Archived: yourAbility Hillingdon Also known as Yew Tree Lodge

yourAbility Hillingdon, also known as Yew Tree Lodge, is a supported living service registered to provide personal care for up to 13 people aged 18 and over. A team of support staff provide 24-hour care and support to adults with learning disabilities, mental health needs and physical disabilities. 12 people were using the service at the time of the inspection.

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. These are to ensure 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 should receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by people having their own flats with kitchens and en-suite bathrooms. They shared the communal kitchen, dining room, laundry facilities, garden and two living rooms. The building design fitted in with the surrounding residential area. Staff were not wearing anything that suggested they were care staff when coming and going with people.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. People were supported to develop more independence and to access some meaningful opportunities and activities. Staff supported people to access mainstream services and specialist health and social care support. The service worked with other professionals to support people to manage behaviours that may challenge others.

Some aspects of the service were not consistently safe as the provider had not sufficiently assessed staff to ensure they were always competent to give the medicines support being asked of them.

The provider did not always promote people’s rights when people were unable to consent to their care arrangements. People were not supported to have maximum choice and control of their lives and staff supported did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

However, people's care and support was person-centred, planned and coordinated.

The provider had systems to monitor the quality of the service, but these had not been sufficiently robust to have identified, or taken timely action, on the areas for improvement we identified.

People had detailed support plans in place and these were regularly reviewed and updated. Plans reflected people’s physical, mental, emotional and social needs and their care and support preferences.

Staff were aware of people's individual needs and preferences and used this knowledge to deliver person centred care. People and their relatives felt staff cared and treated them with respect and dignity.

Staff supported people to manage behaviours that may challenge others in line with good practice.

Staff received training, induction, supervision and support to perform their roles effectively.

We have made a recommendation about safely supporting some people with their food.

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 5 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches in relation to supporting people in line with the principles of the Mental Capacity Act 2005 and having systems in place to monitor the quality of the service. Please see the action we have told the provider to take at the end of this report.

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.

The last inspection of the service was in May 2014 when we found the provider was meeting all of the standards we inspected.

YourAbility Hillingdon provides personal care to people with learning disabilities living in a supported living environment. People who use this service live in their own homes. At the time of this inspection, 13 people were using the service.

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 provider operated systems to keep people safe and staff understood and followed these. There were enough staff to meet people’s care and support needs and the provider carried out checks on staff before they worked with people using the service.

Staff supported people to access to the health care services they needed and made sure people received the medicines they needed safely.

The provider and staff in the service obtained people’s consent before they provided care and support. Where people lacked the capacity to make decisions about their care, the provider acted appropriately and in people’s best interests.

Staff had access to the training and support they needed. They told us they enjoyed working in the service and would be happy if a relative or friend lived there. We saw staff interacted with people in a caring and friendly way and explained the support they gave people to make sure they understood what was happening. People’s relatives also told us staff were kind and caring.

Staff understood the care and support needs of people using the service and used the provider’s care planning and risk management procedures to ensure they met these. People using the service were involved in the development of their care plan and other records, including risk assessments and risk management plans.

The provider had a policy and procedures for people using the service and others about how to make a complaint. They provided information for people using the service in formats they could understand.

The service had a registered manager and clear arrangements for the day to day management of the service.

The provider had systems to monitor the quality of the service that people received and to make improvements. The provider, managers and staff carried out audits and checks to monitor quality in the service and we saw these were up to date.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

People who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. There were procedures in place to protect people from abuse and staff knew how to respond to allegations of abuse.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People's care files contained risk assessments which identified risks to people and ways to reduce them to ensure that their needs were to be met as safely as possible.

There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. We found that accidents and incidents were recorded and saw that appropriate actions were taken by the service.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Records showed that the service worked together with the local authority to ensure that people had care plans to meet their assessed needs. People's care plans were available and were reviewed on a regular basis. People's health was monitored and they received medical attention when it was needed.

Staff we spoke with told us that it was important to them to offer choices and giving people time and sufficient support to enable them to make decisions regarding their support and daily activities.

People's assessed needs, preferences and choices were met by staff that had the necessary skills and knowledge. Staff had effective support, supervision, appraisal and training.

Is the service caring?

People who used the service had varying levels of difficulties to express their views verbally to us with regards to the quality of the care and support they received. Four people we met did not speak to us about their views however they indicated that they were 'alright' or 'ok.' We observed that staff were familiar with people's communication needs and behaviour. We saw that staff treated people respectfully and tried different approaches to achieve positive outcomes.

People who use the service and their representatives were asked for their views about their care and treatment and they were acted on. There was evidence that people's views were regularly sought through various forums including tenants' meetings, one to one key-working sessions and care plan reviews.

During our inspection, we saw people's privacy, dignity and independence were respected.

Is the service responsive?

People were supported in promoting their independence and community involvement. We found that people participated in various activities of their choice in the community such as attending a day centre, swimming, gardening or attending college. We also found that people were encouraged to do as much as they could for themselves in order to promote their independence.

We found that people's diverse needs were reflected in their care plans and that people received personalised support. During our inspection we observed that staff knew people's needs, understood their behaviour and were able to communicate with them effectively.

Is the service well-led?

We found that the quality of the services were regularly assessed and monitored. The service had a quality assurance system in place which consisted of various regular internal audits on different aspects of the service. We saw that when shortcomings were identified the provider responded promptly to improve its service. There were procedures in place to carry out various health and safety checks to ensure that people were getting a safe and appropriate level of service.

We found that the service worked in partnership with the local authority and health professionals to ensure people's health and well-being.

Staff told us that they enjoyed working at the service as the 'team is very good', and there were 'good customers (service users) and management.' Staff also said they were clear about their duties, felt confident about their job and were satisfied with the way the service was run.