Archived: HF Trust - St Austell

HF Trust – St Austell is a domiciliary care agency that provides personal care and support to people with a learning disability in their own homes. At the time of our inspection the service was providing a service to 22 people, 18 of those were receiving support with their personal care needs. The Care Quality Commission has responsibility for regulating personal care and this was the area of the service we looked at. These people were receiving a 24 hour supported living service. A supported living service is one where people live in their own home and receive care and support to enable them to live independently. The contractual arrangements for tenancy agreements and personal care are separate so people can choose to change their care provider and remain living in the same house.

People receiving a service were living in one of four supported living services. One of these was used by people who did not need support with their personal care and so we did not look at that particular service. One of the services was a complex of individual self-contained flats. Each person had their own front door and exclusive possession of the flat. A communal area was used by staff for meetings and supervisions and to carry out paperwork. In the other two services people rented a bedroom and only had exclusive possession of that area. Other parts of the house were shared areas such as kitchens, living areas and bathrooms. Staff sleep-in rooms were also used as office spaces where staff could complete paperwork or have supervisions.

There was a registered manager in post who was responsible for the day to day running of 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.

People told us they felt safe. We observed people as they were being supported by staff. We saw people were relaxed and comfortable in their home and with the staff supporting them.

Staff had received training in how to recognise and report abuse or poor practice. Staff were confident any allegations or concerns would be taken seriously and investigated to help ensure people were safe and protected.

Risk assessments were in place to inform and guide staff so they were able to minimise any identified risk. People told us staff helped keep them safe while supporting them to maintain and develop their independence. We found one person’s behaviour sometimes put other people or staff at risk. This had not been recorded in their care plan and there was no appropriate risk assessment in place. This meant staff would not be aware of the actions to take in this situation.

There were sufficient numbers of suitably qualified staff to meet people’s needs. The recruitment and induction process for new staff was thorough and helped ensure staff were safe and suitably prepared to work with vulnerable people.

People received the support they needed to take their medicines as prescribed. Any medicine errors were investigated and recorded. Following an error staff were required to undertake refresher training or be re-assessed as competent to administer medicines by a senior member of staff.

People received support from staff who had the knowledge and skills to meet their needs. People told us staff knew them well.

Some people had restrictions in place in order to keep them safe. We looked at these people's files and saw there were no mental capacity assessments in place or any evidence of best interest discussions taking place. This meant people’s liberty could have been unlawfully restricted as the provider was not working in accordance with the processes set out in the Mental Capacity Act (2005).

Staff talked about the people they supported affectionately. They demonstrated a pride in people’s achievements and told us they enjoyed supporting people. Positive relationships had been formed between staff and people. We observed people chatting with staff and sharing any concerns they had with them. Staff were supportive and encouraging in their responses. They shared common values and a shared approach to support which centred on independence and community inclusion.

Care plans were well laid out and contained clear guidance for staff. Staff told us they referred to them regularly and found them to be informative and accurate.

There was a management structure in the service which provided clear lines of responsibility and accountability. People and staff knew who to speak to if they had any concerns and felt any issues would be addressed.

The manager and staff monitored the quality of the service by undertaking a range of quality audits and speaking to people to help ensure they were happy with the service they received. In addition regular audits were carried out by HF Trust’s head office.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

The inspection was brought forward in response to a concern raised about the care of one person. We referred the concern to the local authority under their adult safeguarding procedures. We also asked the registered provider to investigate the concern. We were provided with a report about the investigation prior to the inspection. We judged the provider had carried out a comprehensive investigation and taken appropriate action. However we ensured the inspection we completed checked there were no similar concerns raised by other people. As a consequence we completed a lengthy inspection where we spoke with a significant number of people in order to check whether there were any systemic concerns how the service operated.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Yes on the day of the inspection we judged the service was safe.

People we spoke with were positive about the staff who worked with them. Although we did receive the significant concern referred to above, at the inspection all but one of the other people we spoke with told us staff caring and supportive. For example people who used the service said staff were 'all fine,' 'they are all nice,' and 'they are all amazing.' Relatives told us ' they are ok, but some could be more enthusiastic,' 'they are good'very friendly,' 'I am very pleased with them, they communicate very well,' 'they are superb,' 'the staff are very understanding.' One person told us staff did not treat them like an adult. Staff gave us plausible reasons for the support this person received, but the registered manager said they would meet with the person to discuss their concerns. Relatives and people who used the service informed us there were enough staff, and when staff visited them at home staff arrived and stayed for the correct amount of time.

Records were generally to a satisfactory standard. Care plans were appropriate and there was evidence of review.

We checked procedures and systems in place regarding the management of medication. People's medication was well managed, stored correctly and the records which were kept were appropriate. Staff administering medication had received suitable training.

Is the service effective?

Yes on the day of the inspection we judged the service was effective.

People all had an individual care plan which set out their care needs. Care plans contained comprehensive information and were accessible to staff. Relatives and the people who used the service, who we were able to speak with, all said the people's needs were met, and staff responded promptly when assistance was needed.

People had access to doctors, district nurses, chiropodists and opticians. It was sometimes difficult for us to easily ascertain when a person had last seen a specific medical professional.

We checked what training and staff support systems were in place. Training and supervision systems were to a good standard, and comprehensive training was available and delivered to care staff.

Is the service caring?

Yes on the day of the inspection we judged the service was caring.

Our observations of the care provided, discussions with people and records we assessed, enabled us to conclude individual wishes and needs were taken into account and respected. Prior to the inspection we did receive a significant concern. We were satisfied HFT St Austell responded appropriately to this concern as soon as they were informed of it.

People who used the service were able to participate in a range of activities which were tailored according to their needs and abilities. For example from records, and from discussions we had, everyone who used the service had a range of activities from going out on social trips, attending adult education or having voluntary or sheltered work placements.

Staff were trained to work with people in order to encourage choice, develop skills and people's independence. The staff we spoke with demonstrated a good ethos to help people to integrate into wider society. The vast majority of people who used the service said staff were caring and professional .

Is the service responsive?

Yes, on the day of the inspection we judged the service was responsive.

The vast majority of people we spoke with said staff treated them with respect and dignity. The care practice we observed, on the day of the inspection, was professional and supportive. The service had appropriate links with local health services. For example we were told people could see a doctor, optician or a chiropodist, and where necessary other medical professionals such as community nurses and psychiatrists.

Is the service well-led?

Yes on the day of the inspection we judged the service was well led.

The service had three registered managers, and two more senior managers were appointed to oversee this, and other services in Devon and Cornwall.

The service had a satisfactory quality assurance process in place to monitor and where necessary bring about improvement to the service. Records kept were comprehensive and stored appropriately.

In respect of the concerns we received prior to the inspection, the provider took appropriate action to comprehensively investigate the concerns raised. The provider supplied us with a satisfactory action plan which should assist in bringing about improvements to one of the services where concerns had been expressed. When we visited other services, as part of this inspection, we did not find any evidence of poor or unsatisfactory practice in how services were run.

Everyone we met looked well cared for. Typical comments from people who used the service included, 'the staff are very helpful, they are very nice people and they support me when I ask for their help.'

Documentation regarding the service was to a good standard. For example care plans provided clear information regarding care and what support staff needed to assist people with.

Staffing levels were good, and there was evidence that staff had received suitable recruitment checks and training. A satisfactory quality assurance system was in place.

We did receive one concern from a relative but the provider and multi disciplinary team were working with the person's family to resolve the concerns raised. Everyone we met looked well cared for. Typical comments from people who used the service included 'the staff are very helpful, they are very nice people.'

Documentation regarding the service was to a good standard. For example care plans provided clear information regarding care and what support staff needed to assist people with.

Staffing levels were good, and there was evidence that staff had received suitable recruitment checks and training. A satisfactory quality assurance system was in place.