Saracen Care Services Ltd

Saracen Care Services Ltd provides personal care and support to people with a learning disability, physical disability and/or mental health need in their own home or in shared accommodation. At the time of the inspection, there were 25 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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. This ensures 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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and 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.

People continued to receive an outstandingly caring and well-led service. Following our previous inspection, the service had further developed their exceptional person focused approach and responsiveness to people’s needs. Staff viewed each person as individuals and we found people had been empowered, through creative communication, to make truly informed decisions that enabled them to live the lives they wanted. Highly motivated staff worked tirelessly to advocate for people and find solutions with people to negotiate the challenges they faced when making their life choices.

Since the previous inspection the provider and registered manager had continued to develop and improve the service. This had led to improved outcomes for people and excellent levels of support. Time and resources had been invested to develop a variety of accessible communication tools to support people to take control of their care.

People and their relatives spoke highly of the staff and the support provided. Without exception, people and relatives praised the staff for their caring attitude and their commitment to

support people. The staff valued and respected people decisions about how they wanted to lead their lives and the support they required. Staff understood the different and diverse needs of people and delivered care which was non-judgemental and promoted equality. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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.

Care provided by the service was person centred and focused on people’s individuals wishes and strengths. Staff had encouraged people to maintain their interests and relationships and be inclusive in the community. The provider supported people with the use of technology to assist people in communicating and understanding their needs and how to protect them from danger.

Comprehensive care plans were in place to provide staff with the guidance they needed to support people. Control measures and risk management plans were in place for people with specific medical conditions and others who were at risk of harm or harming others. People, where possible, were supported to understand the risk involved in any activities they were doing and how to stay safe. Health care professionals reported that the service was highly effective and responsive to people’s needs and that staff worked collaboratively with them to achieve the best outcomes for people. People’s medicines and finances were managed safely.

Safe recruitment practices of staff were used. The managers valued people’s feedback about the staff who supported them. All staff completed an induction programme and were trained in their role. Staff reported they felt supported and that managers were approachable. An effective on call system was in place to help manage out of hours concerns.

Complaints, accidents and feedback were taken seriously and used as an opportunity to improve the service. The registered manager had informed the CQC of significant events and managers worked openly and took prompt action to address any shortfalls.

There was an extremely positive ‘can-do’ culture within the service. The provider had a well-developed management system in place with clear responsibilities for every member of their staff team. The management team provided support to staff and a clear vision and strong values about how people were supported. The provider's governance was well-embedded and there were effective assurance systems that ensured ongoing compliance. There was a strong ethos of learning when things went wrong.

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 Outstanding (published 26 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Saracen Care Services provides personal care and support to people with a learning disability and/or mental health needs to live in their own homes either on their own or sharing with others in supported living services. A supported living service is one where people receive care and support to enable them to live independently. People have a tenancy agreement with a housing provider and receive their care and support from Saracen Care Services. At the time of our inspection 13 people were receiving a personal care service.

The service was last inspected on 1 and 2 September 2014. At the previous inspection there were no breaches of regulation.

There was a registered manager in post at 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was a clear management structure for providing good quality care. This included; A registered manager, general practitioner, business and quality manager, care director, three care managers, a training and development manager and office based staff. There were senior support workers and support workers providing support for people in their own homes.

The service was safe. Risk assessments were implemented and reflected the current level of risk to people. There were sufficient staffing levels to ensure safe care and treatment.

The service was not always responsible for people’s accommodation; however we found they had ensured people’s homes were safe and comfortable, through liaison with landlords and other relevant agencies. The Care Quality Commission’s role in these settings was to focus on the regulated activity of personal care and had no regulatory responsibility to inspect the accommodation. We saw that the provider had environmental risk assessments and a log of all maintenance records that had, or were due to be completed

People were receiving effective care and support. Staff received training which was relevant to their role. Staff received regular supervisions and appraisals. The service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and where required the Deprivation of Liberty Safeguards (DoLS).

Staff told us there was an open culture and the environment was an enjoyable place to work. Staff were extremely passionate about their job roles and felt integral to the process of providing effective care to people. Management and care staff had a good understanding of people’s needs and wishes and communicated effectively to support them. Where it was clear people’s needs had changed, the registered manager worked with the person, families and health and social care professionals to check if the support needed changing to accommodate any additional care needs or reduced support. Staff said the service was very responsive to feedback.

The service was caring. We observed staff supporting people in a caring and patient way. Staff knew the people they supported well and were able to describe what they like to do and how they wanted to be supported. People were supported sensitively with an emphasis on promoting their rights to privacy, dignity, choice and independence. People were supported to undertake meaningful activities, which reflected their interests.

The service was responsive to people’s needs. Support plans were person centred to provide consistent, high quality care and support. People using the service and their relatives were able to raise concerns and were listened to.

The service was well led. Quality checks were occurring regularly and identified actions to improve the service. Staff, relatives and other professionals spoke positively about the registered manager.

People’s views were sought through care records, reviews, meetings and surveys. Systems were in place to regularly review and update records. People were actively involved in striving to improve the service and support provided.

As part of this inspection we spoke with nine people using the service and 15 staff. We also reviewed records relating to the management of the service which included seven care plans, daily care records and staff training records. Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

Is the service safe?

This service was safe. People and staff knew how to recognise and respond to abuse. The service ensured people were empowered to protect themselves as well as provided with protection. Some of the record keeping around people's finances was not being completed thoroughly to ensure financial abuse was identified as early as possible.

Where risks existed, people were involved in agreeing how these would be managed. The focus was on taking informed risks to maintain people's independence. This included acting in accordance with the Mental Capacity Act 2005.

People's medicines were being stored, recorded and administered safely. Staff had access to the information they needed to safely administer medicines. The competence and performance of staff was being checked to identify any problems as soon as possible.

Is the service effective?

This service was effective. People's support needs and preferences were met. Staff were knowledgeable about the people they supported and used this to help people be as independent as possible and to develop new skills.

Staff received the line management and support they needed to care for people competently. This included identifying and meeting ongoing training and development needs.

Staff monitored people's physical and psychological wellbeing and ensured support was in place to meet their changing needs. Where necessary, staff contacted health and social care professionals for guidance and support.

Is the service caring?

This service was caring. People were treated with kindness and respect. People receiving support told us they were very happy with the support staff provided.

People told us there were plenty of opportunities to express their views about their support and the running of the service. People were involved in making decisions and were consulted by staff.

People were encouraged and supported to be as independent as possible. This required staff to have a detailed knowledge of people's needs and preferences. The result was people were treated with dignity and as individuals.

Is the service responsive?

The service was responsive to people's needs and wishes. Support plans accurately recorded people's likes, dislikes and preferences. Staff had information that enabled them to provide support in line with people's wishes. People were involved in developing and reviewing these plans.

People were supported to take part in activities and to do so as independently as they were able. People were supported to further develop their skills so that their independence increased. Staff helped people to remain in contact with those individuals who were important to them and provided support to meet their spiritual and social needs.

Is the service well-led?

This service was well-led. People using the service and staff said they understood the new management structure. Staff felt well supported and able to challenge poor practice. There was a commitment to listening to people's views and making changes to the service in accordance with people's comments and suggestions.

The service carried out regular audits to monitor the quality of the service and plan improvements. Learning also took place following incidents or complaints. Where a shortfall was highlighted, action was taken promptly. Information was shared with CQC about significant events in a timely manner.

We came across significant variations in the quality of care being provided. Some people had a consistent group of well-trained care workers. One person told us 'I like all the staff. Can't fault them'. Other people told us staff lacked the skills and knowledge to support them and they complained about a lack of consistency.

We found a similar variation in the quality of care planning documents and medicines administration records. Some were personalised and detailed whilst others lacked information needed to support the person. Some people told us they had been involved in the care panning process but others had not been involved.

We identified four safeguarding incidents that had not been reported to the local safeguarding authority. It was questionable whether they have all been satisfactorily managed in house. We were made aware of two further incidents that had not been notified to CQC. This had prevented the ongoing monitoring of risks to the people receiving care.

Staff and professionals from outside the organisation raised concerns with us about the quality of staff training. This primarily affected recently recruited staff in Swindon. They felt their induction had been inadequate and some staff felt ill prepared to support people with complex needs.