Support'ed Limited

Support’ed Limited (known locally as Support’ed) provides care and support to younger and older people living in their own homes who may have a mental health diagnosis, learning disability and/or autism. At the time of the inspection the service was providing personal care to seven people living in their own homes in and around the Plymouth area. Some of these people received care and support on a 24-hour, seven day per week basis. Others received support at particular times of the day when needed.

Not everyone who used the service received personal care. The Care Quality Commission only inspects where people receive personal care. This is help with tasks related to personal hygiene, medicines and diet. Where this support is provided, we also consider any wider social care provided.

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

Support’ed placed people at the heart of the service. People and relatives told us they had received outstanding care from staff who were extremely caring and compassionate. Relatives said that staff had gone the extra mile during the peak of the COVID-19 pandemic to ensure that people remained safe and continued to enjoy a good quality of life. Other agencies were very positive about the service. Comments included, “This is a company with a strong set of values and they clearly care about the people they support”.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People received a service that was exceptionally personalised and supported people to make choices and develop their independence. We saw people had been supported to move into their own homes and enjoy a meaningful and fulfilled lifestyle, with community involvement and contact with family and friends. People told us about their dreams and wishes for the future and the support in place to help them achieve them.

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.

The management team and staff were exceptional at understanding and responding to people’s communication needs. Innovative methods had been used to help people communicate, make choices, have control over their care and lifestyle and stay connected with their loved ones.

The positive, trusting and friendly interactions we observed between people and staff told us people felt safe and comfortable in their own home. Staff knew what to do if they believed people were at risk of harm and were confident the provider would act promptly to safeguard people.

Staff told us they felt very well supported by their colleagues and management. They said training was provided on a regular basis and was relevant to the needs of people they supported.

There was a positive, open and inclusive culture within the service. The management team provided strong leadership and led by example. There was a strong focus on continuous improvement and ensuring best practice. People, relatives and other agencies were very positive about the leadership of the service and how this benefitted the people supported.

Exceptionally good governance of the service, including regular oversight, audits and feedback ensured the quality of care was maintained and enhanced.

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 Outstanding (published 8 January 2020)

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding to test the reliability of our new monitoring approach.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Support’ed Limited (known locally as Support’ed) is a domiciliary care agency. It provides care to younger and older people living in their own homes, who may have a mental health diagnosis, learning disability and/or autism.

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 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

Support’ed placed people at the heart of the service. People and their relatives told us they had received outstanding care from staff who were extremely caring and compassionate. Relatives said the service had been very responsive and supported them in times of crisis. Comments included, “They literally saved us as a family, I didn’t think I was ever going to be able to trust a service again.”

People received a service that was exceptionally personalised and took into account their specific needs, wishes, goals and aspirations. The management team and staff worked with people and their families from the point of referral to develop a plan of care that met their needs and desired outcomes. Some people had been supported to finish their education and move into adult life, and others had been supported to leave hospital and return to live close to their family and home. As a result of using the service people benefitted from more opportunity, choice and control.

People and their families were treated with dignity and respect. People were supported to develop and regain their independence and there was a strong focus on promoting social inclusion and equality.

People had confidence in the staff that supported them and felt safe. Staff were highly skilled and well trained. Staff were highly motivated and well supported and had used their skills, knowledge and innovative thinking to improve 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.

There was a positive, open and inclusive culture within the service. The management team provided strong leadership and led by example. People, relatives and staff were very positive about the leadership of the service. Exceptionally good governance of the service benefitted people because it ensured the quality of care was maintained and enhanced.

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 23 May 2017). Since this rating was awarded the service has moved premises. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Support’ed supported the personal care of three people to live in their own home. They worked with younger and older adults with complex needs. People may have a mental health diagnosis, learning disability or be on the autistic spectrum. The inspection was announced three days in advance. This was due to the complexity of the needs of people Support’ed supports. This gave time for staff time to support one person to feel comfortable speaking to us and to arrange for us to speak to family carers of the two other people. Also, we were only able to speak to staff who were off duty and they needed time to arrange to talk to us.

This is Support’ed’s first inspection following their registration with us in April 2015.

There was a registered manager appointed to run the service. 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.

The service provided care to people in their own homes. The registered manager and directors had spent time designing the service ethos and approach. Personal care was seen as more than washing and dressing and supporting people’s continence. Individualised care for those they supported was deemed essential and staff were part of the same ethos and culture. Parent carers were respected and embraced for their knowledge and as part of the team. As a result, care and support was provided to enable people to live a fulfilled and meaningful life.

There was a positive culture within the service. The management team provided strong leadership and led by example. The registered manager and directors had a clear vision, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people.

Staff were highly motivated and inspired to offer kind and compassionate care and support. All the staff said they enjoyed their work and loved seeing people progress. Regular competency checks were completed to test staff knowledge and to help ensure their skills were up to date and in line with best practice.

One person could tell us verbally about their experiences of the service. They were very positive about the staff and service. For the others, parent carers told us about the immense difference the service had made to their loved ones and family’s lives. People who had previously been restricted were now being supported in a different way, which gave them more freedom and an enhanced quality of life. We heard many examples of how people's lives had changed for the better and about how many new opportunities they now had.

Relatives and other agencies were without exception, extremely positive about the service and the care people received. We were told that since Support’ed took over their care people's lives had changed. Due to the care and the skills of the staff team people had progressed, experienced new opportunities and now had more independence.

Other agencies were very positive about the staff team and leadership of the service. We were told that staff embraced ideas and worked hard to ensure people were able to do the things they wanted. The overall view of other agencies we spoke with was that despite the complex needs of people they supported, the service had managed to deliver excellent quality personalised care within their own home.

People were supported to express their views and have their voice heard. Staff were creative and used innovative methods to help people express their views and understand what was happening around them. There were sufficient numbers of skilled staff to meet people's needs and to keep them safe. Staffing levels reflected their care plans and staff were recruited who had the right attitude and aptitude to meet the needs of the individual person. The provider had clear and effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. The parent carers said they believed and trusted that people were safe.

People were protected by staff who knew how to recognise signs of possible abuse. Staff said reported signs of abuse or poor practice would be taken seriously and investigated thoroughly.

Staff were well trained and said training was relevant to their role and kept updated. The registered manager was passionate about developing the skills of the staff team, and had a commitment to people and their relatives about what the service had said they would deliver. Staff were very aware of the risk of potential exploitation on line and in the community and worked to keep people safe from this.

People’s medicines were managed very safely. Staff undertook training and understood the importance of the safe administration of medicines. Staff ensured medicines were given in the person’s best interests and worked with health professionals to keep people’s medicines under constant review. Medicines that were given to control behaviour had been reduced or removed altogether.

Staff worked really hard to enable people to communicate what they wanted and to reduce the need for behaviours that limited their opportunities. Behaviour management plans were in place for people to help staff understand the behaviour people may present, to recognise the triggers and signs and to safely manage the behaviours if they occurred. Staff had a good understanding of people's behaviours and the guidelines in place to prevent behaviours from escalating. Staff and parent carers said the number of incidents had significantly reduced for some people and they felt this was due to staff knowledge, training and consistency of care provided. Positive relationships in the community were now possible as a result of this.

Management and staff understood their role with regards to the Mental Capacity Act (2005). When people were unable to consent to their care or support, or were unable to make decisions, discussions took place with parent carers, other agencies and staff to help ensure decisions were made in their best interest. Staff and the directors were alert to any time they may be being requested to limit people’s freedoms. For example, they guarded against limiting people’s freedoms in the community. By the use of clear risk assessments and identifying where people were a risk to or a risk from the community, they sought for people to have as full a life as possible.

People's health and dietary needs were well met. People were supported to maintain good health and, when required, were supported to access a range of healthcare services. Annual health checks were arranged and 'hospital passports' were in place to support any admissions to hospital. Hospital passports contained important information about the person to help ensure their needs were appropriately met if they should require an admission to hospital or another healthcare facility.

Staff were clear they were providing care to people in their own home and mindful that although they were there 24 hours a day seven days a week that they needed to support people's privacy. Measures were put in to support people to have alone time safely as necessary.

The service was responsive to people's specific and diverse needs. Other agencies told us they were always impressed with the creative and personalised care provided to people. Support plans were clear and detailed, providing staff with step-by-step guidelines about people's needs, preferences and daily routines. All the staff we spoke with had a very good knowledge of the needs of people they supported.

Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The provider promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. This reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

The registered manager and the other two directors took an active role within the service and demonstrated a passion for the service and modelled high standards of care, through a hands-on approach and attention to detail. All of the staff said they felt valued and supported by their colleagues and management team. Other agencies were very positive about the leadership of the service and said the staff team listened and embraced ideas about how to support people.

The provider had a robust quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service, relatives and other agencies. Learning from quality audits, incidents, concerns and complaints were used to help drive continuous improvement across the service.