Taunton Deane Support Services

Taunton Deane Support Services provides care and support to people with learning disabilities and autistic people who live in their own homes. The service supports people who live in Somerset, Bath and North East Somerset and Bristol. It is registered to provide personal care. At the time of the inspection the service was providing personal care to 21 people living in 9 separate settings. Some people lived in their own home; other people house shared. Where staff slept in to ensure people were safe overnight, they had a private space to do so in a spare bedroom.

In 'supported living' settings people's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

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

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.

The provider was not able to demonstrate how they were meeting all of the underpinning principles of Right support, Right care, Right culture.

Right Support

The quality of care and support people received across different settings was not consistent. In 2 settings, people had not always received the care they needed to live safe and happy lives. Staff did not always support people with their medicines in a safe and effective way and risks to people had not been fully considered and planned for.

Recruitment processes were safe, and the provider was taking active steps to recruit and retain staff. Some settings relied on high levels of temporary staff who did not always have the skills, experience or knowledge to meet people's needs and expectations.

Right Care

People were not always treated respectfully or with compassion. Staff did not always understand or respond to people's individual needs.

Staff had training on how to recognise and report abuse but had not always applied it. Staff had not protected people from poor care and abuse in 1 setting. The service was currently working with other agencies to do so.

People's care and support plans did not always accurately reflect their range of needs or risk and this had not promoted their wellbeing.

Right culture

The culture varied across the service. In 2 settings, people had not received high quality care and support. In 2 other settings we visited people felt engaged, listened to and were happy with their support.

People's quality of life was not enhanced by a culture of learning and improvement. Neither the provider nor the registered manager had effective oversight of practice in all people’s care settings. This had led to people receiving poor or unsafe care.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 25 January 2019).

Why we inspected

We received concerns in relation to safeguarding, the safety of people’s care and the management and oversight of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to requires improvement following this inspection.

Enforcement

We have identified breaches in relation to protecting people from abuse, providing safe care, care planning and governance and oversight of the service. We have also made 1 recommendation in respect of medicine administration practice.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Mencap – Taunton Deane Support Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing including supported living. It provides a service to older and younger disabled adults as well as people on the autistic spectrum. At the time of the inspection,18 people were receiving support we regulate. Others required guidance with medicine administration and other types of support. There were options to have up to 24-hour support from staff because there were sleep-in facilities in some of the homes.

“The care service has been developed and designed 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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At this inspection we found the service remained Good.

Why the service is rated good

People received care from staff who knew them incredibly well. The people were involved in decisions about their care and these were respected. If they were unable to be involved then the relevant individuals were asked to decide on their behalf. The staff continuously were finding ways to share the information with people and used different communication methods. Feedback from people informed us about how well cared for they felt.

Care and support was personalised to each person, which ensured they could make choices about their day to day lives in line with their needs, hobbies and interests. Information about people's preferences were gathered in detail prior to them receiving support. Time was provided for new staff to learn about people’s care through the care plans. However, one type of document had not been obtained to inform the person’s care and support needs. This was rectified by the management following the inspection.

People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received.

The service was responsive to people’s individual needs. Although activities were not part of our remit we saw these were personalised to each person’s preferences and hobbies. People and staff felt there were enough staff all aspects of their care. This had been improved recently by the management.

Interactions were kind and caring. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. Most medicine were managed safely. People were protected from abuse because staff understood how to keep them safe and were sure action would be taken if any concerns were raised. There was a system in place to manage complaints and people felt listened to.

The service continued to ensure people received effective care. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. People who required special support or equipment to eat had their needs met and healthy eating was promoted. Staff had most of the skills and knowledge required to effectively support people. Staff did not have training to provide some specialist support for one person. This was resolved after the inspection. People told us their healthcare needs were met and staff supported them to attend appointments when it was required.

The management had an ethos to ensure staff were supported. Systems were in place to ensure people received safe care in line with their needs. People and staff were positive about the registered manager and other senior staff. The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs.

Further information is in the detailed findings below

The service is registered with the Care Quality Commission (CQC) for the provision of personal care in people’s own homes. 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 36 people living in single occupancy and shared occupancy houses, flats or bedsits in Taunton, Chard, Street and Frome. Personal care was provided to 11 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.

The service was responsible solely for the provision of people’s support services and not for the provision of their premises. This meant people’s personal care was provided under a separate contractual arrangement to their housing provision. Accommodation was provided by separate housing providers or landlords, usually on a rental or lease arrangement. People could choose an alternative service provider if they wished. Some of the people received support from more than one support service provider. People who used the service had varying degrees of difficulties and support needs, ranging from mild to severe learning disabilities and autistic spectrum conditions. Some people had complex needs and required 24 hour support, whereas others were relatively independent and just needed assistance for a few hours each day.

The service had a registered 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.

The registered manager was on annual leave during the week of our inspection. We therefore agreed to meet with another of the provider’s area operations managers who knew the service well. The area operations manager told us the service philosophy was “To have a stable team supporting individuals in the best possible way, to maintain their health and wellbeing and promote their independence”.

People told us they were happy with the personal care and support they received from the service. One person said “They are very kind. I’m very happy”. Another person said “Staff help me to shower but I get dressed myself. They are alright and always turn up on time”. The relative of a person with complex support needs said “They are doing a great job, I’m very happy. [Person’s name] is always happy, clean and well fed”.

We found staff were motivated and committed to ensuring people received the agreed level of support. Each person had a core team of support staff specifically assigned to them. This ensured people were familiar with the staff who supported them and the staff understood their needs and preferences. Staff were available to support people with personal care when needed, but the service tried to encourage people to be as independent as possible. This boosted people’s confidence and self-esteem and enabled them to become much more self-reliant and independent.

People and their relatives told us the management and staff were very accessible and approachable. They said they could raise issues or concerns informally with any member of staff or with the Area Managers and they always received helpful responses. Staff said everyone in the organisation, from the top down, focused on the well-being of the people they supported.

The service had good links with the local community. This included the local authority transition teams and the local specialist colleges for people with learning disabilities. They also had links with local voluntary shops, local businesses, and a local voluntary group that organised trips and parties for people with a learning disability.

Systems were in place to ensure people received their prescribed medicines safely, where they needed assistance or prompting to take their medicines. Where necessary, people were also supported to access other health and social care professionals to maintain good health and well-being.

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

We found the service was responsive to people and listened to comments and complaints using them to improve the service. We observed the people who used the service knew the operations manager and were able to raise issues with them.

We were given examples from the relatives who spoke with us about how the service was caring and supportive to their relation. We were told 'the staff go out of their way to protect my relation's dignity' and 'we are impressed how the staff are always concerned even when they are not on duty.'

We looked at the safeguarding processes the service had in place and found they were robust and protected people from abuse. We heard from staff they were confident in their ability to recognise abuse and use the processes to keep people safe.

We visited people at home and observed the service to be effective at supporting people to be independent in their own homes. We were told by relatives 'we never thought our relation would reach this level of independence, and they are still learning new skills.'

We heard from the staff about the mechanisms in place which trained them and provided ongoing support to them when they were working with people who used services. We saw evidence of supervision and training for staff. We heard 'the management team are very supportive and there is always someone to contact.' We observed the interaction between the people who used the service and the operations manager and noted they had a good understanding and rapport with people.