Advance Support and Enabling Service

Supported living

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.

The service supported people in their own homes, often with 24 hour support. At the time of the inspection 17 people were receiving personal care. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate people received care support. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. People with a learning disability were supported to live as ordinary a life as any citizen.

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.

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. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's experience of using this service:

The service was focussed on placing people at the heart of the service and its values. It had a strong person centred and local community-based ethos. Staff and the service's management told us how they were passionate about providing true person-centred care to people when they needed it.

People's needs, and wishes were met by staff who knew them very well. We saw and were told of many examples of staff helping and supporting the people they cared for so they could live their best lives.

Staff had received training to support their role, often bespoke so that it was relevant to the needs of the people being supported. People and their families were also able to access training to promote consistency for people in all settings. The provider/registered manager said, “Overall the impact of happy relaxed staff, families and relatives is happy people which is why we place such emphasis on supporting everyone.”

Staff had received regular supervision and appraisal. Staff performance was closely monitored in a supportive way. The provider/registered manager had fostered a culture of openness and professional challenge. This ensured all staff understood and were motivated to meet the high standards of quality expected of them. They all told us the people they supported were truly at the centre of all they did and people told us they were very happy.

Quality assurance measures were extremely robust and well embedded into everyday practice. Staff reviewed the quality and safety of care delivered in an in-depth way on a regular basis.

People had good health care support from professionals. The provider and staff worked in partnership with health and care professionals. The service was led by a passionate provider/registered manager who was dedicated to the health and wellbeing of people they supported. They had worked tirelessly to identify each person's risks, needs and preferences, including investigation into the impact of health issues on people's physical and mental wellbeing. Staff had ensured they collected data to act as people’s advocates and help provide information to health professionals. This had led to diagnoses and positive health interventions. This enabled each person to have an improved quality of life, where their independence was promoted. Best practice standards and professional research was used to implement high quality, effective care.

There was a consistent staff team, many of whom were very long-serving and knew people very well. Staff showed very caring, thoughtful and compassionate care to each person. Staff used different communication methods with each person and were able to interpret fluently what people wanted. This meant that people, some of who had little or no verbal communication, were very well understood and supported. Each person had a highly individualised communication and support plan taking into consideration all their communication methods. This was also shared with people they came into contact with in the community, again to promote people’s independence.

Support plans described the risks, needs and preferences and how staff should work with each person to ensure the person was able to lead as fulfilled and independent life as possible. Staff were aware of people's life history and preferences. They used this information to develop positive relationships with people and staff and people and their families and deliver person centred care. People felt very well cared for by staff who treated them with respect and dignity. There was a clear commitment to support people at difficult times with compassion, respect and affection.

People were supported to access a range of leisure pursuits and participate in the community they lived in. New ideas for activities were explored and trialled to keep people occupied in a meaningful and enjoyable way. Staff found individualised ways to enable people to access the activities they wanted, sometimes working discreetly to promote independence. Although the provider was not responsible for the environments which people lived in they had put in place arrangements to work with the housing providers to ensure they met people's needs.

People, and their families, were involved as much as possible in their care and support which helped to give them choice and control in their lives. People's families spoke very highly of the quality of care and of the approach of the provider/registered manager and staff in supporting their relative. Relatives and professionals held the service in very high regard. Health professionals praised the service describing the positive outcomes and benefits to people due to the way staff advocated for each person using evidence to support their proposals.

People said they felt very safe. Risk assessments were very thorough, individualised and flexible. They were devised and shared with people so that they could develop action plans together with staff that promoted independence safely. Staff knew how to keep people safe both from the risk of abuse and from assessed risks. There was enough staff to support people and staff were flexible in their approach and positive risk taking. Efforts were made to ensure people knew who would be supporting them, often matched with support staff with similar ages and interests.

People were supported to have nutritious meals according to their likes and dislikes and their dietary needs had been catered for. This information was detailed in people's care plans. Staff followed guidance provided to manage people's nutrition and enabled people to manage their diet as informed and independently as much as possible.

Care plans contained excellent information about people and their care needs. People were fully involved and care plans were working documents, used and reviewed to reflect each person’s current needs. This included celebrating achievable goals and progress towards independence.

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.

Medicines were administered by staff who were well trained and competent. There were robust systems to ensure medicines were received, stored, administered, recorded and returned safely.

Arrangements were in place to manage and prevent cross infection and ensure good infection control systems were in place.

When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.

Rating at last inspection: Good (Report Published 31 January 2017).

Why we inspected: This inspection was carried out based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

We carried out this announced inspection on 04, 07 and 08 November 2016. The last inspection took place in February 2014 during which we found no breaches in the regulations.

There was a registered manager in post who was also the owner of 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 registered manager worked closely with the service manager, who had day to day oversight of care provision and the office manager, who held responsibility for the administrative side of the business and human resources.

The registered manager was passionate about supporting the rights of people with learning disability to lead happy and fulfilling lives and to achieve as much independence as possible. They said “Our vision is about enabling people to receive their maximum potential - and never assuming they’ve reached it”. The registered manager, working closely with the office manager and service manager, demonstrated their commitment to providing high quality, well-led and inclusive support to each person receiving a service. They had effective systems in place to assess people’s needs, recruit and train dedicated staff and to monitor the quality of the support services they provided.

People either told us directly, or indicated through their demeanour, they felt safe, were happy and staff were caring. We saw people approaching staff with confidence and smiling and laughing, indicating they felt safe in their presence. One person said about their home, “It’s safe, cosy, funky and fantastic”. Relatives had a high level of confidence in the service providing a safe environment for their relatives to live. One relative said “Everyone living in the house is secure, happy and confident. I trust them all implicitly with my daughter’s safety”. We saw staff treating people with great respect, kindness and patience throughout our inspection.

People benefitted from detailed planning and assessment before they were offered a service. This ensured the compatibility of people living together in each house. Support was developed based on people’s needs and aspirations. Great emphasis was placed on people’s rights to make their own decisions and choices as far as they possibly could and people were supported to do this. For example, through the use of skilled communication, advocacy and involvement of people’s circle of support. People and relatives we spoke with expressed a high level of satisfaction.

Person centred plans were developed with the person and people who knew them well. They were personalised and contained a range of formats including symbols, pictures and words to help the person understand their plan. Care plans guided staff in relation to the detailed support people needed to manage their day to day needs. They offered clear guidance for staff in relation to people’s individual social and personal care needs at different times of the day. This included their likes, dislikes, medicines, any healthcare needs and potential areas of risk.

Attention was given to people’s physical and emotional care needs. For example, some people had serious long term health conditions such as diabetes and epilepsy and their care plans gave staff detailed guidance on managing this. Staff were all confident about how they supported these aspects of peoples care needs. Alongside this, some people had specific emotional care needs. For example, following the passing of a much loved parent. Care plans showed one person was receiving individual therapy to support with issues of change and loss and guided staff about supporting their emotional wellbeing. For example, by planting flowers and lighting a candle on significant anniversary of their parent’s death and having time with their family.

Risks to people’s safety and well-being had been assessed and were clearly identified. Management plans had been developed to ensure staff knew how to support people safely and in a way that was individual to that person. Staff were confident and knowledgeable in this area. Relatives we spoke with were pleased with the service’s approach to managing risk without limiting people’s independence. One relative said “The support for increasing [name of relative’s] independence is managed perfectly and with clear achievable goals; never compromising her safety”. Another relative said “She can take risks in a safe way. She’s done so much more here than I would have ever allowed and that is brilliant for her. She is a young woman after all. It’s the right thing.”

The service promoted improving people’s independent living skills to become less dependent upon staff and enjoy more fulfilling lives. We saw and were told about many examples of people achieving levels of independence they or their relatives had not thought possible. For example, people had learnt to use ‘smart’ mobile phones which enabled them to maintain their safety by keeping in touch with staff when they were out.

Relatives praised how staff enabled people to grow in confidence and independence. One relative said, “They’ve given her independence and self-determination. They’ve worked with her to understand her responsibilities and to grow in confidence to try so many new things”.

Staff worked with families to enable people to achieve their full potential. Relatives told us how their relationships with their adult children had improved through the support the service offered. This enabled them to spend positive and relaxing time with them, which they had not been able to before.

People were supported to maintain good health and had access to healthcare services where required. Records showed people had seen their GP for an annual health check and everyone had a ‘hospital passport’ containing important information, should they need to go into hospital. People were accompanied to appointments by staff wherever necessary. Relatives told us staff were very quick to pick up on any changes to people’s health. One person had recently been diagnosed with Type 1 diabetes and this had been identified quickly by the registered manager. This relative said “They [staff] have handled it absolutely brilliantly. I was concerned her independence would be curbed, but that hasn’t happened at all. Staff have supported her to manage blood tests, kept an eye on healthy eating and diet. Just brilliant”.

Where able, and risk assessed as safe, people were involved in administering their own medicines. Records of medicines administered confirmed people had received their medicines as they had been prescribed. Staff had received training to administer people’s medicines safely and were knowledgeable about people’s medicines. Records showed senior managers had assessed staff’s competency to administer medicines.

People benefited from having a stable staff group who they knew well. The registered manager told us they were able to maintain their principles and purpose by remaining a small organisation, with a stable, well trained staff group who they invested in and valued highly. Staff were safely recruited, well trained and happy and motivated within their jobs. One member of staff told us “We are a dynamic and passionate staff group. Always willing to learn and strive for the best for people – and that’s the culture here”.

Staff had received training in, and had an awareness, of the Mental Capacity Act 2005. People were supported to make decisions about where and how they wished to be supported. Where people were not able to make decisions about certain aspects of their care and support, best interest meetings had been held with them and the people who knew them well to decide on the most appropriate support.

People were involved in developing the service and were supported and encouraged to share their views about the support they received. The registered manager told us they monitored the quality of the service provided in a variety of ways including weekly meetings with people as well as management, staff and house meetings. Surveys were also used to gain people’s views.

People had access to the complaints procedure that was presented in accessible formats, including pictures and symbols to help them understand it. Staff checked with people at their weekly meetings if they were happy with the service they were receiving. Relatives told us there was an open door policy that meant they could contact the registered manager at any time of the day or night if they had any concerns. They had total confidence that, should they have any issues or concerns; these would be dealt with openly and transparently.

Health and social care professionals told us the service was committed to providing person-centred support and championing the rights of people with disabilities. They told us staff at the service always went “the extra mile” to enable people to make choices and take as much control of their own life as possible.

We visited two of these houses on the first day of our inspection. We met with four people who used the service and also spoke with the registered manager, and five support workers.

On the second day of our inspection we visited the service's main office in Dawlish. We spoke with the administrator and both of the providers one of which is also the registered manager.

Following our visit we made contact with a health professional and three representatives of people using the service to ask their views.

One family representative told us, 'we are very happy with the values of the service and attitude to promote independence'.

We saw that care plans were comprehensive and reflected the individual needs of the person they related to.

The service had suitable arrangements in place to protect people from the risk of abuse.

We found that people's medication was managed in a safe way.

The provider had an effective system in place to regularly assess and monitor the quality of the service provided.

We saw that the people living in the houses were encouraged and supported to be independent and make their own choices. Risks has been assessed and process put in place to minimise them without having a negative impact on people's lives.

Staff were happy and we saw that they knew each person and worked with them well. We spoke with two staff members who told us that they felt supported by the provider. They said that training was good and they were able to ask questions or advice at any time. People were cared for in a safe environment and told us they felt safe and secure.

The provider had and effective system to regularly assess and monitor the quality of the service that people receive.