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Support for Living Domiciliary Care Agency Outstanding

Inspection Summary

Overall summary & rating


Updated 5 April 2018

This inspection took place on the 11,12, 14 and 15 December 2017. The visit was announced.

The provider for Support for Living Domiciliary Care Agency is Certitude and is often referred to as either Support for Living Limited or Certitude. During this inspection report we will refer to the provider as Certitude.

Support for Living Domiciliary Care Agency provides personal care to people with learning and physical disabilities and mental health needs living in their own houses and flats in the community and specialist housing.

This service provides care and support to people living in ‘supported living’ settings, so that they can live in their own home 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. At the time of our inspection there were one hundred and six people being offered a service in twenty four supported living schemes across four local authorities.

At the last inspection, the service was rated Good. At this inspection, we found the service had continued to make improvements and had introduced innovative practices and ideas in many aspects of the service to further enhance the experiences of people using it. We have therefore rated the service as Outstanding. 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.

People and relatives said that staff were kind, thoughtful and helpful. Staff were enthusiastic and passionate about their work, speaking very positively about people and wanting the best outcomes for them.

It was a strength of the service that staff had been trained in the use of different methods of communication to ensure people were understood. People were well supported to express their views in a variety of ways that were tailored to their individual needs.

The provider had an internal intensive support team and there was good use of speech and language therapist’s and other healthcare professionals to support staff to reach the best outcomes for people. Staff were innovative in their use of technology to support people to express their views and to live more independent lives.

Staff supported people to remain healthy both physically and mentally, there was an emphasis on supporting people’s emotional well- being. Community health care professionals visited people and staff supported people to attend routine appointments and hospital clinics. When people found hospital visits difficult staff worked alongside with health professionals to support them to attend.

People had person centred care plans that gave very good background information about them. Often there were photos of childhood and earlier adult life that showed the person in the context of their life. Care plans reflected their wishes and preferences.

Care plans described people’s circle of support and informed staff how people wanted their care and support provided. Staff supported people to attend a variety of meaningful activities of their choice. Staff explored new activities with people to widen their life experiences this included trips to see sporting events and holidays abroad. Staff demonstrated they believed in making people’s lives as full as possible seeing opportunities rather than the limitations.

People had end of life plans, some of which contained specific information with regard to their end of life care. We saw some excellent work had been undertaken in one service when supporting a person who chose to have their home as their final place of treatment.

The registered manager and the provider Certitude encouraged f

Inspection areas



Updated 5 April 2018

The service was safe. The provider undertook risk assessments to ensure people’s safety and developed plans to mitigate risks to people and others.

The provider had systems in place to analyse and understand when something went wrong to avoid a reoccurrence.

The provider had systems in place for the safe recruitment of staff and there were bank staff to ensure there were enough staff to meet people’s needs during permanent staff absences.

The provider had systems in place for the safe administration of medicines.



Updated 5 April 2018

The service was exceptionally effective. The provider undertook very detailed assessments of people’s needs. They worked in partnership with people, relatives and professionals to tailor people’s care packages to meet their needs.

Staff supported people using innovative methods to support them to access health care, this included the use of technology to familiarise people who were reluctant to visit health settings.

Staff supported and encouraged people to eat a healthy diet and remain hydrated.

The provider worked according to the Mental Capacity Act 2005 to uphold people’s legal rights. Staff understood the need to ask for consent before providing care and support to people.



Updated 5 April 2018

The service was caring. People and relatives told us care staff were thoughtful, kind and helpful.

Staff spoke very positively about the people they supported and were passionate about creating new opportunities for people.

Care plans specified clearly how people communicated. The provider had ensured staff received training to enable them to use a variety of innovative techniques to communicate effectively with people to support them to make choices.

Staff had high regards to people’s privacy and safety and always ensures these were respected. They always supported people to be as independent as possible.



Updated 5 April 2018

The service was responsive. People had individualised person centred plans that were developed with their full involvement or that of their relatives. These described in detail how people’s needs should be met. The service was responsive to all of people’s needs including their social and recreational needs and interests so they led fulfilling and interesting lives.

The staff were aware of people’s end of life care and supported them to express their wishes and preferences in this respect. Information about people’s end of life care was recorded in their care plans.

Staff and managers supported people and their relatives to make complaints and the provider investigated and responded to complaints in a robust manner.



Updated 5 April 2018

The service was exceptionally well- led. The provider went above and beyond in sharing a clear vision of the service with staff, people, and relatives and in seeking their participation in operating the service.

The provider included people who use the service in their audits and checks to make sure people’s perspectives were taken into account when assessing the quality of the service.

The provider had a variety of ways to capture people’s and stakeholder’s views and feedback about the service, including holding listening events to engage with people and their relatives. In addition, the provider obtained people’s opinions through their yearly reviews and questionnaires.

The provider supported people, relatives, and staff to attend events so they could contribute to debates relevant to the development of learning disability and autism services on a national level.

The provider ensured service sustainability by working with a number of local authorities to develop new projects for people with learning disabilities and autism.