Cooper Noble Care Ltd

At the time of our inspection, the service provided support to a total of 109 people living their own tenancies in a supported living community. Additional support was also provided on an outreach basis. Only 14 out of the 109 people however were in receipt of personal care regulated by CQC.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. At the time of the inspection, the location provided support to three people with a learning disability or an autistic person.

Right care

There was a quality assurance system in place to check that people were in receipt of the support they needed. The manager monitored the completion of support tasks daily to ensure people received the support they needed. However, the number of people being supported with personal care had grown since our last inspection from 5 to 14 people, and we found that the quality assurance systems in place required further development to ensure they were fully able to effectively monitor the quality and safety of the service.

We saw that the provider had already identified the current management and governance framework was no longer fit for purpose. They were in the process of implementing a management structure to improve the governance arrangements in place. We recommended that the audits and checks in place were reviewed and expanded as part of this process.

Staff recruitment was safe. The number of staff on duty was sufficient to meet people’s needs and to ensure support was provided in a person centred way. People told us the same staff usually supported them and most were more than happy with the support they received. Comments included, “I’m really happy”; “They’re (Staff) versatile, they listen to your needs” and “All made me feel welcome, very kind, caring. We have a laugh, but they do their job”.

Right Support

Information about people’s medical needs needed to be more detailed and some risks were not adequately assessed. We found no evidence that anyone had been placed at risk or experienced harm with regards to this. We recommended however that the provider reviews the system in place to ensure it is fully able to identify and mitigate risk.

Medicines were managed safely. People were supported to administer their own medicines were possible. This was good practice. People told us they received the medicines they needed. Staff were trained in the administration of medication and had their competency assessed appropriately. There were some minor improvements needed with regards to the recording of medicines with variable doses, self administration and the checking of handwritten MARs. We spoke with the provider about this.

Accident, incidents and safeguarding events were recorded and reported with appropriate action taken. Where people needed additional support, staff had liaised with other external health and social care professionals appropriately.

Right Culture

During the inspection both the provider and the service manager involved in the running of the service were open and honest. We found that they had a good understanding of the service and were committed to ensuring people received good quality care that helped them achieve positive outcomes.

Staff spoken with were passionate about their roles and spoke with genuine warmth about the people they supported. They were knowledgeable about people’s needs and preferences and told us the provider was really supportive of their training and development needs and aspirations.

People told us they felt safe. They said staff supported them well and helped them live independently in their own home. They told us of the activities and interests they were supported to enjoy, and several people spoke about the positive outcomes they had achieved since receiving support from the service.

For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 14 December 2017).

The overall rating for the service remains good. 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 Cooper Noble Care Ltd on our website at www.cqc.org.uk.

Recommendations

We recommend the provider develop the systems in place to ensure people’s individual needs and risks are fully assessed and described.

We recommend the provider reviews and develops the quality assurance systems in place to ensure they are robust.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained as 'good' based on the findings of this inspection.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This service provides care and support to people living in seven ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Additional support was also provided on an outreach basis. At the time of the inspection Cooper-Noble Care provided care for a total of 54 people who held their own tenancies. Only four of the 54 were receiving the regulated activity of personal care. The balance of 50 people were being supported in other ways to maintain their tenancies and access the community. The provider supported people with enduring mental health conditions to maintain and improve their health and independence in community settings.

A registered manager was 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 the last inspection, the service was rated Good.

At this inspection we found the service remained Good. However the rating for the Responsive domain has improved from Good to Outstanding.

Why the service is rated Good.

The people that we spoke with were extremely positive about their involvement in the assessment and care planning process. They were equally positive about the impact that effective planning and implementation had on their health and wellbeing. We saw evidence of the positive impact that the service had on people’s lives.

Health and social care professionals were extremely complimentary about the quality of care and support provided by the service.

We looked at the care plans for all four people receiving regulated activity. The quality of the information was exceptional. Each record contained extensive, person-centred information which included; life histories, descriptions of important relationships, goals, aspirations and risks.

People were supported to follow their interests and develop new ones as part of the planning and review process. Interests and activities included; holidays, work placements, shopping and volunteering.

A social care professional responding on behalf of the local authority said, ‘I have spoken to a number of social workers about the response Cooper Noble have provided to the service users they support and again this has all been positive. They describe a person centred response to care in which individuals are thriving. I have found Cooper Noble to be very responsive to the needs of the city. When we have been in a position of requiring immediate placements, such as the closure of [named nursing home], they were very proactive in assessing individual’s needs.’

We were shown evidence of the service accommodating the needs of people from different cultures and backgrounds. The needs and preferences of people from other cultures and faiths was clearly documented and available to staff. The provider also considered people’s gender and sexuality as part of the assessment and planning process.

The service had a robust complaints procedure which required formal responses to be produced within very short timeframes. We did not see any evidence that any formal complaints had been recently submitted, but the registered manager and staff were clear about the process.

People using the service and their relatives told us that they felt safe being supported by Cooper Noble Care. We saw evidence that the service regularly provided additional support to people based on their needs. Staff knew how to recognised signs of abuse and how to report them.

Staff had been recruited safely and closely matched to meet the needs of people receiving a service. The staff files that we saw had been completed to a high standard.

The majority of people using the service did not require support with their medicines. Where support was required we saw that medicines were stored safely and securely.

We saw evidence that staff were trained in a range of subjects appropriate to the needs of people receiving support. Training was regularly refreshed and staff had been given support to access additional specialist training to improve their skills and competence.

People’s capacity was assessed and consent sought in accordance with the Mental Capacity Act 2005 (MCA). The processes and records relating to the assessment of capacity and consent to care were thorough and well-detailed. Consent was sought and recorded in care records.

We saw from care records that staff supported people to access a range of community based healthcare services on a regular basis. Some people were also supported to access specialist healthcare services where there was an identified need.

People receiving support and the relative that we spoke with were extremely complimentary about the quality of care provided by staff and the positive impact that it had. It was clear when speaking with staff and observing their practice that they knew people well and had positive relationships with them.

People’s privacy and dignity were protected by staff in all aspects of care and support. Confidential records were stored securely and discussions about people were always conducted respectfully behind closed doors.

The service was well managed. People using the service, relatives, staff and professionals spoke very positively about the registered manager and the general management of the service.

It was clear that service was developed with input from people receiving support and staff. The provider regularly issued questionnaires and surveys. We saw that the information from questionnaires and surveys was used to develop activities, secure new resources and drive quality improvements.

The provider had a clear vision and strong, consistent values in relation to the provision of care and support. The registered manager and other staff were able to explain the vision and values of Cooper Noble Care in clear terms.

The registered manager and other senior staff were well-known to people using the service and regularly visited and worked to support people in their homes. The registered manger completed regular audits of safety and quality.

The ratings from the previous inspection were displayed as required at the registered office and on the provider’s website.