Archived: Totnes Domiciliary Care Service (South Devon Support Service)

Totnes Domiciliary Care Service (South Devon Support Service) is a supported living service providing personal care and support to people with a learning disability who live in their own homes or supported living accommodation. The service supports some people on a 24-hour basis and others at specific times, enabling people to live independently. At the time of the inspection the service was supporting 12 people, seven of whom lived in two shared homes, and five lived in their own homes. Nine people required support with their personal care. Where staff were required to support people overnight, there were sleep-in facilities.

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.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the management team at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

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

People received a safe service. People were protected from the risk of abuse as staff received training in safeguarding adults and were aware of their responsibilities to protect people. During our visits we observed people to be relaxed in staff’s presence, and we saw they made eye contact with staff and smiled.

Risks associated with people’s care needs were assessed and management plans guided staff about how to mitigate risks and what action to take in an emergency. Where people exhibited behaviours that could place themselves or others at risk, they were supported safely without imposing unnecessary restrictions on them. People’s medicines were managed safely.

Staff were safely recruited and well trained. The services supervision and appraisal systems provided staff with opportunities to develop their career. People and relatives were involved in the selection of staff.

Care plans were detailed and described people’s support needs and how staff should provide care in line with their preferences and best practice. Staff worked closely with other healthcare professionals to ensure people’s needs were well understood and met.

The service respected people’s rights to make their own decisions and staff had a good understanding of the principles of the Mental Capacity Act 2005. 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.

People were treated with respect. Staff told us the service was inclusive and supported people’s relationships with others, including those of same sex relationships.

People’s independence was promoted, and emphasis was placed oin developing people’s skills and confidence. People were supported to engage in hobbies and interests in the local community.

The service applied the principles and values apply 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. Staff spoke fondly of the people they supported and said their aim was to ensure people were as happy as possible and to give them a good quality of life.

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.

The service was managed well. Relatives and staff spoke positively about the management team and how the service was run. Feedback was used to 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 (published 28 February 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

This inspection took place on 19 and 20 December 2016 and was announced. The provider was given 48 hours' notice because the location was a domiciliary care agency and we needed to be sure that someone would be present in the office. On the day of the inspection, nine people were supported by South Devon Support Service with their personal care needs.

The service had a registered manager in post. 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 and comfortable with the staff that supported them. One person said the staff “help me to live in my own home safely.” People were protected from the risks of abuse and harm. Staff had received training in safeguarding adults and knew how to recognise signs of potential abuse. They understood how to report any concerns in line with the service's safeguarding policy and were confident any issues would be dealt with thoroughly.

Recruitment procedures were robust and records demonstrated the service had carried out checks to help ensure staff employed were suitable for their role. Staff received appropriate training and support to effectively provide safe care and treatment. Newly appointed staff undertook a comprehensive 12 week induction programme, shadowed more experienced staff, and did not work alone until the service managers were confident they had the right skills to carry out their role.

People were supported by kind and caring staff who ensured people received support that was responsive to their needs and as set out in their individual support plans. Staff ensured people's privacy and dignity was respected. People's support plans were designed to help ensure people received personalised care that met their needs and wishes. People told us they were involved in developing their care and support and encouraged to take ownership of their support plans and contribute to them as much or as little as they wished.

People were kept safe because risks associated with people’s support needs; lifestyle choices as well as those relating to the environment had been identified and action taken to minimise and reduce the risk of any harm to the individual or others. Where risks had been identified, management plans were developed to help ensure support staff knew how to support people safely.

People's rights were upheld because staff displayed a good understanding of the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguarding (DoLS).

People were encouraged to make choices and were involved in the care and support they received. Staff told us they would always respect people's decisions.

There was a complaints procedure in place and people knew how to voice their concerns if they were unhappy with the care they received. People's feedback was valued and acted on. There was visible leadership within the service and a clear management structure. The service had an effective quality assurance system in place to help identify areas of improvement and enable the provider to address them promptly.

The registered provider had not always notified the Care Quality Commission of significant events, which had occurred in line with their legal responsibilities.

We have made a recommendation that the provider keep the system for notifying the commission of significant events under review.

One person we spoke with responded in a positive way when we asked them about living in the home and the care workers. During our visit we observed good interactions between care workers and the three people who lived in the home. Relatives told us 'We are absolutely thrilled and delighted with x's enabler. They get on so well together' and 'I am quite happy with them, the carers are good and the food is good'.

We spoke with care workers who were able to tell us how they met people's care needs. We found that care workers received appropriate training and professional development so they could carry out their job role effectively. Staff knew how to report concerns to ensure people were protected from the risk of harm.

There were systems in place to monitor the quality of the service provided. People were asked to give their views about the support they received.