Archived: Community Choices

Updated 21 June 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.

This comprehensive inspection took place on 25 and 30 April 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit because it is spread over two locations and we needed to make sure the provider was in and available to speak with us.

The inspection team consisted on one adult social care inspector. Inspection site activity started on 23 April and ended on 25 May 2018.

The provider had previously been responsible for delivering a personal care service to people living at another service. A different provider owned this service who subcontracted the personal care element of their service from this provider. The arrangement had been agreed by the Care Quality Commission (CQC) registrations team under a ‘shared care agreement’. At the time of writing this report, the provider confirmed in writing that this specific arrangement had ceased; the service had now been sold with legal contracts exchanged. Therefore, these locations were not included in this inspection.

Before the inspection we reviewed information available to us about the service. The provider had completed a Provider Information Return (PIR). The PIR is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed safeguarding alerts, share your experience forms and statutory notifications that had been sent to us. A notification is information about important events which the provider is required to send us by law.

The inspection was informed by feedback from questionnaires completed by a number of surveys sent to care professionals and staff before the inspection took place. CQC sent surveys to eight staff and received five replies and seven surveys to professionals and received three replies.

We visited and spent time with all five people living in both locations. Two people were able to give verbal feedback of their experiences at the service and three were unable to. We observed their body language and interaction with staff throughout the two inspection days. We also received feedback from three relatives and two social care professionals.

We met and spoke with the provider, deputy manager and five care workers.

We reviewed information about people's care and how the service was managed. These included: two people's care files and medicine records; three staff files which included recruitment records of the last staff to be appointed; staff rotas; staff induction, training and supervision records; quality monitoring systems such as audits, spot checks and competency checks; complaints and compliments; incident and accident reporting; minutes of meetings and the most recent quality questionnaire returned.

Updated 21 June 2018

This comprehensive inspection took place on 25 and 30 April 2018 and was announced. The provider provided care and support to people living in two ‘supported living’ locations in North Devon. These were Manor Lodge in Bideford and Lower Fisherton in Umberleigh. The service supported five younger people living with a complex learning disability or an autistic spectrum disorder.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Manor Lodge was a ‘single house in multi-occupation’ where four younger adults lived together. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom and kitchen facilities. Each person had their own bedroom on the upper floor and shared a living room, dining room, conservatory and kitchen on the ground floor. There was also a small office and staff sleep in facilities. The service was situated in a quiet residential area and had large outdoor space.

Lower Fisherton was a large house currently occupied by one younger adult only. They had full use of the house and staff had office and sleep in facilities. The service was situated in a very rural area with no close neighbours and had outdoor space.

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 our last comprehensive inspection in April 2016 we rated the service Good. At this inspection we found the evidence continued to support the overall rating of Good. There was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good:

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.

The provider and support workers delivered care and support which took into account people's individual choices and preferences. People were seen to be very happy and content at the service and positive interactions took place with staff. Staff treated people with respect, dignity and respect at all times. Meaningful relationships had been developed with the support workers who looked after them. Families and friends were involved in people’s on going care, support and wellbeing.

People were encouraged to be as independent as possible and develop individual activities, hobbies and interests. They felt safe and trusted the staff who supported them. Two people said, “All the staff are really kind to me … they really respect me here … I like everybody” and “I am very happy here … I’m a lot happier than my last place …I get to go all over.” People were encouraged to establish community links and take part in things that mattered to them.

People were kept safe and supported by care workers who were aware of their safeguarding responsibilities. There had been one recent safeguarding concern which had been investigated and resolved by the local authority safeguarding team. Support workers were safely recruited, trained and supervised in their work. They enjoyed their jobs, felt very passionate about their roles and were complimentary of the staff team. Comments included, “They (people) actually do what they want to do” and “If you enjoy your job you never have to work a day in your life … it’s brilliant here …we are a really good team who are passionate in what we do.”

People and relatives had confidence in the management of the service and the provider’s management skills. They were confident any issues would be dealt with appropriately. One relative commented, “(The provider) is approachable, professional, warm and popular with us and his staff … he provides any required action plans and outcomes are communicated effectively.”

People were supported by adequate staff levels to meet their needs. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes.

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 support this practice. Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.

People and relative’s views and suggestions were taken into account to improve the service. Regular feedback was sought from them both informally and formally through questionnaires. Health and social care professionals were involved when necessary. People and relatives knew how to make a complaint. There had been no complaints received at the service since our last inspection.

People were supported to eat and drink enough and maintain a balanced diet. Their food choices were reflected in the menus. Medicines were safely managed and procedures were in place, although these could be improved upon.

The provider had a range of robust quality monitoring systems in place which were used to continually review and improve the service.

Further information is in the detailed findings below.