Background to this inspection
Updated
31 August 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 11 and 12 July 2018 and was announced. An adult social care inspector completed the inspection. We gave the provider 48 hours’ notice of the inspection visit to ensure the manager was available. Also, so they could invite people using the service to participate in the inspection.
The provider completed a Provider Information Return, (PIR) which we used to help prepare for the inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, such as contact from the service, members of the public and through notifications. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern.
In preparation for the inspection, we sent 17 questionnaires to people identified as able to able to respond to questionnaires and received six responses. We also sent 17 questionnaires to friends and relatives but received no responses. We sent 25 questionnaires to community health and social care professionals and received three responses. We sent 53 questionnaires to staff and received no responses. (The service thought this was because staff e mail addresses provided had changed during the organisational change).
During the inspection we visited two supported living services and met with 10 people to seek their views about the service. We spent time in communal areas with them and observed their interactions with staff, which helped us make a judgment about the values of the service.
We looked in detail at three people's care records and at their medicine records. We met with the manager, another local manager, the area manager and with three care staff. We spoke by telephone with a team leader and another member of care staff. We looked at seven staff files which included details of recruitment, training, supervision and appraisals. We looked at staff meeting minutes, accident and incident reports, and at records of observations of staff providing care in people's homes. We also looked at the providers quality monitoring systems which included audits of medicines, care records and staff training.
We sought feedback from commissioners, Healthwatch England (the consumer champion for health and social care), as well as from health and social care professionals. We received a response from six of them.
Updated
31 August 2018
This comprehensive inspection took place on 11 and 12 July 2018 and was announced. This was first inspection since a new provider, United Response, registered the service on 27 June 2017.
United Response Supported Living Exeter and East Devon (formerly known as Robert Owen Communities) provides personal care to 12 people in supported living in Exeter, Exmouth and Honiton areas. Support ranged from a few hours a week to 24 hours a day. This was so people could live in their own home as independently as possible. United Response is a UK wide registered charity that supports adults and young people with learning disabilities, including autism, sensory impairment, and people living with dementia, mental health needs and physical disabilities.
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 using the service lived in houses with their own bedroom and shared toilet, bathroom, kitchen and lounge facilities. Everyone paid rent to a landlord and contributed towards shared utility bills and other expenses.
Not everyone using United Response Supported Living Exeter and East Devon receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
At the time of the inspection, the service did not have a registered manager. The previous registered manager had moved to a new post and deregistered. Another manager who worked in the service had taken on the role and was in process of registering with the Care Quality Commission. 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.
People were at the heart of the service, which was organised to suit their individual needs and aspirations. People were supported by exceptionally committed staff that were compassionate and treated them with the utmost dignity and respect.
Care and support was person centred and well planned. People were part of their local community and led interesting and fulfilling lives. Staff supported them to live as independently as possible and do their own cooking, shopping, laundry and housework, according to their ability. People had a wide range of hobbies and interests, and were part of their local community.
Prior to the inspection we received several safeguarding alerts from the service about a person whose behaviours others found challenging. Although none of the people involved received a regulated activity, the service kept us up to date about how they were working with those people and with other agencies to protect them and meet their individual needs.
People felt safe and well cared for by sufficient staff who received good training and support to do their job safely and effectively. The risk of abuse was minimised because staff demonstrated a good understanding of what constituted abuse and knew how to report concerns within the service and to external agencies.
Risk assessments were in place for each person to minimise risks as much as possible in the least restrictive way. People received their medicines safely and on time. Accidents and incidents were carefully monitored, analysed and lessons learnt from mistakes.
Safe recruitment practices were followed before new staff were employed to work with people. People had a range of ways through which they could raise concerns. People’s concerns and complaints were listened and responded to.
People were supported to have maximum 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. People's consent to care and treatment was sought. Staff used the Mental Capacity Act (2005) (MCA) and understood how this applied to their practice.
The service was well led by the manager and area manager, who led by example. Robust quality monitoring systems were used to monitor and continually improve. People, relatives and staff were regularly consulted and involved in developing the service. Staff used evidence of what works best to continually review and improve their practice.