SeeAbility South Gloucestershire Support Service

Seeability is a service providing personal care to people with learning difficulties and/or sensory impairments. At the time of our inspection there were nine people receiving support with personal care.

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

People received good care and support. The service had experienced some difficulties in recruiting and retaining a consistent staff team and this had led to some anxieties for people. However, there were robust plans in place to recruit and retain staff in order to rely less on agency staff.

People told us they felt safe. The inconsistencies in staffing had caused some concern for people, particularly in relation to their skills and training. However, we saw that there were procedures in place to induct agency staff and ensure they had clear information about people they were to support. Prior to the inspection there had been a number of medicines errors at the service. The registered manager had recognised this as a concern and taken action in response.

Staff were positive about the training and support they received and felt like senior staff were approachable and supportive. People were supported to maintain their health and nutrition.

The service was responsive and person centred in nature and took account of people’s individual needs and wishes. Care plans were reviewed regularly to ensure they were up to date and reflected people’s current needs. People were supported to take part in activities they enjoyed. People felt able to raise concerns and issues and felt confident they would be responded to.

The service was well led. The registered manager understood the responsibilities of their role; they were supported by a deputy manager and senior support staff. There were systems in place to monitor the safety and quality of the service.

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

The last rating for this service was good (published 5 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

There was a registered manager in post. 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.

At our last inspection in April 2015 we rated the service overall as Good. However, at that inspection we found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the records were not fully effective in supporting staff to monitor people’s health needs around fluid and nutritional intake.

Following that inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of that regulation. At this inspection we saw the provider had taken the action they had identified in their action plan. As a result improvements had been made and the service was no longer in breach of this regulation.

As a result of this inspection we have rated the service Good.

Why the service is rated Good

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage, monitor and review these.

People were supported by the service’s recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Staff had the knowledge and skills they needed to carry out their roles effectively. They were supported by the provider and the registered manager at all times. Staff had completed nationally recognised qualifications in health and social care and others were in the process of completing these.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care arrangements amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. People who used the service felt able to make requests and express their opinions and views.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made.

People benefitted from a service that was well led. The vision, values and culture of the service were clearly communicated to and understood by staff. The registered manager had implemented a programme of ‘planned growth’ that had been well managed and they were committed to continuous improvement. The registered manager demonstrated strong values and, a desire to learn about and implement best practice throughout the service.

The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

Further information is in the detailed findings below.

People told us they felt they were involved in planning their care. One person told us 'I am very much involved in writing my care plan. Staff worked with me to develop my care plan. This is to make sure I have the right staff who know how to support me'.

The records we saw for assessing risks had been regularly reviewed. This meant that the information about the welfare and safety of people using the service was accurate. The provider had made changes in the way safeguarding incidents were reported to ensure they were improved and monitored. We saw that the local authority had been notified of incidents that impacted on the health and safety of the people who used the service.

We found that people were protected against the risks associated with medicines. We spoke with three people who used the service. They were satisfied with the service they received in regards to their medication administration.

We also saw that the views of people using the service were considered and acted on.

The provider sent us a copy of their action plan and kept us informed of their ongoing progress in respect of meeting the action plan. This included sending us supporting documents to demonstrate compliance. The purpose of this inspection was to check that the necessary improvements had been made.

We spoke with the registered manager who told us about the progress they had made to improve the service since our last inspection. We were told that the service had employed a fulltime administrator. They were also in the process of recruiting an additional full time deputy manager for a period of six months to provide additional support to the management team.

Staff told us that the service had improved since the return of the registered manager. This was confirmed by speaking with people who used the service. Senior staff told us that they felt that they had the right support and resources in place to ensure further improvements in the service they provided.

All the records we viewed during our inspection were accurate, up to date and fit for purpose.

During our inspection we looked at three people's care records. We saw that records of assessment were not present in two of the viewed care records. Senior staff told us that assessments were carried out on everyone who was referred to the service. The service was unable to provide us with the assessments for these two people. This meant that it was not clear as to whether the service was meeting all of these people's assessed needs.

We found that there weren't safe systems in place for managing people's medication. Staff were not following the guidance in the provider's medication policy.

Staff and people using the service were provided with information on how to raise safeguarding concerns. However, our review of people's records found that some incidents that should have been reported to the local safeguarding authority were not.

We found that systems in place for monitoring the service were not always effective.

Records were not completed in many areas of the service. This meant that people were at risk of receiving inappropriate care and support due to records not being completed appropriately.

We spoke with three people, looked at three care records and made observations throughout the day.

People who used the service told us that they were treated with respect. Each person we spoke to said they were happy to live there. One person said he 'never wanted to leave'. People were encouraged to be responsible for upkeep of their flat and did all their own cooking and cleaning with support from their staff team.

We saw that staff were polite and professional. They respected people's privacy and dignity at all times. All information was clearly communicated in order to provide good continuity of support. We saw that everyone's care records were an accurate reflection of people's support needs and how those needs were met.

People were involved in recruiting and training their own support teams. One person said they were 'listened to'. Another person told us that they were given 'time to make their own decisions' and that they were able to talk to staff if they had concerns.

All staff received safeguarding training and people in the service felt safe.