Newsome Road - St Paul's House

This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. 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.

People’s experience of using this service: The service was exceptional at placing people at the heart of the service. The managers and staff of the service had a strong focus on people having as many opportunities as possible to develop their confidence, gain new skills and become as independent as possible.

There was a very positive culture in the service. Staff attributed this to the strong guidance in the service and believed the high levels of positivity in the service stemmed from outstanding leadership.

The outcomes for people using the service truly reflected the principles and values of Registering the Right Support in the promotion of choice, control independence and inclusion. People’s support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Promoting people’s independence was a significant strength of the staff team.

Managers constantly looked for ways to improve the service. They had engaged people in how they would prefer the provider’s governance arrangements to be carried out to avoid any impact on people living in their own home.

Relatives and other professionals we spoke with during our inspection highly praised the service and the impact it was having on people. People were in control of their own lives and were supported by staff who were determined to ensure people could make their own choices. Staff assisted people to make their wishes a reality.

Staff understood people’s personal risks and had worked with them to develop their skills and minimise risks. People had been enabled to access the community and public transport with confidence.

People, relatives and other professionals told us how people were highly valued, shown great respect and their dignity preserved. Managers engaged representatives from across their services to listen to their views.People were supported to have the optimum 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 practice.

Staff were exceptionally caring. They all shared the same hopes and aspirations for people to continue to live the lifestyle of their choice. People’s voices were of paramount importance in the service.

There was clear and consistent working with other professionals who supported people. Staff had promoted people working with other professionals and sought their advice when needed.

Recruitment practices for the service were safe. Staff were supported through an induction, training and supervision. This included the safe management of medicines and safeguarding. Additional training had been sourced for staff when people’s needs had changed.

People were actively engaged in managing their own records. Care plans were accurate, up to date and based on robust assessments of need.

The provider welcomed comments about the service. They had an accessible complaint’s process available to people. The service had not received any complaints.

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

Rating at last inspection: Good (Date last report published November 2016).

Why we inspected: This was a scheduled inspection based on our previous rating of the service

Follow up: We will continue to monitor the service and re-inspect the service in line with the current rating

This inspection took place on 13 September 2016 and was announced. A registered manager was 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 was present during our inspection and assisted us with our enquiries. We were also supported during the inspection by a service manager who was in daily contact with the service. The registered manager also managed other services in the organisation and having set up this service, planned to deregister as the manager and for the service manager to take on this role.

We looked at the management of medicines and found that there were safe procedures in place for the administration of medicines. Where people self- administered their own medicine, appropriate assessments were in place. Medicines were stored securely and there were regular audits carried out which included checking stock balances and medicine administration records [MAR's] to ensure there were no gaps in records and that medicines had been given as prescribed.

A safeguarding policy and procedure was in place, and staff had received training in the safeguarding of vulnerable adults. We spoke with staff who were aware of procedures to follow in the event of concerns and a flow chart was displayed which outlined clearly the action staff should take when alerting concerns of a safeguarding nature. A whistleblowing policy was also in place. There had been no safeguarding issues.

Individual risks to people had been assessed. These included risks related to mobility, accessing the community, bathing, using the stairs, falls, and the use of bed rails. Although the provider was registered to provide personal care only, regular checks on the safety of the premises and equipment were also carried out. A record of accidents and incidents was maintained and these were reviewed by the registered manager to ensure appropriate action was taken and to monitor for any patterns or trends.

Safe staff recruitment practices were followed. Appropriate checks including obtaining two references and checks with the Disclosure and Barring Service [DBS] were carried out. The DBS checks lists of people to see if they are suitable to work with vulnerable adults. This helps employees to make safer recruitment decisions to help to protect people from abuse. The identity of staff was verified and new staff were interviewed twice; once in the office and once in the service involving people who lived there. There were suitable numbers of staff on duty on the day that we visited, including a sleep in member of staff. An intercom was in place for people in the house next door to contact the sleep in staff member if they needed them.

Staff received regular training in topics considered mandatory by the provider, such as moving and handling, health and safety, infection control, medicines awareness, first aid, mental capacity and deprivation of liberty. Additional training was provided related to the specific needs of people who used the service. A system of regular supervision and annual appraisal was in place. This meant that the development and support needs of staff were considered by the provider.

Capacity assessments had been carried out in relation to the ability of people to consent to living and care arrangements. There was evidence that a clear process was followed when supporting people to make complex decisions and they were consulted about the application of policies that might impact upon their rights and choices. The service had sought advice from an independent advocate to review policies to ensure they didn't have practices or procedures in place which were overly restrictive. This was important due to the greater role of the service in supporting independence following their previous experience as a residential care provider.

People were provided with appropriate support with eating and drinking. Two people who shared a house preferred to go shopping together and to take a basic list of essential items and then choose meals from the supermarket. Another person liked to prepare menus and then go shopping independently for items on their shopping list. Advice was provided about healthy eating which was promoted but it was recognised that people could make their own choices about diet. People accessed health services in the community and were supported as necessary by staff.

We observed caring interactions between people and staff. The registered manager, service manager and staff spoke passionately about their role in supporting people in the transition to the new service and the difference this had made in empowering people and supporting them to live more independently. The registered manager also had strong views and values related to how staff should be treated, and this included thanking staff and acknowledging things that had been done well. We saw evidence of professional, caring and respectful written and verbal interactions between staff and managers.

The privacy and dignity of people was promoted and respected. There was a staff sleep in room which was also a small office space in one property. There was a deliberate effort made to avoid staff encroaching on the privacy of people, and staff meetings were held at the office base. Records were stored securely to maintain confidentiality of information held about people. We were advised that future tenancies would be agreed with people who used the service to ensure they were happy to share their home with that person.

Person centred care plans were in place. These were up to date, regularly reviewed and included information about the aspirations and goals of people who told us they were happy with the support they received. A complaints procedure was in place and there was a log to record these. There had been no formal complaints made about the service. A pictorial easy read complaints format was available to support people who used the service to make a complaint. People were consulted before family members were involved in any discussions about their care.

People were involved in a range of activities and attended day care services. They were supported to choose activities and the staff member with whom they spent one to one time.

There were systems in place to audit the quality and safety of the service and staff told us they felt well supported by the registered manager and service manager. Morale appeared good within the service. The views of people, relatives and staff were sought on a regular basis via questionnaires, meetings and general feedback.