Arrow Support Limited

About the service

Arrow Support Limited provide personal care and support to people of working age with a learning disability, autism or who have complex needs associated with their mental and /or physical health. The support is provided to people who live in their own homes in Plymouth and the surrounding area. Packages of care varied from daily visits (a few hours) to 24-hour care. At the time of this inspection Arrow Support Limited were supporting 43 people within their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection there were 9 people using the service who were in receipt of the regulated activity of personal care.

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

Right Support:

People were not always supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people’s best interests.

People were not always protected from the risk of harm as staff did not always have all of the information needed to meet people's needs safely. People were able to choose how they spent their time and were supported by staff to take part in activities and pursue their interests in their local area.

Right Care:

People’s care and support plans were not always reflective of their range of needs. However, staff knew people well and understood how to communicate effectively with people. Staff spoke to people in a dignified and respectful way and it was clear from what we were told that people and staff had developed good relationships.

Right Culture:

The management team had created an open and transparent culture, where constructive feedback was encouraged. Relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns. However, we found more work was needed to ensure the service was operating in accordance with the regulations and best practice guidance.

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 on 27 September 2017).

Why we inspected

We undertook this inspection as part of a selection of services rated Good and Outstanding. We undertook a focused inspection to review the key questions of safe, effective, 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 changed from good to requires improvement based on the findings of this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Arrow Support Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding, need for consent, deprivation of liberty safeguards (DoLS) and good governance. We have also made a recommendation in relation to training . Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Some of the people who lived in the home had limited communication and mental health needs so we spoke to some people and also used observations to understand people.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated good:

There is a registered manager in post who was also the provider. 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 management team were committed to providing a high quality effective service to people. They did this by supporting staff well, listening to people’s views using their preferred means of communication and looking at ways to continually improve. One person said, “It’s a very good service, they do everything for me well.” A relative told us, “They are absolutely marvellous. We had an agency before who were a nightmare. With Arrow you couldn’t ask for more. I can’t speak highly enough of them.”

The registered manager/provider and management team aimed to provide a service which met people’s emotional needs as well as supporting people with physical tasks. They aimed to ensure people with mental health and physical needs were empowered to live a fulfilling life in the way they chose. This included ensuring people could access the community and do activities and hobbies they enjoyed safely by reducing barriers and supporting them in a very person centred way. For example, one person with physical disabilities was able to continue enjoying nightclubs and DJing because support workers had thought about how they could ensure easy access by contructing a DJ booth. People told us they appreciated the visits and support from support workers who were always cheerful. One person said, “They are nice. They listen to me and know what I need.”

All staff were well motivated and committed to providing a service that was very personalised to each individual. People were fully involved in planning their care and support and care plans were very comprehensive to make sure staff had all the information required to support the person. People not only had input into their care plans but used ways to communicate their content that worked for them. For example, some people had videos and arts and crafts incorporated into their plans, making them a project they enjoyed doing with support workers. This helped to make sure people got the support they wanted in a way that suited them.

There were quality assurance systems which monitored standards and ensured any shortfalls were addressed. People and staff felt listened to and said they could speak with a member of the management team at any time. The deputy manager said, “It’s good to bounce ideas off each other. When the registered manager went on leave, the systems worked and we felt confident keeping the agency running well.” Any complaints made were fully investigated and treated as learning to enable the service to improve.

People received effective, safe care which met their individual needs and preferences. People told us the service was flexible and made adjustments to accommodate their wishes and changing needs. Where people wanted to try new activities, there were clear risk assessments and discussions about how to make this an enjoyable, positive experience for the person. This included ensuring staff knew what to do, trying out road routes and looking at the most appropriate swimming pools for example. Where any concerns were raised about a person’s health or well-being prompt action was taken to make sure they received the support and treatment needed.

People were very complimentary about the staff who supported them. People told us staff were kind, caring and respected their privacy and dignity. There were sufficient numbers of staff employed to ensure people received their care and support at times of their choosing and from staff who knew them well and matched their personalities. Each person had a small team of care professionals who they were able to build trusting relationships with. The registered manager tried to match staff to people using the service to promote good relationships. One person had overcome their anxiety by working with staff they knew. They now were more independent with minimal support and had a job. A support worker said, “What we do makes a difference every day. I love working for Arrow.”

Staff were well trained and competent in their roles. Staff undertook training in health and safety subjects and received the training and information they needed to meet people’s specific needs. People told us they felt safe and comfortable with the staff who supported them, which we saw. One person had an up to date notice board which told them what was happening each day. This enabled them to feel secure and reduced their anxiety.

People and a relative described the service as very reliable, telling us that support workers arrived on time and stayed followed people’s individual care plans. People knew who was supporting them and kept diaries so everyone knew what people were doing each day and what support was required.

Further information is in the detailed findings below

We talked with people who told us that they were 'very happy with the care they received' and also said that the staff had 'really helped me become more independent and confident'. People we spoke with told us that staff always respected them and asked their permission before they undertook any care. We saw evidence in care records that people were involved in the development of care plans and that these were personalised and supported people to maximise their independence. We saw evidence of high levels of satisfaction from people in annual surveys.

We reviewed rotas which showed that there were adequate numbers of skilled and experienced staff. Staff were supported to undertake additional vocational qualifications as well as training on specific needs.

We saw evidence that the provider worked with other health and social care providers involved in a person's care to ensure the person's needs were met.

The provider had a number of approaches to monitor the quality of services provided. These included an annual survey of people and their relatives, monthly quality assurance phone calls and six monthly audits of services. The provider also had systems for managing complaints, incidents and accidents which included undertaking actions to reduce the likelihood of recurrence.

We found that each person had an assessment and care plan that guided staff in how to meet the person's needs. People said, 'They support me with cooking and going out' and 'I like that the staff are consistent.'

We found that the service had systems in place to safeguard vulnerable people from the risk of harm and abuse. These included training and policies and procedures.

We found that staff had access to induction, training, support and supervision, which enabled them to feel skilled and confident when supporting people.

We found that the service had a quality assurance system that included audits and seeking people's views. People told us they were asked their views about the quality of the service provided and that these were listened to.