One to One Plus South

One to One Plus South provides personal care and support to people in their own homes. Personal care and support is provided for people living with a learning disability or autism. At the time of the inspection personal care and support was provided to 23 people in seven supported living services, which are houses privately rented by people. The supported living services are staffed over a 24-hour period and people are supported with social care needs such as, activities and occupation, as well as their personal care. The Care Quality Commission inspects the care and support people receive in supported living homes, but does not inspect the accommodation people live in.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing 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.

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.

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. There was, however, a lack of clarity in care records regarding consent to care and treatment and when best interests decisions were made on behalf of one person whose liberty was restricted for their own safety. Staff were not clear about the correct procedures they needed to follow to ensure legal safeguards were followed when people did not have capacity to consent and where their liberty was restricted. We have made a recommendation about this.

Medicines were safely managed.

Staff had a good awareness of the importance of protecting people and what to do if they considered people were not being treated appropriately. Risks were assessed and there were procedures for care staff to follow to ensure people were safely supported. Sufficient numbers of staff were provided to meet people’s needs. Checks were made on the suitability of new staff to work in a care setting. Staff were trained in infection control and had access to protective clothing to help prevent the spread of infection. The provider had a comprehensive system to review any accidents or incidents and when lessons could be learned.

Care staff were supported well and had access to a range of training courses including nationally recognised qualifications in care.

People’s nutritional needs were assessed and people were supported with food and drinks. Health care needs were assessed and the provider worked well with other health and social care services to ensure care needs were met.

Care staff treated people with dignity and respect. People were supported to make decisions about their care and support which promoted their independence. Care staff had a good understanding of the need to ensure people’s privacy was upheld. People and their relatives said they were very satisfied with the service. For example, one relative said, “We are very happy with the service. If I had to score it out of 20 I would give it 40.”

People’s needs were comprehensively assessed; this included assessments of people’s behaviour needs by the provider’s own behaviour consultant. Each person had care plans which reflected their needs, preferences and choices. Relatives told us the staff were responsive to people’s care needs and ensured person centred care was provided. People’s communication needs were assessed to a good standard and staff were trained and skilled in communicating with people.

Relatives said they had a good dialogue with the care staff and management team and felt able to raise any concerns or issues were always responded to.

The service was well-led and was responsive to the challenges it faced. The provider had systems to assess and monitor the quality of the service as well as plans to develop and improve. This included seeking the views of people, their relatives and staff about the quality of the service. Staff were supported to develop their skills and knowledge.

Further information is in the detailed findings below.

This inspection was announced which meant people, the registered manager and staff knew we were coming shortly before we visited the service. The provider was given notice because there are different locations providing a supported living service for adults who are often out during the day. There is a main office from which the service is managed and we needed to be sure that someone would be in and people would be available to talk with us.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 management structure for One to One Plus South consists of a registered manager who is the operations director for Kent, Surrey and the South East. There are then three locality mangers that cover Brighton and Hove, Worthing and Littlehampton.

At one of the locations where support was provided there had been significant concerns reported in relation to medicines management, staffing levels and staffing support. As a result of this a new management team was recently in post and an action plan was being worked to with the local authority to ensure improvements were being made. We saw this to be the case on the day of our inspection but also that these changes needed to be embedded and sustained. We therefore identified this as an area that needs improvement.

There were clear lines of accountability. The different localities had good leadership and direction from the registered manager and operational oversight from the locality managers. Staff felt supported by their managers to undertake their roles. Staff were given regular training updates, supervision and development opportunities. Peoples relatives, staff and professionals who knew the service spoke positively about the registered manager and locality managers and said they were always available when needed. A staff member said of their manager “I do feel really supported by my manager, they always respond if there is a problem”

People told us they felt safe and were happy with the support they received from One to One Plus South. One person told us, ““I feel safe; the staff look after me well”. People were safe as they were supported by staff that were trained in safeguarding adults at risk procedures and knew how to recognise signs of abuse. Medicines were managed and administered safely. Accidents and incidents had been recorded and appropriate action had been taken and recorded by the manager.

We saw people were supported by staff that knew them well, gave them individual attention and looked at providing additional assistance as and when required.

Staff, the registered manager and locality managers were knowledgeable about the Mental Capacity Act 2005. They were aware this legislation protected the rights of people who lacked capacity to make decisions about their care and welfare.

Staff received training to support them with their role on a continuous basis to ensure they could meet people’s needs effectively.

The staff team were responsive to people’s social needs and supported people to maintain and foster interests and relationships that were important to them. People were central to the practices involved in the planning and reviews of their support. People were encouraged to be as independent as possible. One relative said of their family member that staff were “Challenging him to reach goals and develop”.

People received regular assessments of their needs and any identified risks. Records were maintained in relation to people’s healthcare, for example when people were supported with making or attending GP appointments.

People told us that staff were kind and caring. One person told us about staff, “I love them all, they keep me safe and look after me”. We observed staff treating people with dignity and respect and involving them in their care.