Background to this inspection
Updated
14 February 2020
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by one inspector.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the registered manager would be in the office to support the inspection. The inspection started on 10 December 2019 and ended on 11 December 2019.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, commissioners and Healthwatch who work with the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
During the inspection
We spoke with two people who used the service and four relatives about their experience of the care provided. We spoke with four staff from the local authority who supported people who use the service and a team manager. We spoke with eight members of staff. They included the registered manager, business development manager, team leader, senior operations manager, a trainer and two support workers. We also spoke with the nominated individual who is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training information, internal and external quality reports and evidence of studies that demonstrated the outstanding person-centred care provided to people.
Updated
14 February 2020
About the service
SENAD Community Limited - Derby provides care and support to children and adults diagnosed with learning disabilities, autistic spectrum disorders, brain injuries and mental health needs living in their own homes. At the time of the inspection they were supporting 36 children and adults locally and in other towns and cities.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
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/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.
People’s experience of using this service and what we found
The service was exceptional in placing children, people with a learning disability, autism, mental health difficulties and associated complex needs at the heart of the service. It had a strong ethos of providing high-quality and outstanding person-centred care. The management team and staff understood and shared the provider’s values.
The service promoted people's safety, wellbeing and happiness as the top priorities. Effective children and adults safeguarding systems were in place and staff were trained in this area. Comprehensive risk assessments were in place. These were reviewed on an ongoing basis and staff had clear guidance to follow to support people in a safe way, whilst encouraging positive risk taking to promote self-awareness and independence.
Staff recruitment was central to meeting people’s individual needs. People and their relatives were encouraged to be take part in the process to recruit the right staff. This process was robust and ensured individual requirements were met. People were supported by an exceptionally dedicated staff team who understood their needs, had similar interests and upheld the provider’s values. Staff were given time to get to know the individual and to build a relationship based on trust and honesty. This promoted continuity and person-centred care as people developed positive trusting relationships with the staff team.
The staff induction and training programme was comprehensive and tailored around the specific needs of the person they supported and met individual leaning needs. People were supported by very well-trained staff who were supported by a 24-hours management support team to respond quickly to any care emergencies.
People received exceptionally good care because they, their relatives and professionals where required were involved in the assessment and care planning process. Assessments were very comprehensive and covered in detail support needs in all aspects of people’s lives including their current needs, lifestyle choices and aspirations. These were reviewed and updated on an ongoing basis to ensure changes to people’s needs were communicated with staff to promote their wellbeing and independence.
People were supported with all aspects of their health care needs. Staff were trained to support people with their medicines. Where people desired to manage their medicines staff provided the support, guidance and encouragement as required until this was achieved. Staff worked in partnership with other community professionals to provide 'joined up care' to people. This was important for people who needed to access different health care services on a regular basis. Care plans included guidance and advice provided by health professionals to enable staff to support people in an effective and consistent way to promote wellness. This demonstrated the service embraced innovation and learning to improve people's care experiences.
Everyone we spoke with said how passionate the staff and management team were about providing outstanding person-centred care to people when they needed it. They all commented positively about the effectiveness and responsiveness of the support people received. People and relatives thought of their support workers as being like friends or family members who were highly compassionate, caring and flexible. People had achieved excellent care outcomes and feedback from relatives and professionals supported this.
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. Staff empowered people to make informed decisions and enabled them to maintain control and achieve their goals and independence.
The service applied the principles and values consistently of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and to gain new skills and become more independent.
The provider's values were reflected in the way staff interacted with everyone and how they supported people. There was a positive, open and inclusive culture within the service. People received exceptionally personalised care and support, which met their needs, respected their preferences and lifestyles and promoted their independence and wellbeing. People felt they mattered. For example, innovative steps were taken to ensure people’s communication needs were identified and met. Staff received training around specific communication techniques to reduce communication barriers.
Staff roles and responsibilities were clear. Staff were supported and encouraged to use creative and individualised methods to support people to achieve their personal goals. Staff were valued for their contribution. They worked with people, relatives and professionals to continuously enhance people’s quality of life and experiences. Management and staff listened to suggestions and acted on concerns and complaints. All feedback including complaints was used to continually improve the service.
The provider had comprehensive and robust quality monitoring systems and processes in place. Technology was used to identify and affect change to improve the service. People, relatives, staff and professionals views were sought about the service and they were encouraged to comment on new initiatives. The provider and management team worked with other regulators and national organisations to review best practice guidance and training for staff working in this sector. This meant they influenced strategies to improve the care for children and people with a learning disability, autism, mental health difficulties and associated complex needs.
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 5 July 2017).
Why we inspected
This was a planned inspection based on the previous rating.
The overall rating for the service has changed from good to outstanding. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for SENAD Community Living - Derby 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.