Blue Sky Care Ltd community services

Pure Offices is registered to support people with their personal care. Pure Offices specialises in providing care and support for people who live with a learning disability, in their own home and when out in the community. At the time of the inspection there were 10 people receiving support with their personal care.

People’s experience of using this service:

People and relatives were extremely satisfied with the service people received and spoke highly of staff and the registered manager. A comment from a relative summed this up by saying, “Care has surpassed what we could have ever imagined!”

People who used the service were treated with compassion and kindness and their privacy and dignity respected. We observed staff supporting people safely in their own homes.

Relatives and a person using the service told us they felt staff provided safe and extremely effective care. Staff turnover was low which people and relatives valued. People were supported by a small team of staff that understood their needs.

We found robust systems, processes and practices were followed effectively to safeguard people from situations in which they may experience harm. Risks to people’s safety had been thoroughly assessed, monitored and managed so they were supported to stay safe while their freedom was respected.

People told us they received their medicines as prescribed and records reviewed confirmed this.

Safe recruitment practices were followed. Arrangements to prevent and control infection were in place.

Staff had received all the training required to support people safely. Staff received regular supervision and annual appraisals and were able to reflect on the care and support they delivered. Staff were able to access further training in addition to their mandatory training.

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 had been involved in agreeing their care plans and participated in reviews of the care and support provided to them. People and family members said that staff always asked for consent when carrying out care and support tasks.

People were fully supported to live healthier lives by having on-going support to access suitable healthcare services.

People received personalised care that was exceptionally responsive to their needs. Care staff understood the importance of promoting equality and diversity by supporting people to make choices about their lives. Confidential information was kept private.

There was strong sense of leadership in the service that was open and inclusive. The registered persons focused on achieving positive outcomes for people and their staff.

People and relatives benefited from a robust professional management framework that helped care staff to understand their responsibilities so that risks and regulatory requirements were met.

The service encouraged regular feedback from people who used the service, relatives, care staff and professionals. Views were gathered through questionnaires, telephone conversations, regular face to face meetings at people’s home and at staff team meetings in the office.

No complaints had been received in the last 12 months. People were introduced to lay advocates if necessary.

Comprehensive quality checks had been completed to ensure people benefited from the service being able to quickly put problems right and to innovate so that people could consistently receive safe care.

Good team work was promoted and care staff were supported to speak out if they had any concerns about people not being treated in the right way. Staff were clear about the vision and values of the service. In addition, the registered persons worked in partnership with other agencies and stakeholders to support the development of joined-up care.

More information is available in the full report.

Rating at last inspection:

Good (report published April 2016)

Why we inspected:

This was a planned inspection based on the rating at the last inspection when we rated the service as good overall. At this inspection there had been further improvements which resulted in the service being rated outstanding overall.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

On the day of our inspection there was a registered manager in place. 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 risk to people’s safety was reduced because staff had attended safeguarding adults training, could identify the different types of abuse, and knew the procedure for reporting concerns. Risk assessments had been completed in areas where people’s safety could be at risk. People had the freedom to live their lives as they wanted to. Staff were recruited in a safe way and there were enough staff to meet people’s needs and to keep them safe.

Accidents and incidents were investigated. Assessments of the risks associated with the environment which people lived were carried out and people had personal emergency evacuation plans (PEEPs) in place. People’s medicines were stored, handled and administered safely.

People were supported by staff who received an induction, were well trained and received regular assessments of their work.

The registered manager ensured the principles of the Mental Capacity Act (2005) had been applied when decisions had been made for people. Staff ensured people were given choices about their support needs and day to day life. The registered manager was aware of the requirements to apply for and implement Deprivation of Liberty Safeguards.

People were encouraged to plan, buy and cook their own food and were supported to follow a healthy and balanced diet. People’s day to day health needs were met by the staff and external professionals. Referrals to relevant health services were made where needed.

People were supported by staff who were very kind and caring and treated them with respect and dignity. Treating people with dignity was one of the provider’s top priorities. Innovative methods were used to communicate with people to make them feel their views mattered and they would be acted on. Staff responded quickly to people who had become distressed. There was a high emphasis on person centred care and staff were aware of the importance of encouraging people to live their lives as independently as possible.

People were able to contribute to decisions about their care and support needs. People were provided with an independent advocate, if appropriate, to support them with decisions about their care. People’s friends and relatives were able to visit whenever they wanted to.

People’s support records were person centred and focused on what was important to them. The records were regularly reviewed and people and their relatives were involved. People were encouraged to take part in activities that were important to them and were provided with the information they needed, in a format they could understand, if they wished to make a complaint.

People, relatives and staff spoke highly of the registered manager; they found him approachable and supportive. The registered manager understood their responsibilities and ensured staff felt able to contribute to the development of the service. Staff roles were developed and the risks to the service were explained to them. People who used the service were encouraged to provide their feedback on how the service could be improved. There were a number of quality assurance processes in place that regularly assessed the quality and effectiveness of the support provided.

Throughout this inspection we focused on these five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes the records we looked at and what relatives of people who used the service and the staff told us.

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

Is the service safe?

We asked relatives of people who used the service whether they felt their family member was safe when support was provided by the staff. A relative we spoke with said, 'I have no worries at all when the staff are with them and they go out together.' Another relative said, 'My son is absolutely safe.'

The relatives we spoke with told us they were involved in decisions about their family member's support. All spoke positively about the registered manager and the staff stating they were pleased that they were consulted. However, support plan documentation did not always record when discussions with relatives had been held.

There were procedures in place to identify and prevent abuse to people occurring. Staff showed a good knowledge of the referral process and could explain the process they would follow, both internally and externally, should they suspect someone had been the victim of abuse.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. At the time of the inspection no application for DoLS had been made, but the registered manager could explain the process for doing so.

Is the service effective?

We asked relatives of people who used the service what they thought of the support provided by the staff. One relative we spoke with said, 'They had a new support worker start recently. They were introduced to my daughter first and really got to know her before she then went out alone with her. She gained my daughter's trust. It was a really effective and clever way of approaching this.'

We looked at three staff personnel files, training records and the training matrix. The training matrix showed what training had been completed by the staff. The training matrix, on the whole, showed training was up to date, although we identified some areas where training for some staff had expired.

Staff received regular supervision and assessment of their work and areas for future development were identified.

All four of the staff we spoke with told us they felt appropriately trained for their role.

Is the service caring?

We asked relatives of people who used the service whether they felt the staff provided support in a caring manner. One relative said, 'I can't fault the staff in anyway. From start to finish they have accommodated my son so well. The staff are spot on.'

Is the service responsive?

People's individual needs were assessed and responded to appropriately. One support plan we looked at stated the person required staff to use Makaton signs and symbols. Makaton is a language programme which uses signs and symbols to help people to communicate. It is designed to support spoken language and the signs and symbols are used with speech, in spoken word order. We spoke with this person's relative and they spoke very highly of the staff. They said, 'They [staff] are great with my son, they know his needs straight away.'

We saw the provider's policy which stated how they prevented people from unlawful discrimination.

Is the service well-led?

Staff spoken with told us they felt able to raise any issues they had with the registered manager. They told us they felt supported and their views were respected. A support worker we spoke with said, 'I get on really well with the manager, they are very approachable and supportive. They are always there to help.' A relative we spoke with said, 'The manager is spot on and thorough. They ensure such a consistent approach to the care provided.'

The registered manager was aware of the parts of the service that required improvement and plans were in place to ensure the improvements were made.