Archived: RNIB Community Living Service Redhill

RNIB Domiciliary Community Living Service - Redhill (RNIB CLS) provides personal care to people either living in their own independent accommodation or in one of the service’s supported living properties. The service offers specialist support to adults with visual impairment or sight loss. People may also have additional learning disabilities, emotional or mental health needs. RNIB CLS supports people across a range of locations; at the time of our inspection, the service was providing the regulated activity of personal care to 17 people across three locations. CQC does not regulate the premises used for supported living; this inspection only looked at people’s personal care and support.

People’s experience of using this service

People were now being supported to live more independently and develop their skills. The management team had worked hard to engage more effectively with people and their representatives and develop the service in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion to ensure that people with learning disabilities or autism can live as ordinary a life as any citizen. The service was becoming better in its mission to provide bespoke support to people living with visual impairment or sight loss.

A real focus on the recruitment of permanent staff now enabled people to be supported by a regular team of staff that they trusted and who knew and understood their needs. Appropriate employment checks were carried out to ensure staff were vetted prior to appointment. Staff received induction and ongoing training and support to enable them to carry out their roles effectively.

Comprehensive assessments and care plans provided the basis of personalised care and ensured that staff supported people safely and in accordance with their needs and preferences. Risks to people were identified and managed in a way that balanced their safety with their right to freedom.

Staff facilitated opportunities for people to engage in a range of meaningful activities and work towards goals which were personal to them. People were encouraged and supported to lead active and healthy lifestyles.

Staff were kind and compassionate and people enjoyed relationships with them that were fun and inclusive. The management team championed people’s rights and worked collaboratively with each other and external partners to constantly improve the service.

Rating at last inspection

Requires Improvement (16/01/2018)

Why we inspected

This was a scheduled inspection based on the previous rating. We inspect all services rated as 'Requires improvement' every 12 months to ensure that we regularly monitor and review the quality and safety of the service people receive. At the last inspection we found that some people were not able to live fulfilling lives that enabled them to reach their full potential. We also identified that management and governance systems needed to be further strengthened and embedded to ensure the service was able to consistently deliver high quality and specialist support to people living with a visual impairment. At this inspection, we saw that improvements had been made to the service people received since our last inspection. We found that people’s support was not more personalised and they had greater opportunities to participate in activities that were meaningful and developed their independence.

Follow up

We will continue to engage with the provider and monitor the progress they are making against their own development plan.

The inspection took place on 9 & 16 January 2018 and was announced.

The inspection was facilitated by the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We last inspected RNIB CLS in May 2016 where the service was rated as Requires Improvement overall and two breaches of regulations, relating to consent and the appropriate assessment of people’s needs were found. That inspection highlighted significant concerns with the way in which a large scale redevelopment project had been managed. The project had involved the moving of some people from their homes in Redhill to new locations and the communication, planning and execution of that move had not been done in a way that met people’s needs or protected their legal rights.

Following that inspection, the provider wrote to us and outlined an action plan that detailed how the service would improve. Since that time, the RNIB has also undergone an organisational restructure and as such the registration of the provider and manager has changed. The service being provided however has continued at the same locations with many of the same staff. As such, this report can be read in conjunction with the report from our previous inspection.

This inspection identified that whilst some people were still experiencing a negative impact from the move, the provider had taken the action they told us they would and had made significant improvements to the way most people were being supported. The management team were open about the actions they were still working on and had plans in place to ensure good outcomes for all were achieved. We made two recommendations as a result of this inspection in order to encourage the provider to develop best practices for people with visual impairment in a supported living setting.

Until recently, the operational focus for the management team had been on rectifying previous mistakes in order to ensure people received a safe and personalised service. Now those objectives had been achieved, Governance frameworks required strengthening to ensure a future of consistently proactive and high quality support.

Support was becoming increasingly person centred and staff responded well to people’s changing needs. Each person had a plan of care that identified how to support them effectively. Whilst people’s preferences were known, more work was needed to ensure lead active and fulfilling lives that enabled them to reach their full potential.

The management team had improved the systems in place to communicate with people and other stakeholders. A culture of reflective learning was growing across the service to ensure lessons were learned when things went wrong. People’s views were being better listened to and concerns and complaints responded to in a way that improved the quality of care. Group meetings had taken place to facilitate a more collaborative way of working with people and others important to their support.

Despite a high number of staff vacancies, the management had worked hard to ensure people received support in a way that kept them safe and met their needs. Care staff had worked flexibly for the benefit of people using the service and put the needs of people ahead of their own.

There were appropriate systems, processes and practices to safeguard people from abuse. Appropriate checks were undertaken to ensure only suitable staff were employed and staff understood their roles and responsibilities in protecting people from harm. An ongoing programme of training and support equipped staff with the necessary skills to deliver appropriate support.

People were encouraged to develop their skills and risks in doing so were assessed and managed in a way that balanced people’s safety with their right to freedom. Staff had a better understanding of people’s capacity and were proactive in the way they protected people’s legal rights, ensuring that support was delivered in a way that achieved effective outcomes.

The service had good links with other health care professionals to ensure people kept healthy and well. Medicines were managed safely and there were good processes in place to ensure people received the right medicines at the right time. Where possible, people were supported to learn the necessary skills to be involved in the management of their own medicines.

People were involved in the planning, shopping and preparation of their meals and were encouraged to eat and drink so as to maintain a healthy and balanced diet.

People had great relationships with the staff that supported them and were clearly relaxed with staff and felt happy and confident in their company. Staff were kind and compassionate and advocated strongly on behalf of the people they supported. Staff respected people’s privacy and provided support in a way that promoted their dignity.