Archived: Guinness Supported Living Devon

Guinness Supported Living Devon is a supported living service providing personal care to 47 people at the time of the inspection. People lived in shared houses in towns across Devon. The service supports adults with learning disabilities, physical and sensory disabilities and mental illness. 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.

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

The purpose of this inspection was to check specific concerns which we had received about the service related to the safe care and treatment of people, specifically how the service safeguarded people from abuse, how risks were managed, how lessons were learnt when things go wrong and whether there were enough staff to support people appropriately. We were assured that people were receiving safe care and support.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they are working towards meeting the underpinning principles of right support, right care, right culture.

Right support: Model of care and setting maximises people’s choice, control and Independence. For example, people were encouraged to set goals for things they wanted to achieve.

Right care: Care is person-centred and promotes people’s dignity, privacy and human rights. For example, people were receiving person-centred care and support in line with their individual care plans.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. For example, people were empowered to take positive risks in order to live independent and fulfilled lives.

People were comfortable in their surroundings and with the staff group who supported them. Positive feedback was received from relatives. One relative commented: “(Relative) is incredibly lucky. We are kept informed of how (relative) is. When (relative) had to go to hospital the staff looked after her very well. I have no concerns.”

The service was proactively working with external health and social care professionals as part of a local authority whole service safeguarding process. As a result, an increased emphasis on lessons learnt had been adopted and processes had been strengthened. For example, staff have received training on how to complete incident forms ensuring they were detailed.

The service has also introduced ‘professional discussions’ which are conversations with staff regards to specific care and support related subjects. These address issues with staff in a timely manner in between formal supervision sessions. The aim being to drive up quality and improvement in staff practice.

People’s individual risks were identified, and extensive risk assessment reviews had been carried out to identify ways to keep people safe.

The service has developed a tool entitled a ‘continuous improvement plan’ based on the four principles of person-centred care, which are dignity, compassion and respect; coordinated care, support and treatment; personalised care, support and treatment and developing strengths and abilities. The plan is service user led with staff support. The plan covers, what we do well; what areas we could improve and positive outcomes for people.

One area of the plan looks at positive risk taking in order to support people to take positive risks in order to be empowered to make choices and set goals they want to achieve to enhance their independence and lead fulfilled lives.

There were sufficient staff to meet people’s needs. People were supported by a core team of staff who knew them well.

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 outstanding (published December 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about whether people were receiving safe care and treatment. A decision was made for us to inspect and examine those risks. The overall rating for the service has not changed following this targeted inspection and remains outstanding.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Guinness Supported Living Devon on our website at www.cqc.org.uk.

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.

Guinness Supported Living Devon is a supported living service providing personal care to 45 people at the time of the inspection. People lived in shared houses in towns across Devon. The service supports adults with learning disabilities, physical and sensory disabilities and mental illness. 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.

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 possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Most of the people who used Guinness Supported Living Devon had, until a few years ago, lived in residential care homes. Since moving into supported living settings their lives have been enriched in many ways. Since the last inspection staff have supported people to learn new skills, become more independent, and, where possible, work towards moving into their own individual accommodation. People had become more integrated into their local communities, with some having jobs or voluntary work, and others were involved in local projects. People had gained confidence and greater control over their lives. People were supported to lead fulfilling and active lives.

Staff were exceptionally caring and responsive to each person’s needs and wishes. They demonstrated empathy and sensitivity and were passionate about helping people achieve positive changes in their lives. A member of staff said, “I am passionate about my job. I like things done right. It is about them first and foremost”. Staff demonstrated understanding and respect for each person. People were supported to maintain and develop friendships and relationships. A person told us, “They give me space and allow me to lead my life as I want”. They went on to say, “The staff are lovely here. They are always lovely here."

People told us they felt safe. They were supported by staff who had been carefully recruited, well trained and well supported. Staff knew people well and understood the risks to people’s health and safety and how to help them stay safe. People received support tailored to their individual needs to help them manage their medicines safely. There were sufficient staff to enable people to receive individual support at times to suit them.

The service was effective in meeting people’s needs. Care needs were carefully assessed, and support plans drawn up to ensure staff understood all aspects of each person’s needs and how they wanted to be supported. Staff understood people’s dietary needs. People planned the meals they wanted and were supported to shop for ingredients and prepare meals. People enjoyed a varied and healthy range of meals.

The service was well-led. People and staff were involved and consulted, and their views were listened to and acted upon. Staff told us they felt valued. The provider had systems in place to continuously review and improve the service.

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 (Report published 25 April 2017)

Why we inspected

This was a planned inspection based on the previous rating.

At the last inspection the service was rated Good. At this inspection we found the service remained Good because the provider continued to ensure safe procedures were followed.

Since the last inspection the staff had developed their caring skills, especially in supporting people at the end of their lives. Many people had lived together and received support from the provider for many years and were becoming older. Staff had developed their skills in recognising signs of illness associated with old age, and had prepared themselves through careful care planning and training to give people dignified and caring support at the end of their lives. People were involved in decisions about the care and support they received as far as they were able. Staff had good communication skills and a clear understanding of each person’s likes, dislikes, and personality. A relative told us “We can’t fault this place. The staff are lovely.”

Care was taken when recruiting staff to ensure applicants were trustworthy, honest and had the right skills for the job. Staff had a good understanding of safeguarding procedures and knew how to support people to remain safe and free from harm or abuse. An advocate gave special praise to staff in one shared living setting saying “They are honest as the day is long”. A relative said “We go away knowing she is well cared-for”.

Staff and relatives felt there were sufficient staff employed to meet people’s needs. Some relatives said they would like greater clarity about the use of shared care and individual support hours. The registered manager told us they were in the process of improving their information processes to address this.

Staff had a good awareness of potential risks and the measures needed to reduce risks, for example monitoring people’s weight, and reducing the risk of choking. Regular audits and checks were carried out to ensure medicines were managed safely. People’s finances were well managed.

People continued to receive effective care because staff had the skills and knowledge required to effectively support them. Staff received a good induction and ongoing training and were supported to gain relevant qualifications. Staff were well supported, regularly supervised and were positive and happy in their jobs. Staff understood each person’s ability to make decisions and choices. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were involved and supported to plan and prepare their meals and eat a healthy diet that met their individual needs.

The service remained responsive to people’s individual needs. People, their families and where necessary, representatives were involved and consulted about each person’s support needs. Care plans reflected people’s health and personal care needs, their preferred daily routines, and the people and things that were important to them. Complaints were fully investigated and responded to.

The service continued to be well led. Staff and most relatives spoke very positively about the management of the service. The turnover of staff has been low and there was a happy, stable and positive staff team in place. The provider had good auditing and quality monitoring systems in place to make sure all aspects of the service was running smoothly.

There had been some changes to the management structure. The registered manager was about to leave the service and the provider was in the process of recruiting a new 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.

Further information is in the detailed findings below.

During the first two days of this inspection we visited each of the nine people who received support from the agency. We also met the staff on duty at the time of our visits. We looked at a selection of care and medication records and staff communication records, as well as records relating to staffing levels. We also visited the agency office where we spoke with the registered manager and a senior member of the enabling staff team.

Before this inspection took place we received concerns about insufficient staff to meet individual care needs, lack of management support, and medication errors for people living in Exeter. We found evidence to show that some people were not supported safely and their needs were not being fully met. We found no evidence of similar concerns for those people who lived in Dawlish and found people there were safe and received the support they required.

After the first two days of this inspection we received further concerns and safeguarding alerts. We attended a safeguarding planning meeting where it was agreed further investigations would be carried out by the local authority and by the Care Quality Commission. We returned to the agency for a third day when we focussed on recruitment and selection of staff, and on safeguarding of people’s finances. The provider has given us assurances they will take prompt action to address the issues we found for those people living in Exeter.

Is the service safe?

The service was not fully safe. Risks to the health and well-being of people living in a shared house in Exeter were not monitored or regularly assessed. There were insufficient staff to meet people’s individual needs in Exeter.

Some people did not have adequate support to help them manage their money safely. Where people were unable to manage their own money the provider did not have systems in place to make sure every person had safe access to their savings. Checks had not been carried out regularly by the provider to make sure people’s savings were well managed and safe. In one property we found people’s cash and medicines were not held securely and no assessment had been carried out to consider any potential security risk, or to consider people’s ability to manage their own money or medicines or to keep them safe. There were no assessments showing how risks relating to medications for each person had been considered.

In Dawlish we found the staff rotas had been arranged to meet individual needs. We found risks were monitored and actions taken promptly where changes were noted.

Is the service effective?

The service was not fully effective. There was a lack of overview to make sure every person received individual support to meet their needs. The quality of the care and services was not consistent across each group of people and each shared house. For example, in one shared house people were leading active lives and were out and about in the local community. They received support from staff at times to suit their individual needs. However, people living in another shared house did not receive adequate support and spent much of their time sitting in the lounge or in their bedrooms.

Is the service caring?

People were supported by friendly and caring staff. We saw that care workers showed gentle patience, understanding and kindness when supporting people.

Is the service responsive?

The service was not always responsive. We looked at people's care plans and we saw evidence of assessments being carried out for each person. Care plans had been reviewed and daily reports completed showing the support given to people with their personal care needs.

However new risks were not identified or acted on promptly. For example, in one shared house we found people had not been supported to raise complaints or issues about their environment.

In one shared house we saw evidence of how the staff were pro-active to identify potential risks. They had acted promptly to help people find solutions and to gain greater independence. For example, there was no shared vehicle for the property. To help people overcome transport difficulties they had helped people obtain bus and rail cards and helped people to use these safely. This meant people were able to access local services and facilities and to become active in the local community.

This inspection was announced and took place over two days. On the first day we visited the agency office where we spoke with two managers. We looked at the records held in the agency office relating to people's care needs and systems used by the agency to plan visits to people. On the second day we visited four people who received a service to find out if they received a safe service that met their needs. During and after our visit we also spoke with nine care workers. We were also assisted by two 'experts by experience' who contacted approximately 50 people by telephone.

Most people we spoke with or visited told us the care workers treated them with respect and dignity. Comments included 'They are brilliant with him. They treat him as a person and don't talk down to him especially as he can't verbally communicate with them.' However, we found there was a risk that important care tasks may be missed because care needs were not fully assessed or regularly reviewed. Care plans did not always provide sufficient information about each person's care needs.

Some people said they could not always trust the information they received in their weekly timetables to let them know who would be visiting, or the times of the visits. However, we saw evidence to show the agency had recently taken action to improve the way they planned care visits and this had resulted in a more reliable and consistent service in recent weeks.

The agency had improved the way medicines were administered and recorded. People could be confident that medication was administered safely. Some improvements were still needed to the way prescribed creams were recorded.

The provider had safe recruitment procedures in place although there were weaknesses in the way copies of recruitment checks were passed from the head office to the local agency office.

People had been asked for their views about the service. The agency had systems in place to help them identify areas where they needed to take action to improve the service.

We visited the agency office where we spoke with a senior manager, two team leaders and an auditor who was reviewing agency procedures. On the second day we visited four people who received a service and spoke with them and their relatives. Following the inspection we spoke with five people who received a service and/or their relatives on the telephone, and also six care workers.

People told us they were mainly satisfied with the service they received from the agency and praised the care workers for their standard of care. Comments included 'Yes, they are very caring', and 'He enjoys their visits ' they have a good rapport.'

Some people told us they had experienced some problems with timekeeping and reliability but there was some evidence of recent improvements. People told us they were confident if they had any concerns or problems they could ring the agency office and their concerns would be taken seriously and dealt with satisfactorily.

We saw some examples of poor recording of medicines administered to people. The provider told us they had recently become aware of risk related to their medicine administration process and had drawn up an action plan to address these.