The inspection of Support’ed Limited (known locally as ‘Support’ed) took place on the 6 and 7 April 2017. Support’ed supported the personal care of three people to live in their own home. They worked with younger and older adults with complex needs. People may have a mental health diagnosis, learning disability or be on the autistic spectrum. The inspection was announced three days in advance. This was due to the complexity of the needs of people Support’ed supports. This gave time for staff time to support one person to feel comfortable speaking to us and to arrange for us to speak to family carers of the two other people. Also, we were only able to speak to staff who were off duty and they needed time to arrange to talk to us.
This is Support’ed’s first inspection following their registration with us in April 2015.
There was a registered manager appointed to run 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.
The service provided care to people in their own homes. The registered manager and directors had spent time designing the service ethos and approach. Personal care was seen as more than washing and dressing and supporting people’s continence. Individualised care for those they supported was deemed essential and staff were part of the same ethos and culture. Parent carers were respected and embraced for their knowledge and as part of the team. As a result, care and support was provided to enable people to live a fulfilled and meaningful life.
There was a positive culture within the service. The management team provided strong leadership and led by example. The registered manager and directors had a clear vision, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. Staff had clearly adopted the same ethos and enthusiasm and this showed in the way they cared for people.
Staff were highly motivated and inspired to offer kind and compassionate care and support. All the staff said they enjoyed their work and loved seeing people progress. Regular competency checks were completed to test staff knowledge and to help ensure their skills were up to date and in line with best practice.
One person could tell us verbally about their experiences of the service. They were very positive about the staff and service. For the others, parent carers told us about the immense difference the service had made to their loved ones and family’s lives. People who had previously been restricted were now being supported in a different way, which gave them more freedom and an enhanced quality of life. We heard many examples of how people's lives had changed for the better and about how many new opportunities they now had.
Relatives and other agencies were without exception, extremely positive about the service and the care people received. We were told that since Support’ed took over their care people's lives had changed. Due to the care and the skills of the staff team people had progressed, experienced new opportunities and now had more independence.
Other agencies were very positive about the staff team and leadership of the service. We were told that staff embraced ideas and worked hard to ensure people were able to do the things they wanted. The overall view of other agencies we spoke with was that despite the complex needs of people they supported, the service had managed to deliver excellent quality personalised care within their own home.
People were supported to express their views and have their voice heard. Staff were creative and used innovative methods to help people express their views and understand what was happening around them. There were sufficient numbers of skilled staff to meet people's needs and to keep them safe. Staffing levels reflected their care plans and staff were recruited who had the right attitude and aptitude to meet the needs of the individual person. The provider had clear and effective recruitment procedures in place and carried out checks when they employed staff to help ensure people were safe. The parent carers said they believed and trusted that people were safe.
People were protected by staff who knew how to recognise signs of possible abuse. Staff said reported signs of abuse or poor practice would be taken seriously and investigated thoroughly.
Staff were well trained and said training was relevant to their role and kept updated. The registered manager was passionate about developing the skills of the staff team, and had a commitment to people and their relatives about what the service had said they would deliver. Staff were very aware of the risk of potential exploitation on line and in the community and worked to keep people safe from this.
People’s medicines were managed very safely. Staff undertook training and understood the importance of the safe administration of medicines. Staff ensured medicines were given in the person’s best interests and worked with health professionals to keep people’s medicines under constant review. Medicines that were given to control behaviour had been reduced or removed altogether.
Staff worked really hard to enable people to communicate what they wanted and to reduce the need for behaviours that limited their opportunities. Behaviour management plans were in place for people to help staff understand the behaviour people may present, to recognise the triggers and signs and to safely manage the behaviours if they occurred. Staff had a good understanding of people's behaviours and the guidelines in place to prevent behaviours from escalating. Staff and parent carers said the number of incidents had significantly reduced for some people and they felt this was due to staff knowledge, training and consistency of care provided. Positive relationships in the community were now possible as a result of this.
Management and staff understood their role with regards to the Mental Capacity Act (2005). When people were unable to consent to their care or support, or were unable to make decisions, discussions took place with parent carers, other agencies and staff to help ensure decisions were made in their best interest. Staff and the directors were alert to any time they may be being requested to limit people’s freedoms. For example, they guarded against limiting people’s freedoms in the community. By the use of clear risk assessments and identifying where people were a risk to or a risk from the community, they sought for people to have as full a life as possible.
People's health and dietary needs were well met. People were supported to maintain good health and, when required, were supported to access a range of healthcare services. Annual health checks were arranged and 'hospital passports' were in place to support any admissions to hospital. Hospital passports contained important information about the person to help ensure their needs were appropriately met if they should require an admission to hospital or another healthcare facility.
Staff were clear they were providing care to people in their own home and mindful that although they were there 24 hours a day seven days a week that they needed to support people's privacy. Measures were put in to support people to have alone time safely as necessary.
The service was responsive to people's specific and diverse needs. Other agencies told us they were always impressed with the creative and personalised care provided to people. Support plans were clear and detailed, providing staff with step-by-step guidelines about people's needs, preferences and daily routines. All the staff we spoke with had a very good knowledge of the needs of people they supported.
Systems were in place to deal promptly and appropriately with any complaints or concerns raised about the service. The provider promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. This reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment.
The registered manager and the other two directors took an active role within the service and demonstrated a passion for the service and modelled high standards of care, through a hands-on approach and attention to detail. All of the staff said they felt valued and supported by their colleagues and management team. Other agencies were very positive about the leadership of the service and said the staff team listened and embraced ideas about how to support people.
The provider had a robust quality assurance system in place and gathered information about the quality of the service from a variety of sources including people who used the service, relatives and other agencies. Learning from quality audits, incidents, concerns and complaints were used to help drive continuous improvement across the service.