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Inspection carried out on 26 February 2020

During a routine inspection

About the service

Outlook Care - Unit 6 Shelduck House, Billericay is a supported living service providing personal care for approximately 130 people. Support is primarily provided to people with learning disabilities or autistic spectrum disorder.

Support is provided in approximately 20 supported living schemes based across South Essex and East London, ranging from shared houses to large complexes of individual flats, with shared communal areas. The level of support varies from minimal support to intensive 24-hour care to meet people’s complex needs. Not everyone who used the service at the time of the inspection 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.

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

At the last inspection, we rated the leadership of the service as outstanding. At this inspection, we found the leadership provided high quality management which we rated as good. People and their families gave us positive feedback about the service, and we found examples of exceptional person-centred leadership and care. However, the provider was still working towards ensuring people experienced consistently outstanding care across the service.

We were assured by the provider’s commitment to promote exceptional care. In particular, we found the service was outstandingly effective, which provided a good foundation to achieve a consistent standard of care.

When we last visited the service, the registered manager was implementing guidance to minimise the risk of choking. On our return we found these improvements had been sustained and represented an example of best practice, reflected in positive improvements to people’s quality of life and safety. The provider had shared this learning in a positive, pro-active manner. Staff had embraced the guidance. They focused on ensuring people enjoyed what they ate and drunk, respecting their preferences and cultural needs.

Senior staff used best practice to select local staff teams who worked effectively to deliver person-centred care. Staff had varied opportunities to develop their skills, including attending training which involved the people who used the service. Staff worked well with external health professionals to enable people to develop skills so they could take control of their health needs.

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. Technology was used creatively to minimise restrictions and improve people’s quality of life.

There was a new management structure which was ensuring a more consistent quality of care. The culture of the organisation was open. People, families and staff were encouraged to speak out and were confident they would be listened to. Comprehensive quality checks included people who used the service and highlighted areas for improvement which were acted on promptly. The provider worked well with external organisations and was committed to promoting best practice in their sector.

Risk was well managed across the service. Staff supported people to stay safe, whilst promoting their independence. Detailed risk assessments provided staff with the information about people’s individual circumstances. People received the necessary support to take their medicines safely. There were enough staff to meet people’s needs.

People received support from stable and caring staff teams who knew them well and treated them with respect and dignity. Staff promoted people’s voice and ensured they were involved in making decisions about their care. Staff worked in an inclusive manner with people to maximise their independence.

Care and support was tailored around people’s needs, adapting flexibly when their need

Inspection carried out on 11 July 2017

During a routine inspection

The inspection took place on 11 to 13 July 2017 and was announced.

Outlook Care provides personal care to approximately 150 people with learning disabilities in a variety of supported living schemes. The service does not provide nursing care. People required a varying level of support, from people who required minimal input to continue remaining independent to people with more complex health needs. The schemes included shared houses and blocks of individual flats situated across East London and South Essex. We were not inspecting the accommodation, which was managed by a number of different landlords.

A registered manager was in post at the service. 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 manager was a passionate leader who put people at the centre of the service. There was a focus on continuous improvement and developing best practice to promote the wellbeing and safety of people in the service. There were robust and wide ranging systems in place to check the quality of the service and information from these checks was used to improve the service. The registered manager had helped build strong, value based foundations which had the potential to develop an outstanding service.

There was a focus on people being central to decisions around safeguarding. People were supported to take risks and increase their independence in a safe way. The provider had a robust recruitment process to protect people from the risk of avoidable harm. Staff deployment ensured people were supported by staff who knew them. There were sufficient numbers of skilled staff to support people in a flexible manner. Staff supported people to take their prescribed medicines safely. There were measures in place to support people who wanted to take medicines independently.

Staff were skilled in meeting people’s needs. Bespoke training was developed in line with best practice and with the involvement of the people being supported. The managers communicated well with staff and supported them in their role. People were enabled to make healthy and safe choices about what they ate and drank. The guidance in place to prevent choking was exceptional. Staff worked well with outside professionals and supported people to access health and social care services when needed.

Managers and staff worked well within the Mental Capacity Act and supported people’s to make safe choices. Where required, correct procedures had been followed in line with existing legislation. There were effective tools in place to assess people’s capacity, which took into account people’s communication.

Staff were caring to people in a manner which empowered them and promoted their independence. People were communicated with as individuals and where they were not able to communicate verbally, staff used alternative forms of communication. Their rights and dignity were respected. People had access to independent advocacy both as individuals and in groups.

People received support that was personalised around their needs. Staff had the necessary information to support people in a flexible manner, reviewing and adjusting support to meet a variety of needs within each scheme.

People and families were aware of how to make a complaint and were confident these would be responded to positively. The manager had developed an exceptional array of opportunities for people to express their views and give feedback about the service. There was a commitment to best practice in this area and the manager constantly drove improvements and innovations to ensure people were at the centre of developments within the service.

Inspection carried out on 29 and 30 July 2015

During a routine inspection

The inspection took place on 29 and 30 July 2015 and was announced.

Outlook Care - Unit 6 Shelduck House, Billericay provides personal care to people living in supported living. People who use the service have their own tenancies and receive their support from staff employed by Outlook Care. The majority of staff work regularly at a specific address and so provide consistent support for the same people. At the time of our visit the service was supporting 126 people.

The Commission had been made aware of an incident occurring at the service in which a person who used the service died, and this prompted us to carry out a full inspection. In the course of the inspection the Commission considered relevant matters arising from that incident to see if people using the service were receiving safe and effective care.

The service has a registered manager. 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 were safe and staff knew what actions to take to protect them from abuse. Comprehensive and personalised risk assessments were carried out and measures put in place to manage and minimise any risk identified. People were supported by sufficient numbers of staff who were safely recruited. There were systems in place to support people to take their prescribed medicines safely.

People received support from staff that were regularly supervised and had the skills to meet people’s complex and varied needs. New and existing staff had access to a flexible and comprehensive training programme.

The provider had policies in place with regard to the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act (MCA) 2005. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

Staff had a good understanding of the importance of obtaining consent and had put suitable measures in place where people lacked the capacity to make decisions. People were supported with meals and staff at the service worked with health professionals to support people with their health care needs.

People’s independence was promoted by staff and they were involved in decisions about their care. People were treated with kindness, dignity and respect by staff who knew them well and their rights were upheld.

Detailed assessments had been carried out and personalised care plans were in place which reflected individual needs and preferences. The provider had an effective complaints procedure and people had confidence that concerns would be investigated and addressed.

There was a commitment to listening to people who used the service and to placing them at the centre of the organisation. The service benefitted from a clear management structure and visible leadership. A range of systems were in place to monitor the quality of the service being delivered and drive improvement.

Inspection carried out on 21 February 2014

During a routine inspection

People told us that staff asked them what they wanted to do and helped them make decisions. One person said, "They help me sort everything out." Relatives and a visiting professional felt that staff tried to support people to make decisions. Where it was thought people may not understand decisions, such as about spending money, assessments of their mental capacity were carried out so any decisions taken would be in their best interests.

People and their relatives told us they felt that care and support offered was good. Risks were assessed so that people could be supported safely. Where people needed support to prepare meals and drinks and to eat healthily, we were told this was provided.

The agency's office was well maintained and the safety of the premises for staff and visitors was assessed and monitored. People using wheelchairs would be able to access the ground floor office and toilet.

There were proper recruitment systems to ensure that staff were checked before they started work with vulnerable people. Staff also received induction training.

We found that there were good systems for checking the quality and safety of the service and for learning from incidents. There were plans to improve how involved people using the service were, by using an advocacy agency for support and advice.

Some people and their relatives could not remember having any information about how to complain. However, we found that this was available in information given to people using the service. No one had any complaints and were confident that they could speak with staff if they did.

Inspection carried out on 4 December 2012

During a routine inspection

On this occasion we have not been able to talk to many people who used the service. This was because people were out of their homes or because of their care needs it meant that they were unable to participate. In light of this we reviewed feedback from people using the service, including surveys, complaints and compliments. We also spoke to staff.

People who used services that we spoke to felt that they had choice in their day to day lives and we found that people were supported to exercise their rights and voice their opinions.

We found that people experienced care that supported them to be as independent as possible and develop new skills. The staff knew people well and were focused upon helping people to achieve what they wanted to achieve. We spoke to a person who used the service who told us that the staff helped them with daily living tasks, such as shopping, exercise and keeping in contact with family. They said that the staff were �Very good.�

People using the service were supported to understand what abuse was and to report any concerns. Staff were trained in this subject and overall people felt safe.

We found that staff were well trained and supported and this included through induction and supervision. The provider had good quality assurance systems in place for monitoring and assessing the quality of the service. Overall people were very satisfied with the service provided. One person we spoke to told us "Problems are sorted out properly."