This inspection took place on 28 September and 10 and 11 October 2016. The inspection was announced. We last inspected the service on 24 October 2013 when we found the service to be meeting the standards in relation to all regulations inspected. At this inspection we identified one breach of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which was in relation to governance.The service was registered to provide personal care to people living in their own homes. This included supported living schemes that were based across Greater Manchester and ‘outreach’ services provided across the Greater Manchester and Cheshire areas. The outreach services were provided to children and young people, and primarily consisted of support for them to access leisure activities outside of school hours. However, a small number of people using the outreach service also received regular support with personal care at home. At the time of our inspection, 10 people were being supported who lived in the supported living schemes. The outreach services were providing support to 84 people, although not all of these people were receiving support with the regulated activity of personal care.
There was a registered manager 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.
People using the service, relatives and carers we spoke with all told us they were very satisfied with the service provided by Together Trust. Relatives told us the service was responsive and listened to them.
People using the service were supported by consistent staff teams, which helped staff get to know people well. Some people supported by the outreach service had one regular support worker who worked with them, and people in the supported living services had small teams of regular staff. The provider ensured there was sufficient time for people to get to know new members of staff if they needed to introduce a new staff member to the teams.
The service had access to in-house professionals including a psychologist and speech and language therapist. Relatives told us input from such professionals had helped their family members progress and build confidence. Staff worked alongside these professionals to provide effective support to people that reduced the need for reactive strategies to behaviours that could challenge the service.
Staff worked in ways to help ensure people were provided with the care and support they needed in the least restrictive ways possible. Staff were positive about supporting people to develop their independence and to build their skills. This including using special support approaches that staff had received training in to help people engage in tasks such as preparing drinks or meals.
Staff told us they were well supported and received good quality training that supported them in carrying out their role effectively. We saw staff had been trained in a variety of topics, including training in autistic spectrum disorders, safeguarding, medicines and positive behavioural support. Staff received regular supervision that helped ensure their competence.
Staff were motivated and committed. They spoke positively about the people they provided support to and were proud of the progress they had supported people to make. Staff were consistently positive about Together Trust, who they told us were supportive and interested in providing effective person centred support.
Peoples’ support plans were person centred and identified their needs, preferences, strengths, goals and interests. We saw staff had regularly reviewed and updated support plans to ensure they reflected peoples’ current needs. However, we found one care plan contained contradictory information in relation to monitoring a person’s weight. The registered manager told us they would ensure this detail was clarified.
The service had taken appropriate steps to manage risks to people’s health and wellbeing. However, we saw such steps were not always clearly recorded in people’s risk assessments, which would increase the risk that support, would not always be provided consistently and safely. The provider took prompt action to address this issue shortly after the inspection.
Staff were aware of their responsibilities in relation to safeguarding and told us they would be confident to report any concerns to a manager or team leader. We saw concerns had been reported to the local authority safeguarding teams as required. However, the service had not always notified CQC when they had made such referrals as is a legal requirement. The service did not have a clear recorded overview of safeguarding referrals made, which would make it more difficult to ensure such incidents were adequately monitored.
The service regularly gathered feedback from people who used the service. There were systems and processes in place to monitor and improve the quality and safety of the service. Whilst we were confident accidents and incidents were closely monitored within support teams, this information was not always easily identifiable from the information held within people’s care files or the audit documentation.
Staff had received training in communication, and used communication aids such as pictures to help involve people in their care planning and to assist them to communicate effectively.
People took part in a range of activities including visiting the library, taking part in sporting activities and attending day services. Staff had explored voluntary opportunities for a person who had expressed an interest in gaining work skills.
There was a thorough process in place to help ensure only staff of suitable character were employed by the service.