SENSE Community Services and Supported Living (South West)

Sense Community Services and Supported Living (South West) provides an outreach service and supported living service for deafblind adults who are dual or single sensory impaired with additional physical or learning disabilities. The location headquarters is at Providence Court. The provider is Sense, a national charity organisation for people who are deafblind. The term 'deafblind' covers a wide range of people, some of whom may or may not be totally deaf and blind. At the time of this inspection there were nine people who received support from the service in a supported living setting and 12 people receiving an outreach service.

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:

People were supported by staff who were passionate about giving people the right support. The staff team were exceptionally sensitive to the needs of people with sensory loss. Staff understood the things that were important to each individual, including the small everyday things that people with full hearing and sight may take for granted, such as who was in the room with them, and what other people were wearing. People wanted to know about the colours around them, the plants in the garden, and if there was a rainbow in the sky. They also enjoyed a joke. The skilled support from staff enabled people to experience the world around them, and to feel connected to friends, family and the local community.

People were truly respected and valued as individuals. Staff were sensitive to people’s feelings, worries and concerns and used their communication skills to help people express their feelings. member of staff told us, “When people feel emotional staff give people time to sit and chat”. People told us they felt safe in the service. Staff knew how to protect people from all forms of abuse or discrimination. The service considered innovative ways of helping people gain independence and achieve goals and wishes, and at the same time remain safe, for example through the use of technology.

Staff were highly skilled in using the appropriate communication methods for each person. We observed staff using British Sign Language fluently. People and staff enjoyed sharing a joke. We observed people and staff laughing and enjoying lots of friendly banter through the use of sign language. People told us the staff were well trained, and the records we saw supported this. There was a stable and consistent staff group who people knew and trusted. Staff were recruited safely and there were enough staff available to meet people’s needs. Staff were flexible, and willing to work at times to suit each person, which meant people were able to go out, and to do the things they wanted, when they wanted. Staff received good induction and ongoing training and updates on a range of topics relevant to people’s needs.

People were empowered to realise their full potential and achieve their dreams and goals. The service employed specialists such as art therapists, and also worked with external specialists to support people to learn new skills. Staff were exceptionally skilled in recognising people’s abilities and talents and giving them the confidence and emotional support to succeed. Staff were passionate about embracing people’s interests. We saw examples of colourful and skilled artwork, and heard about the many hobbies and interests people participated in. We also heard how some people’s lives had been transformed since they began receiving support from Sense. A relative told us, “Its heaven for [person]. She can do so much here. She has come out of herself.”

People were fully involved and consulted in every aspect of the support they received. A person who was deafblind told us, “I have a support plan. I give feedback on the plan. I give text feedback on the plan. It's all good. I use Braille. I can make changes and edits. I am confident the staff follow the care plan”.

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. If people lived in settings that did not give them the freedom or independence they wanted, the service worked with other agencies such as housing associations to help them find a place to live that better suited their needs.

The service was well-led. The well-established staff team were highly motivated and told us the registered managers were supportive. There were good quality assurance systems in place and people were consulted and involved in making positive improvements to the service. A person told us about the service they received and said, “Well I think it's outstanding!”

Rating at last inspection: The previous inspection took place on 23 September 2016 when the service was rated as Good overall, with Outstanding in the Responsive domain.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.

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

Sense Community Services and Supported Living (South West) supports deafblind people who are dual or single sensory impaired with additional physical or learning disabilities. The location headquarters is at Providence Court. The provider is Sense, a national charity organisation for people who are deafblind. The term 'deafblind' covers a wide range of people, some of whom may or may not be totally deaf and blind.

The service is registered with the Care Quality Commission (CQC) for the provision of personal care in people’s own homes. This includes assistance or prompting with washing, toileting, dressing, eating and drinking. At the time of the inspection the service supported nine people under a ‘supported living’ arrangement in five single and shared occupancy houses in Exeter, Poole and Havant. The service was responsible solely for the provision of people’s support services and not for the provision of their accommodation. This meant people had individual tenancy agreements and their personal care was provided under a separate contractual arrangement. In addition, the 'intervenor' service provided specialist one to one support to nine adults, communication support worker services supported one adult and the day service community support worker supported one adult. The role of the intervenor is to help the deafblind person interact and communicate with the outside world. These people lived in a variety of settings, including with families, in an adult placement and in a residential home. The service also provided other forms of social care support that are not included within CQC’s registration requirements for a supported living service. In addition to personal care support, the service assisted people with their housekeeping, shopping, social and employment activities, attending appointments and other independent living skills. Providence Court provided a day service and was the home of Café 55, run by deafblind and disabled volunteers and open to the general public.

At the time of the inspection a management restructure was underway. The intervenor service was managed by a person who was registered with the Care Quality Commission as the registered manager for the service. Two new managers were managing the supported living services and in the process of registering with the Care Quality Commission. The previous registered manager for the supported living services was now, ‘operations manager’ for the region. 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.

Staff really enabled people to live meaningful and fulfilling lives; working in partnership with them to identify and achieve their personal goals. They were available to support people with personal care when needed, but the focus was on providing practical support while promoting people’s independence. This boosted people’s confidence and self-esteem and they told us how proud they felt when they achieved their goals.

People engaged in a wide range of activities of their choosing. The service assisted people with work placements, holidays, budgeting, safety, family contact, social networks and clubs. Recently people had created a play with a drama therapist, and performed it at a local theatre. Another person had helped to raise awareness about Sense by making a video about the intervenor service and doing a presentation to health and social care students at a local college.

A manager told us, “Genuinely the people we support are at the centre of what we do… They choose what they do. They tell you what they want”. The service worked to ensure that people were fully and meaningfully involved in decisions about their care and the way the service was run. Where possible, people and their families were supported to recruit their own staff team and instruct them on how they wanted their care to be provided. Some people kept their own daily records in a format of their choosing. The service ensured people were able to contribute by using a wide range of communication methods, according to their individual needs, like giving staff smart phones to create a pictorial record for people to use in their reviews. Where people did not have the capacity to make decisions for themselves, for example about going to the dentist, they were fully supported to express their views during the best interest process, using photographs of the dentist to facilitate discussion.

Each person had a core team of support staff, and the majority had worked for Sense for a long time. This meant people knew the staff who supported them well, and the staff had a detailed knowledge of their needs and preferences. We found staff were motivated and committed to valuing people and their achievements and supporting them to fulfil their potential.

Care plans were clear and contained detailed guidance for staff to help them promote people’s ability to make choices and meet their support needs effectively. People told us they were happy with the personal care and support they received from the service. One person said, “The carers are kind and respectful, they support me to be more independent” The relative of a person with complex support needs said, “For anybody who has complex needs like [person’s name] I think it’s an absolutely fantastic service”.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff had received a range of training and information including safeguarding adults and safeguarding children. They were confident they knew how to recognise and report potential abuse.

Systems were in place to ensure people received their prescribed medicines safely. People were also supported to access other health and social care professionals to maintain good health and well-being.

Staff told us they were well supported by the provider, managers and each other. They received a thorough induction and ongoing training which allowed them to meet people’s needs effectively, and continue to develop professionally. Some training in British Sign Language (BSL) was given by people who used the service. Staff whose first language was BSL were able to access additional support, such as interpreters, and the service was considering how to make their professional development more accessible by making it more competency based. Staff received regular one-to-one supervision and attended staff meetings. They were kept informed and up to date via staff publications, briefings and Sense’s intranet site, where there was an area dedicated to practice sharing and recognising best practice.

People and their relatives told us the management and staff were very accessible and approachable. They said they could raise issues or concerns with any member of staff or with the managers and were confident they would be dealt with effectively.

The provider had a range of monitoring systems in place to check the service was running smoothly and to identify where improvements were needed. People and their relatives were encouraged to speak out and raise concerns, complaints or suggestions in a variety of ways. They were asked to complete annual survey forms seeking their views on all aspects of the service. People were invited to contribute to audits of the service, using a ‘personalisation’ tool which allowed them to express what was working for them and what wasn’t. People were also able to express their views through a representative who attended the providers service users reference group (SURG).

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.

If you want to see the evidence that support our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had been supported in an environment that was safe, clean and hygienic. Equipment at the location had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people receiving the service and a member of the management team was available on call in case of emergencies. People using the service were encouraged to be responsible for their own safety, for example through managing their own medication. Most of the activities took place outside the location in the community and we saw on the files that people had individual risk assessments in place regarding their support needs in the community.

The staff, called intervenors, were well supported, receiving regular supervision and annual performance reviews. They also benefited from an intensive induction training programme when they commenced working for Sense. This was augmented by regular on-going training which was delivered either through training sessions or through e-learning. Staff were also encouraged to gain additional qualifications such as learning British Sign Language.

Is the service effective?

The purpose of the service was to enable people who received services to access mainstream community activities. An example of the effectiveness of this was that for the first two hours of our inspection there was nobody in the location. Everyone was out in the community with their intervenor's support. Two people returned to the location for lunch. After lunch one person left with their intervenor to attend sports practice and the second person remained to receive personal support. In the late afternoon a third person came in after a day's activities with their intervenor. All the other people receiving services did not access the location on that day, being collected and returned directly to their homes. One person told us that they chose what they wanted to do each day while another person said that they preferred to have a regular routine. They explained, using signs, what activities they did each day.

Is the service caring?

People were supported by kind and attentive intervenors. The manager explained that staff were called intervenors as they "intervened" between the person and the wider community, acting as interpreters and safety monitors. People got to know their team of intervenors very well and in turn the intervenors knew their people well. The management tried hard to "match" intervenors to people who used the service. Linking people with similar interests. For example one person told us that they liked walking and it was important that their intervenor shared this pleasure as they would be doing a lot of walks.

Over lunch we observed the interactions between people and the intervenors. We saw that there was mutual respect and gentle teasing of each other. For example one person was teasing their intervenor about using incorrect signs.

Is the service responsive?

People's needs were carefully assessed and the files confirmed that their preferences, interests and aspirations had been recorded and the support and activities that they participated in reflected this. Each person took part in an annual review of their service. A report was written that described what they had been doing over the year. People participated in their reviews by preparing photographs of the activities that they had been involved in over the year. People chose who to invite to their reviews. At the review people discussed what their future aspirations were. We asked to see the minutes of the reviews and these were shown to us.

The organisation also carried out surveys of how people felt about the services they received.

Is the service well-led?

On our arrival at the location the manager was out supporting a person. They returned at lunch time. The other manager was part time and not due in work until lunch. However their line manager, from Bristol, was on the premises. When we spoke with the managers it was clear that they know the people who use the service very well indeed. They explained that they needed to as they would step into provide support in the event of an intervenor being absent. We were only able to speak with one intervenor, but it was clear that they had a good understanding of their role and the purpose of the service. They told us that they felt well supported by management. Both people that we spoke with also clearly indicated their appreciation of the service they received. One person told us that they had left another day-service in order to maximise their time at Sense.

There were twelve people receiving support services at the time of our inspection. People appeared comfortable whether in the providers central office activity room facilities or out in the community enjoying their daily routines. We saw that staff had a good knowledge of the needs of the people they supported. Staff were observed to address people by their preferred names and were polite and respectful at all times. They checked that people were happy to do things such as assisting with their chosen activities or personal care before supporting them.

We saw that people were safe when receiving the service and their care and welfare were managed in accordance with their care plans. Staff were recruited in line with the providers' policies and were knowledgeable about the needs of people and the level of independence they had. Staff were appropriately skilled and received induction training and support.

Equipment provided was designed to support the services people received and was maintained and checked regularly. There were appropriate systems in place to routinely monitor the records related to the running of the service as well as those about the support needs of people receiving services.