SENSE - Community Services (South West)

SENSE - Community Services (South West) is a domiciliary care agency providing personal care to children and young people in their own homes. The service provides support to children and young people who may have sight and hearing impairments but may also have other disabilities or complex needs.

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 12 children and young people were receiving personal care from the service. Staff providing this service were called 'Intervenors'. We have used this term when referring to staff directly providing the service throughout our report.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

Intervenors focused on children and young people’s strengths and preferences. They promoted what children and young people could do to support them in having a fulfilling and meaningful everyday life. Children and young people benefitted from the interactions with Intervenors.

Intervenors knew how to communicate with children and young people in ways that best met their needs.

Intervenors supported children and young people to have maximum choice and control of their lives where possible. Intervenors supported children and young people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Families were involved in discussions about how their children received support and reviewed this regularly.

Right Care:

Children and young people received kind and compassionate care. Intervenors understood and responded to their individual needs.

Intervenors usually supported the same children and young people. They had a good understanding of individual communication needs and supported children effectively.

Intervenors understood how to protect children and young people from poor care and abuse. The service worked well with other agencies to do so. Intervenors had training on how to recognise and report abuse and they knew how to apply it.

Families worked with Intervenors and managers to assess and manage the risks children and young people might face. Where appropriate, Intervenors encouraged and enabled children and young people to take positive risks.

Although the service had enough appropriately skilled staff to meet children and young people’s needs and keep them safe, more staff were needed. There was a programme of ongoing recruitment to enable to the service to expand.

Right Culture:

Intervenors understood the wide range of strengths, impairments and sensitivities the children and young people could face. This meant children and young people received compassionate and empowering care that was tailored to their needs.

Intervenors and managers were positive about their roles. They placed children and young people’s wishes, needs and rights at the heart of what they did.

Intervenors provided consistent care to children and young people. The management team were endeavouring to recruit more staff to provide additional sessions.

Families, managers and Intervenors worked together to plan and evaluate the support provided to children and young people.

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 13 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service and the length of time since the last inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Sense Community Services (South West) provides care and support to people with complex disabilities living in the community. The part of the service we inspected is a ‘supported living’ setting.

People received personal care and support to live in shared flats and houses as independently as possible. The service is spread across two houses. Up to eight people can live in one of these properties, whilst the other can accommodate two people. A total of eight people were living in the two houses at the time of our inspection.

In ‘supported living’ settings, people's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The service applied the principles and values of Registering the Right Support and other best practice guidance. Although one of the houses was larger than recommended by best practice, the provider had arranged the service to ensure it did not feel institutional. People were supported to have choice and control, as well as opportunities to gain new skills and become more independent.

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

Some support plans were not consistently completed or easy to follow. This could lead to care not being personalised or needs not being clearly understood by staff. Support plans at Monks Park Avenue were more comprehensive. We made a recommendation about reviewing the information kept by the service.

There had been staffing changes at all levels. A large number of new staff had been recruited to work in the supported living services. This was positive, although the changes had been challenging at times. Support staff were still developing skills and knowledge, although the staff we spoke with appeared confident and professional. A registered manager was being recruited to lead the supported living services. We made a recommendation about prioritising the recruitment and retention of staff and experienced managers. We will continue to monitor progress in this area.

Relatives felt they had not received enough information about their loved ones. They recognised that this was mainly due to the numerous staffing changes but were clear they would like to receive more communication and feedback from the service. We made a recommendation to the provider about improving communication.

The provider had regular reviews with specialists following incidents and to plan person centred care. Some actions had not been implemented or clearly communicated due to staff changes.

People were protected from the risk of harm or abuse as far as possible. Staff knew how to keep people safe, and guidance was available if staff needed to report concerns. Risk assessments reflected people’s needs and were up to date.

At the time of our inspection, there were enough staff to meet the identified needs of people who lived at the service. This was a combination of permanent and agency staff. Staff received training and induction to ensure they had the skills and knowledge to support people.

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.

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

Rating at last inspection

SENSE - Community Services (South West) was last rated good (published 13 December 2017). At the time of the last inspection, the supported living services were not in place. This rating related only to the Communicator Guide Service for people with a dual sensory loss and, the Intervenor Service for congenitally deafblind children, adults and their families.

The supported living services were registered with CQC in October 2019. This is the first inspection of these services.

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about staffing and the management of incidents.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

There were two distinct services provided. A Communicator Guide Service for people with a dual sensory loss and, an Intervenor Service for congenitally deafblind children, adults and their families.

At the time of this inspection people using the communicator guide service were not receiving personal care. Therefore their support does not come within the remit of our inspection. At the time of this inspection four children were using the intervenor service and receiving personal care. It is the care and support received by them that was inspected and is reported on in this report. Staff providing this service were called ‘intervenors’. We have used this term when referring to staff directly providing the service throughout our report.

The inspection was carried out by one adult social care inspector and took place on 8 November 2017. We gave the provider 48 hours' notice of the inspection to ensure people we needed to speak with were available.

We previously inspected this service on 16 and 19 August 2016. At that inspection we rated the service overall as Requires Improvement. We also identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We told the provider to send us an action plan detailing the improvements they would make.

As a result of this inspection we have rated the service as Good. We found the provider had made the improvements detailed in their action plan and, we found there were no breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Overall, we found the children received person centred care and support from skilled and motivated intervenors that were well managed.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 registered manager and intervenors followed procedures which reduced the risk of the children being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. There was enough staff to safely provide the care and support detailed in care plans. Checks were carried out on all staff before they started work with people to assess their suitability. Where assistance with medicines was required this was well managed.

Intervenors were highly skilled and had the knowledge, skills and abilities they needed to carry out their roles effectively. They received regular supervision and the training needed to meet the needs of the children and their families.

The children were cared for and supported by intervenors who knew them well. Intervenors and managers treated the children and their families with dignity and respect. The care and support provided was person centred. Each child had detailed care plans and individual risk assessments in place. Children and their families were at the centre of all decision making about the service and encouraged to express their views and opinions.

The vision, values and culture of the service were clearly communicated and understood by staff, relatives and others. The registered manager demonstrated excellent communication skills, provided good leadership and management and, received effective support from the provider to assist with this. An effective quality assurance system was in place. This meant the safety and quality of service received was monitored on a regular basis and where shortfalls were identified they were acted upon.