Ena Hughes Resource Centre

The care service had been developed and designed in line with the values that underpin 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 life as any citizen.

People’s experience of using this service: People’s care needs were assessed, and they received good quality person-centred care from carers and support workers who understood their needs well. Carers and support workers promoted people’s choice and independence and ensured they had access to a wide range of individualised activities. People were engaged and involved in the day to day running of their home. They 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.

Carers and support workers were caring. They were knowledgeable and received training, supervision and support to carry out their roles effectively. Carers and support workers were committed to providing person centred support and fulfilling opportunities for people.

Support workers used a variety of communication styles to ensure people’s wishes were heard and acted upon.

People and their relatives praised the standard of care in the various settings. People said they felt safe and there were enough support workers on duty. People and relatives said support workers and carers were kind and caring.

Not all the people in receipt of care could communicate with us verbally, but those who could told us they were happy with the support they received.

Medicines were managed safely, and people’s health needs were met.

The registered manager provided people with leadership and promoted an open and supportive team culture. Robust systems were in place to assess, monitor and improve the service. People’s views were welcomed on the running of the service. Carers and support workers told us there was an inclusive and relaxed atmosphere and they felt valued by the service.

More information is in the full report.

Rating at last inspection: At the last inspection on 10 & 11 October 2016 the service was rated good.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in accordance with our re-inspection programme.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 10 and 11 October 2016 and was announced. The provider was given a minimum of 48 hours’ notice because they support people with learning disabilities and autism spectrum disorder who are often out during the day; we needed to be sure that someone would be in and also that office staff would be able to assist us. The inspection was carried out by one inspector.

Two registered managers were in post at the time of our inspection, both of whom had been registered with the Commission to manage the carrying on of the regulated activity since October 2013. One registered manager was responsible for the delivery of the regulated activity under the supported living side of the service and the other, under the shared lives element of the service. 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.

Not all of the people in receipt of care could communicate with us verbally, but those who could told us they were happy with the support they received. They said they liked the staff team or the carers who supported them and we saw they enjoyed good relationships. People told us they felt safe when they were cared for and we had no concerns about how staff or carers supported people when we visited them in their own homes.

Safeguarding policies and procedures were in place for staff and carers to follow and records showed they had taken appropriate action to safeguard people from harm and abuse when certain circumstances arose. Staff and carers were knowledgeable about safeguarding vulnerable adults and records confirmed they had been trained in this topic. Risks that people had been exposed to in their daily lives and within the environments of their homes had been assessed and mitigated against to ensure they remained safe. Accidents and incidents were dealt with appropriately and measures were put in place where necessary to prevent repeat events.

Recruitment procedures were thorough and included suitable checks to ensure that staff and carers employed to deliver care were of suitable character to work with vulnerable adults. Medicines were managed safely and reflected best practice guidance. Staffing levels were determined by the level of support each individual needed and when we visited people in their homes these levels were appropriate to people's needs.

Staff and carers were aware of people's needs and effective plans were in place to support them to meet these needs. Care plans and risk assessments were regularly reviewed to ensure they remained current and up to date. They were very person-centred and described in detail how staff should support people, the risks associated with their needs, their personal behaviour traits, their likes, dislikes and any habits. People were supported to attend medical appointments as and when necessary and specialist input into their care was evident where needed. People's conditions and their care was monitored through a range of tools to ensure that the care delivered remained appropriate and that when changes were needed these were made.

Care staff and carers were trained in key areas relevant to their role such as infection control and fire safety. They were also trained in areas such as autism awareness and deprivation of liberty safeguards, which was relevant to the needs of some of the people they supported. An induction package was in place and supervisions, appraisals and staff meetings took place regularly to provide support to the staff team. Carers told us they felt supported by the office staff and management on the shared lives scheme element of the service and said they had regular contact and reviews with them.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The service understood their legal responsibility under this act and they assessed people’s capacity when their care commenced and on an on-going basis when necessary. Decisions that needed to be made in people’s best interests had been undertaken in line with procedures set out in the MCA. Applications to the Court of Protection were currently being considered by people's care managers in the local authority, and the registered managers were working with the local authority to progress these as soon as possible. People's consent to care and treatment was obtained before staff delivered care and we saw this in practice when we observed care being delivered during our visits to people's homes.

Equality and diversity was considered and respected. People were treated with dignity and respect and they were afforded privacy by care staff and carers as and when they required it. Staff were motivated and reflected pride in their work. They talked about people in a way which demonstrated they wanted to support them as much as possible and provide a high standard of care. People had differing levels of independence within the boundaries of their abilities and needs, but staff and carers encouraged them to become as independent as possible. Staff and carers provided people with explanations about their care, activities and choices available to them. Information such as service user guides were also distributed to people when they started using the service, in a format that met their needs.

People were supported to make their own choices about what they did in their lives and they pursued activities that they enjoyed. Some people enjoyed employment at local businesses. A formal complaints system was in place and feedback about the service was actively sought and acted upon.

We received positive feedback about the registered managers and overall leadership of the service. A structured management reporting system was in place which provided support to carers, care staff, office staff and all levels of junior and senior management. Meetings were held within the service internally and also within the provider's organisation at a more regional level. Quality monitoring systems were robust including a range of audits and checks being carried out in relation to health and safety matters, medicines management, finances, records and staff practice. Regular audits were carried out by the associate director of operations to ensure that the registered managers were managing and monitoring the service effectively.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

The summary is based on a visit to the service offices where we looked at records and talked to the manager and staff (care coordinators). Following the visit we contacted, by telephone, a sample of people who used the service and a sample of the people who supported them (carers).

The full report contains the evidence to support this summary.

Is the service safe?

The service had written policies and procedures in connection with safeguarding vulnerable adults. Staff had received training in safeguarding which meant they understood what to look out for and what they should do if they had any concerns. Care coordinators maintained regular contact with the carers and people who used the service to monitor progress and help ensure the carers and people using the service were safe.

Health and safety assessments were undertaken and periodically reviewed to help ensure the physical safety of people using the service.

People who used the service told us they felt safe and had good relationships with the carers who supported them. People knew how to get additional support if it was needed.

Is the service effective?

The service undertook careful assessments of the needs of people planning to use the service. The process for 'matching' carers and people using the service was thorough and involved everyone in a meaningful way. No one was pressurised to agree to a placement if they had reservations. People were listened to and their opinions were valued by the care coordinators and management.

There was regular contact between the care coordinators and the carers to help ensure the service was working well.

There were effective systems to record and track information. This meant that management had good access to information about how well expectations about frequency of training, support and reviews were being met. Audits of other information were also undertaken and acted on.

Everyone who we spoke with was positive about the service and support provided. Comments included 'its brilliant', 'very helpful team' and 'everybody is marvellous'.

Is the service caring?

Care coordinators spoke with passion about the importance of the person centred focus of the service. This was supported by the positive views expressed by the people using the service.

The matching process between carers and people using the service was thorough. It was designed to help ensure the 'match' was effective in providing consistent support and care over a potentially lengthy time. People's likes and dislikes were recorded and formed an important part of the matching process.

People were encouraged to share their views. Their opinions were listened to. All people using the service spoke positively about their relationships with their carers.

Is the service responsive?

We did not look specifically at the service's complaints procedure. However people using the service and the carers told us they knew how to contact the care coordinators if they needed to. They also told us that they believed they would be listened to and their opinions were valued.

Quality monitoring systems were in place. These would enable the service to identify if any modifications to the service would be beneficial.

There was regular contact between the care coordinators and the carers and people using the service. This enabled any problems, or the requirement for extra support, to be identified.

Is the service well led?

There were clear lines of accountability within the service.

Communication within the service was good. This enabled the care coordinators, carers and people using the service to have confidence that they knew who they needed to contact in different circumstances, and that any required support would be forthcoming.

Quality monitoring and audit systems were well maintained to help ensure management information was up to date and accessible.

Care coordinators received regular supervision and described their managers as supportive and accessible. One commented 'without the managers' support I'd not be as good as I am'.