Catherine Tam Agency

People’s experience of using this service: The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support. For example, people's support focused on them having choice and control over the care and support they received and as many opportunities as possible to become more independent.

People were exceptionally well supported by staff who genuinely cared about people. People were supported to be in control of their lives and make their own decisions.

People were supported to take positive risks. Healthcare professionals were involved in decision making so risks were minimised and emotional well-being maximised.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Innovative ways were used to support people’s involvement in recruiting the right staff. Matching tools were used to make sure staff had not only the right skills and experience to support people, but also the right interests and personality characteristics so positive and trusting relationships could be built. People chose who supported them to which activity or event so they were able to have the best experience possible.

Medicines were managed in a safe way whilst also giving people as much independence and control as possible. People had attended medicines training alongside their staff team and training was also open to people’s relatives to support and enhance their confidence.

Staff training was exceptional and involved training deemed mandatory by the provider, which included emotionally led training which supported the development of empathic relationships with people. Staff were encouraged and supported to attend additional training, such as music in care practitioner training and mindfulness training as this supported the culture of the organisation.

A holistic approach to assessing people’s needs was used which included their physical and mental health as well their hopes and aspirations. People’s needs were continuously assessed and there was a focus on future planning to ensure staff could meet people’s needs into the future as well.

People were encouraged and supported to have a healthy lifestyle, including a balanced diet, with new food experiences and taking part in exercise. People attended regular health check-ups and were supported to access external healthcare professionals including GP’s, and dieticians, opticians and dentists.

Staff had used their shared interests and personality characteristics to form strong emotional bonds with people. There was clearly mutual respect between people and staff which fostered an environment where people’s rights were valued and upheld. Staff treated people with kindness and compassion and relationships were also filled with fun and laughter. There was clearly shared humour amongst everyone we met.

Creative ways were used to people at the heart of planning their care and achieving their goals and aspirations. Support plans were incredibly specific to the person and included information on people’s histories and the reasons why people needed to be supported in particular ways. There was also a focus on what people’s future needs would be and how they could continue to be supported in their current home by staff who knew them well.

People were supported with a range of activities from voluntary jobs and entrepreneurial ventures to keeping chickens, going to the theatre, going to football matches and spending time with family and friends. Anything people suggested to staff that they would like to do was taken on board and staff enthusiastically supported people to make this come true.

There was an absolute focus on ensuring the governance of the service was used to enhance the quality of the service, so people could live the life they wanted. The registered manager and team leader continued to support people, so they could maintain positive relationships and act as role models for staff.

All staff understood their role as being to support and empower people to be active citizens who were in control of their lives, took positive risks and who were valued and accepted by society.

Partnership working was used to raise awareness and develop the creative and innovative ways staff used to enhance people’s lives. Work had begun to achieve accreditation with Opening Doors London as a ‘Pride in Care’ provider. This aimed to raise awareness and support Lesbian, Gay, Bisexual and Transgender people to life happy, healthy lives, free from loneliness prejudice and discrimination. The provider also worked with other key speakers and trainers to enhance people’s lives, raise awareness and act as role models for other providers.

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

Rating at last inspection: Good. (Report published 14 November 2016)

Why we inspected: This was a scheduled inspection based on the previous rating of good. The service has improved its rating from good and has now achieved outstanding in four key questions.

Follow up: We will continue to monitor the service and complete a further inspection in line with the rating of outstanding. If any information of concern is received, we may inspect sooner.

Catherine Tam Agency is situated in the grounds of Landermeads Care Home in the Nottingham suburb of Chilwell. The service is provided from two bungalows which have been adapted to meet people’s needs and allow them to live as independently as possible. The agency provides a supported living service to three adults who experience a learning disability or who have acquired brain injury.

At the time of our inspection, the service did not have a registered manager in place although an application had been submitted and was in progress. 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.

People told us the service provided made them feel safe and they did not have any concerns about the care they received. Staff showed a high level of understanding of how to keep people safe and protect them from harm. Safeguarding referrals were made to the appropriate authority when concerns were raised.

Risks to people’s safety were identified and managed and assessments carried out to minimise the risk of harm. People were kept safe with as few restrictions as possible. People were supported to take positive risks which enhanced their experience and enjoyment of life.

People received care and support in a timely way and there were sufficient numbers of suitably qualified and experienced staff employed. Appropriate pre-employment checks were carried out before staff began work at Catherine Tam Agency.

People received their prescribed medicines when required and these were stored and administered safely.

People received effective care from staff who received thorough induction, training and support to ensure they could meet people’s needs and ensure they had a good quality of life. Ongoing training and assessment for care staff was scheduled to help maintain and further develop their knowledge.

The provider kept up to date with latest research guidance and developments and had links with organisations that promote and guide best practice. Staff had access to guidance and training which helped drive improvement of the service and enhance people’s quality of life.

People provided consent to any care and treatment provided. Where they did not have capacity to offer informed consent their best interests and rights were protected under the Mental Capacity Act (2005). People’s wishes regarding their care and treatment were respected by staff.

Staff supported people to help them maintain healthy nutrition and hydration.

Excellent links were established with healthcare professionals and people had access to these when required. Staff worked in partnership with healthcare professionals and followed their guidance to ensure people maintained good health.

People told us they were treated with compassion dignity and respect and staff ensured their privacy was protected. We observed very positive, caring relationships between staff, people using the service and their relatives. Staff always ensured that people and their relatives were involved in making decisions about their care and their wishes were respected. .

Staff had an excellent understanding of people’s support needs and used skill and innovative methods to ensure they received personalised, responsive care. Staff ensured that people had the opportunity to take part in enjoyable, constructive activities that reflected their interests and life history. There was an open and transparent culture at the service. People were encouraged to raise any issues or complaints and could be assured these would be listened to and acted on by the provider.

Effective quality monitoring systems were in place and were reviewed continuously to identify areas for improvement and develop action plans to address these.

People received the care and support they needed to meet their individual needs. All of the people were happy with the care they received, one person told us, 'I like my home, the staff support me and help me when I need it.'

Staff followed good hygiene practices to make sure people were protected against the risk of infections. One person told us, "It's nice and clean. I clean my bedroom; staff help me if I need it."

We found that people had the equipment they needed to keep them safe and to make them comfortable. One person showed us the assisted bathing facilities. They told us, 'I love having a bath; I know how to work it and I can have a soak.' They showed us how this equipment worked showing they could use it independently.

Staff files did not have all of the information the provider would need to check that staff were suitable to work with vulnerable adults. They said they would take urgent steps to sort this out.

Two people told us they would talk to the staff if they had any concerns about the service. One person said, 'If I was worried I would talk to the staff. I think they would help me and it would be ok.'

People we spoke to told us that they valued the service and the staff who provide the service.

People we spoke to told us about a wide range of staff supported activities they enjoy including shopping, meals out, attending football matches, bowling and involvement with a drama project. People told us about and showed us photographs from holidays they had enjoyed, supported by staff, family and friends. One person told us that with support from staff 'things are going well' One person who experiences mobility and dexterity problems, and who enjoys hot drinks told us that, sometimes 'staff get the coffee for me'

People we spoke to told us that they feel safe with service providers. People told us the names of key staff and service managers. One person told us that 'I go to staff' when they have problems and 'I speak to the manager' if they have problems with staff.

The relative we spoke to told us of their satisfaction with the service provided stating that 'I cannot fault it' and 'staff are excellent.'