.

However, resources to facilitate communication were not always available. One person’s communication plan referred to symbol and picture cards for staff to use to support the person to make day-to-day choices, however we asked the support staff to show us these, and they told us there weren’t any.

Staff supported some people to attend places of worship and celebrate cultural and religious festivals that were important to them. However, some of the issues with the environment meant that this support was stopped for long periods of time, for example when the lift was broken for many months in one supported living setting.

In two supported living settings we visited, people were beautifully dressed and groomed in ways that enhanced and recognised their individuality. Their facial expressions and vocalisations showed they enjoyed being well-dressed and wearing jewellery and makeup.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

Staff supported people to maintain relationships that were important to them. Where people needed support from staff to phone or have video calls with their friends and family, staff facilitated this. One person told us, “I speak with my mum every day.” Another person said, “My brother visits me some weekends. We go out to the pub.”

Staff supported some people to make day-to-day choices about what food they ate, what clothes they wore and how they wanted to spend their time within their home. However, some people could not be supported to make day-to-day choices with the resources that were available. In some supported living settings , there were not enough staff to facilitate the time necessary to support people to understand the choices that were available to them, and the consequences and potential outcomes of each of these. As such, in some of the supported living settings people did not have independence, choice and control over their lives, where they lived, who they lived with or who supported them.

For example, although people had tenancy agreements for their homes in which they had lived for more than 20 years, the interim service manager spoke of ‘closing this service’ and moving people to “voids” in different homes, to consolidate staffing resources. The provider did not respect, support or uphold people’s rights as tenants.

The provider listened to and understood people’s needs, views and wishes. Staff responded to people’s needs in the moment and acted to minimise any discomfort, concern or distress.

We observed an example of one staff member responding to one person’s immediate distress. The support worker spoke to the person calmly and soothingly and redirected them to where they could have their sensory needs met. The person responded well and calmed down.

The staff member followed the strategies outlined in the person’s ‘challenging behaviour risk management form’, however we noted that the next step detailed in the form, should de-escalation not work, was to ‘refer to a behaviour specialist’. While this was a good long-term strategy, it would not reduce the immediate risk of the person self-harming or the person’s immediate distress. In another supported living setting we observed staff responding to a person whose foot had twisted on the footplate of their wheelchair. The support worker spoke soothingly and calmly to the person while gently manoeuvring their foot back to the footplate. Their facial expressions and vocalisations showed they were comfortable.

The provider did not care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.The provider had not always consistently supported the whole staff team. For example, some staff had not attended supervision meetings. Staff had not completed any surveys to give feedback and suggest ways to improve the service or staff experiences.

We found staff were not supported appropriately There was inconsistent evidence of staff having access to wellbeing services and staff were not actively encouraged to give feedback on the service. There was a lack of supervisions carried out and no appraisals conducted. The excessive hours worked by some staff, and lack of adequate rest periods between shifts did not enhance their well-being.

We overheard a conversation between the interim service manager and a team leader from a supported living setting that we did not visit. The team leader asked if staff were allowed to eat while on shift and the interim service manager responded that they weren’t sure. As some staff were lone working for up to 72 hours at a time, not eating while they were at work would have caused them significant physical discomfort. The provider did not prioritise staff well-being.

There was inconsistent monitoring of staffs’ performance. Shadowing and formal induction for new staff were not reliably provided, including for those working with individuals with complex needs. The lack of a structured induction process led to gaps in essential knowledge and skills. As a result, this has potential to put people at risk of harm.

Some staff told us about how they did not feel valued by the provider. They told us about how the lack of consistent managers had impacted upon the support they received from the provider organisation. One support worker said, “We don’t know who to go to if there any issues, there are too many changes and uncertainty. We work very hard to make sure we provide a stable home for the [people they support] regardless of anything else going on, it’s our job to support and protect them and their quality of life depends on us.”

Other support workers told us about how the provider had reduced people’s support hours, and how this impacted on people’s support. One support worker said, “There is no flexibility in the rota anymore, they say there is no budget. [People supported] haven’t been on holiday for two years as they have reduced the payments to staff when people go on holiday.”

Another staff member told us, “The staff wouldn’t be here if they weren’t so committed to the people [they support].”