Archived: Prospects for People with Learning Disabilities

The service is registered with the Care Quality Commission (CQC) for the provision of personal care for people with a learning disability living in the community. This includes assistance or prompting with washing, toileting, dressing, eating and drinking. We call this type of service a ‘supported living’ service. At the time of the inspection the service supported 25 people living in single occupancy flats or shared occupancy houses in Bridgwater, Burnham and Bath; and two people living with their parents in Trowbridge and Taunton. Personal care was provided to 24 of these people.

The service also provided other forms of social care support that are not included within CQC’s registration requirements for a supported living service. For example, in addition to personal care, the service also assisted people with their housekeeping, shopping, attending appointments and other independent living skills. Systems were also in place to ensure people received their medicines safely. Most of the people were able to take their own prescribed medicines although some needed assistance or prompting.

The service provided people’s personal care and support under a separate contractual arrangement to people’s housing provision. People’s accommodation was provided by separate private landlords, usually on a rental or lease arrangement. This meant people could choose to use an alternative support service if they wished. The service was happy to support people with reporting any faults or maintenance requirements to their respective landlords or housing association.

People who used the service had varying degrees of learning disabilities and other support needs. The amount of support provided was based on people’s assessed needs and varied from 24 hour a day support for people with very complex needs; to just a few hours each week for people who were relatively independent.

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.

The registered manager told us the provider was a Christian based charity but they supported people of all faiths and of no faith. Although the service promoted a Christian ethos, staff respected people’s individual beliefs and preferences. Some people engaged actively with the local church, while others who had no particular interest in spiritual matters, were free to follow their own interests and were under no obligation to participate in spiritual activities. Similarly, the service employed staff with both Christian and non-Christian beliefs. The registered manager said their service philosophy was about “What the people we support, and the whole team, wants the service to be like. We want people to be involved, enthusiastic and to be part of any changes or developments. I want everyone to feel part of the team, to be comfortable and happy”.

People, relatives and staff all said the registered manager and deputy managers were very accessible and approachable. They said they could raise issues or concerns with any of the managers and they always received helpful responses. Support staff told us everyone in the organisation, from the top down, focused on the well-being of the people they supported.

People and their relatives said the staff were very good at meeting people’s personal care and support needs. One person said “I get on well with all of the staff and we are all good friends”. Another person said “The staff help me and I get on so well with everyone”. A relative said “[Person’s name] has been supported very well and he always appears to be happy”. The families of 13 people who used the service responded to the service’s most recent quality feedback questionnaire. The great majority of relatives rated the service as either very good or outstanding in most areas, including staff being courteous, helpful and friendly.

People had a say in which members of staff supported them and staff members of the same gender were available to assist people with personal care, if this was their preference. For example, a female who used the service said “I only have ladies to help me with my showers”. People’s views were also sought when prospective new staff were being interviewed.

The number of hours of staffing support was agreed with the relevant funding authority to meet each person’s individual needs. Staff told us they felt the staffing levels were appropriate to meet the needs and preferences of the people they supported. People told us the staff always assisted them, when needed, but encouraged them to be as independent as possible. This helped to boost people’s confidence and self-esteem and enabled them to become more self-reliant and independent over time.

Most of the staff employed by the service had worked with the people they supported for a number of years and knew people’s needs and preferences well. Staff also received regular training and supervision to ensure they knew how to deliver effective support. People’s care plans were comprehensive and provided guidance to staff on how to meet people’s needs. However, we have made a recommendation about improving the format of the care plans.

The registered manager told us they worked collaboratively with all of the local health and social care professionals. They also had links with the local community through voluntary work placements, people’s social and leisure interests, and activities organised by the local church.

The provider had an effective quality monitoring system to ensure standards of service were maintained and improved.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service caring?

From our observations and our conversations with people who used the service and the staff we could see this was a very caring service.

Everyone we spoke with said the staff were 'very nice and kind'. One person said 'Staff are really kind to us' another person said 'I get on well with all the staff. No one is bossy or rude'. Everyone we talked with spoke well of the manager and knew them on first name terms.

In each house we visited we observed staff were respectful and kind toward the people who used the service. They addressed people in a polite, patient and friendly way. We could see people had established very good relationships with the staff that supported them.

One person said 'What I really love about living here is people mixing together, everyone, staff and tenants. We are a big family, we get on so well and we look out for one another'. Another person from a different home said 'This is a very happy home, everyone has their ups and downs but we are all friends. We go out together with our key workers to clubs, church, and on holidays'.

Is the service responsive?

We found the service was responsive to people's preferences and needs. People said they were able to make their own daily living choices. One person said 'I have a good say in what I do. I can get up when I want and at night I can stay up as late as I want to. I can go out whenever I want with my support worker or family to keep me safe'. Another person said 'There is lots to do and we go out all the time. But I don't have to go out if I don't want to'.

In addition to monthly individual care plan review discussions, each house held a monthly Tenants Meeting where people could express their views about the service. We saw notes of some of the meetings which included actions to meet requests made by the people who use the service. One person who used the service said 'I've got no complaints. It couldn't be better, I love it here'.

The service employed sufficient female and male support staff to allow people who use the service to express a preference. However, only female staff were allowed to support female service users with intimate personal care.

Is the service safe?

People who use the service told us they felt safe and were well treated by staff. People said if they had any concerns they would speak with their key worker, family members or the manager.

People were protected from the risk of abuse. We spoke with ten members of staff in three different locations. They all knew about the different forms of abuse, how to recognise the signs of abuse and how to report any concerns.

There were effective recruitment and selection processes in place. We saw enhanced criminal record checks were made prior to new staff taking up post. These checks identified if the applicant had any criminal conviction or had been barred from working with vulnerable adults.

We saw care plans included a range of individual risk assessments and actions for managing these risks. We saw the person's GP and other health professionals were consulted when advice was needed.

There were arrangements in place to deal with foreseeable emergencies. This included fire safety procedures, individual evacuation plans for each tenant and emergency telephone contact numbers.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards which applies to care homes. These safeguards protect vulnerable people from being inappropriately deprived of their liberty. The manager said no one had been deprived of their liberty in any of their homes. However, if the need arose they knew when an application should be made and who to go to.

Is the service effective?

The service was effective in meeting people's needs. People told us they were very happy with the care and support they received. One person said 'I'm very well. I'm happy with the care I've had up to now'. Another person said 'It's lovely here, we're well looked after'. We observed staff supporting people in a caring, competent and professional manner.

New staff received a comprehensive induction programme. This included training in subjects relevant to their role and a period up to three months shadowing more experienced care staff. This ensured the staff had the skills and training required to meet the needs of the people they supported.

In our conversations with staff they had a good understanding of each individual's needs and preferences. One person's relative said 'X has a team of three care workers. They are all excellent and they are clear what they can and can't do'.

People were supported in promoting their independence and community involvement. Everyone we spoke with said they regularly participated in a wide range of external activities. The activities included day centres and clubs, visits to places of interest, holidays, riding for the disabled, and ab sailing. One person told us they had attended the House of Commons to promote the rights of people with a disability.

The results of the service's 2013 annual survey of people who use the service and their families showed high levels of satisfaction. People gave the service an overall satisfaction rating of 94% and families gave a 91% satisfaction rating. We were told the 2014 survey was due out in the near future.

Is the service well led?

We found the service was well led. It was managed by a person who was registered with the Care Quality Commission as the registered manager for this service. People who used the service knew the manager on first name terms and said the manager visited their home on a weekly basis. Everyone we spoke with said they could talk to the manager about any issues or concerns. They said the manager and staff always did their best to meet their needs.

Staff told us management were very approachable and supportive. One member of staff said 'It is a really good organisation. The manager or deputy manager visit us on a weekly basis and we can always ring the office if we need anything'. Another member of staff said 'The organisation as a whole has the right ideas when it comes to policies and practices. There's not as many staff or managers as when I first started but they do visit regularly and are only at the end of the telephone if we need them'.

There was a clear staffing structure in place with clear lines of reporting and accountability. The manager and deputy manager provided supervision for the care staff. Care staff told us they were well supported by the manager, deputy manager, administrator and their care staff colleagues.

People's diversity, values and human rights were respected. The service was established as a Christian charity and had a strong Christian ethos but they also supported people of other faiths and no faith.

The service identified, assessed and managed risks to the health, safety and welfare of people. We saw current health and safety risk assessments for areas such as fire safety, utilities, buildings and equipment. The manager said the tenants' landlords were responsive to any requests they made on behalf of people living in the houses.