Archived: Somerset Domiciliary Service and Floating Support (Minehead)

Somerset Domiciliary Service and floating support (Minehead) provides personal care and support to people living in their own homes in Minehead and the surrounding areas. The service specialises in supporting people with a learning disability.

This service provides care and support to some people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. 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.

At the time of this inspection the service was supporting eight people with personal care. All the eight people lived in a supported living setting.

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. Registering the Right Support CQC policy

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.

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At this inspection we found the service remained Good.

Why the service is rated Good;

People and their family members were very happy with the service they received. One relative said, “I have nothing but praise for the staff and the management of the service.”

People received a safe service because the provider had systems and processes which helped to minimise risks. This included a robust recruitment procedure and training for staff about how to recognise and report suspicions of abuse.

Staff who supported people had the skills and experience to meet their needs. Staff felt well supported which lead to good staff morale and a happy atmosphere for people to live in.

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. Staff worked in accordance with up to date guidance to make sure people’s legal rights were protected.

People received a personalised service from staff who were kind and caring. Staff supported people to maintain and develop their independence and to achieve their goals. One person told us, “You can do what you want. Staff will help you if you want them to.”

People were supported by staff to take part in social activities and to access community facilities. Risk assessments were carried out to promote independence and enable people to pursue their hobbies and interests safely.

The management structure in the service ensured people and staff had access to, and support from, a competent management team. The provider had systems in place to monitor quality, seek people’s views and plan on-going improvements.

Further information is in the detailed findings below.

Somerset domiciliary service and floating support (Minehead) provides personal care to people in their own homes. Some people who receive the service live in a house with shared communal facilities and some shared support hours but all have individual tenancies. This is known as supported living. The service specialises in providing care to people who have a learning disability.

At the time of this inspection the service was providing personal care to 14 people. Seven people lived in the supported living house and the other seven lived in and around the Minehead area. Hours of support provided to people ranged from four hours a week to 32 hours per week.

The last inspection of the service was carried out in August 2014. No concerns were identified with the service provided at that inspection.

There is 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 registered manager for this service was also registered to manage three other services owned by the same provider. This meant they were not always available at this location and therefore two team managers managed the service on a day to day basis. People described the management of the service as very open and approachable.

People felt safe with the staff who supported them. One person said “They make you feel safe and talk to you about how to keep safe.” People were fully involved in planning their care and support and any risk assessments in place were discussed with them.

There were adequate numbers of well trained and experienced staff to ensure people received the care and support they required. The service was flexible to meet people’s changing needs and wishes.

Staff were well motivated and people described them as friendly and easy to talk with. Staff felt well supported by the provider which enabled them to provide consistent care to people.

People were able to make choices about all aspects of the support they received. People chose when they received their allocated hours and which staff supported them. Staff encouraged and enabled people to maintain and develop their independence.

Staff helped people to access healthcare professionals and ensured they received regular health check-ups. Staff supported people to attend appointments if people wished them to. People were offered advice on healthy eating and staff assisted some people to shop and cook for themselves.

Information was provided to people in a range of formats which meant they had access to the information they needed to make informed choices. Each person had a care plan which was very personal to them and set out their goals as well as their needs.

People were offered a range of opportunities to meet their social needs and staff supported people to find and access community facilities in line with their interests.

There were ways for people to share their views about the service. These included satisfaction surveys and tenants meetings for people who lived in the supported living house. People knew how to make a complaint and were confident that staff would sort out any worries or concerns. One person said “You just tell staff. They’d make things better.”

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. When people displayed behaviour, which challenged others, staff dealt with it effectively and respected people's dignity and protected their rights.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible protect their welfare. People we spoke with told us, 'Staff listen to me' and 'They give me choices.' Staff told us, 'We respect people's decisions as far as possible.'

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The managers and staff understood the requirements of the Mental Capacity Act 2005, its main Codes of Practice and Deprivation of Liberty Safeguards (DoLS) and put them into practice to protect people. This meant that people were protected from discrimination and their human rights were protected.

The service followed safe recruitment practices. People were safe because the service considered skill mix and experience when arranging staffing.

Is the service effective?

We found the service to be effective because there was an advocacy service available if people needed it, this meant when required people could access additional support.

Care plans reflected people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were quickly made to health services when people's needs changed.

Staff had effective support, induction, supervision and appraisal.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. Appropriate professionals were involved in planning, management and decision making. People we spoke with said, 'Staff ask me what I want in my care plan then print it out for me' and 'I get lots of care and support.' Staff we spoke with said, 'We know people's needs really well' and 'It's nice to have the good friendship we've got.'

Staff knew the people they were caring for and supporting. People were as independent as they wanted to be. We saw people were supported to access community activities. People told us, 'I do archery, drama and I work' and 'I do lots of stuff' and 'I went on a course to give me confidence.' One person said, 'It's nice to have independence and freedom.'

Is the service responsive?

We found the service responsive because, where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. When a person did not have capacity, decisions were always made in their best interests. Advocacy support was provided when needed.

People had their individual needs regularly assessed and met. There were arrangements in place to speak to people about what was important to them.

People completed a range of activities in and outside the service regularly. People had access to activities that were important and relevant to them and were protected from social isolation.

Is the service well-led?

There was a registered manager in post on the day of our visit and all other conditions of registration were met.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system, records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuingly improving. Robust quality assurance and governance systems were in place and used to drive continuous improvement.

Managers used information from compliments to extend best practice across the service.

The service supported people to lead independent lives, to fulfil their aspirations and goals. We found that people were confident in their own environment and welcomed us into their home. We observed positive relationships between people and staff who knew each other well. People said 'I look forward to my visits', and 'staff are great'. People told us they enjoyed the independence of living in their own accommodation and were well supported by staff. There were clear communication procedures in place to ensure that people received the support needed.

We examined care files which were detailed, accurate and up to date. We observed people were involved and given choice in all aspects of their care. The staff rota demonstrated that there were sufficient qualified and experienced staff to meet people's needs.

The service worked closely with other providers which meant people could be confident of a coordinated service.

We found that there were systems in place that sought people's views, took account of complaints and comments and learnt from investigation into incidents. People were encouraged to put forward ideas and suggestions for the improvement of the service.

People told us that they had the support and care they needed. We were told staff were very supportive, helped people make decisions and gave them help when they needed it. We were told by one person that staff 'help with managing money took one worry away from me'.

People told us that felt safe and confident that staff would look after them. People told us that they were able to tell staff if they were unhappy and they would act upon any worries they may have. The people we spoke with told us that they liked the staff and when new staff were employed they were introduced to them before they started working with them on their own. Another person told us how they had become more independent since they had had support from the service.

We were told about the staff by one person that they received support from 'a very good team and I get on with all of those who help me.' Other people said or indicated by big 'smiles' or 'thumbs up' that staff were 'ok.'