The inspection took place from 17 June 2015 with home visits being completed by 22 June. Further phone calls were completed by 7 July 2015. The inspection was announced as we wished to ensure there was someone at the office when we visited.
The service specialises in social support and care for people with complex needs related to learning disabilities or mental health diagnoses including people with Autistic Spectrum Disorders. The service is provided to people in their own home and currently supports around 40 people living in Dorset, Bournemouth and Hampshire. Currently eight people are supported with personal care, as defined in the Health and Social Care Act 2008 regulations. The inspection only looked at the service in relation to people receiving personal care as part of their overall support. This is because personal care is a regulated activity.
The service is required to have a registered manager. 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 service had a registered manager in place.
The people receiving personal care had need for support and care on a mostly continuous basis to ensure their safety and participation in everyday life. This was due to people’s learning disability, including some people who had additional physical or mental health needs. Staffing was tailored to each person with small groups of staff providing the service on a rotational basis. Staffing arranged in one geographical area was insufficient which meant one person did not get the care they needed on two occasions during the inspection. These issues were being addressed by the management, however due to the impact on the person we judged the service was not meeting the standard for having sufficient staff available when needed. This was raised with the local authority as a safeguarding issue by another agency who was involved with the person.
Most people could not tell us about their experience so we used observation, speaking with staff and people who knew the person. People were relaxed and happy when we visited. Two people told us they were happy in their home and felt supported to do what they wanted. The service supported people to have regular involvement with their families and friends, depending on individual circumstances. Feedback was recorded from three relatives as part of a recent survey which described their satisfaction with the standard of the service. We spoke with one relative who told us they were happy with the service provided.
People were relaxed and responsive in the presence of the staff providing the service and we observed that positive relationship had been developed. People were supported in a person centred way by staff who were enthusiastic and worked with people to enable them to positive outcomes. They understood their roles in relation to encouraging people’s independence while protecting and safeguarding people from harm.
The service aimed to provide continuity and familiarity between people in the way the service was planned. The service was not responsible for people’s accommodation however we found they had ensured people’s homes were safe and comfortable, through effective liaison with the landlords and other relevant agencies.
The service demonstrated a culture which promoted people’s rights. Risk assessments were used to promote a balance of autonomy and safety for each individual in relation to their day to day care and support. People were supported to visit friends, family and their chosen activities in the wider communities where they lived, however any risks associated with this had been considered and staffing arranged accordingly.
Staff received an induction into the service before starting work on their own, including opportunities for shadowing more experienced members of staff. There was a plan of ongoing training and supervision to ensure they had the necessary skills and knowledge to provide an effective and safe service. The needs of people were taken into account when making decisions about the qualifications, skills and experience required when appointing new staff and in the delivery of on-going training. Plans were in place to make recruitment safer by improving the quality of checking employment history.
Staff received supervision and told us they felt well supported by their supervisors however some staff told us they were worried about pressure on staff on occasions due to staffing shortages.
People’s rights were protected because the management team understood where people did not have mental capacity to consent to their care that decisions had to be made within the framework of the Mental Capacity Act 2005 (MCA). Procedures had been followed appropriately in this area.
People received their medicines safely and staff understood the importance of safe practice in this area including their role in monitoring any symptoms or side effects.
People were supported to have a balanced diet through one to one support in their own home. Some people were supported to be involved in shopping for their food. Written care plans reflected individual preferences and any special dietary requirements.
Staff and managers ensured people had access to healthcare services when needed and worked with a range of health professionals to implement a health action plan for each person.
Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced risk to people who used the service and helped the service to continually improve. The service had addressed a number of issues raised through safeguarding procedures over the last six months. Action had also been taken by the service in response to recommendations made by two of the local authorities which commission the service, following a contract review in January 2015. From speaking with the management of the service and a number of external professionals, it was evident that each party wished to improve the relationship between the service and the commissioning authorities, particularly communication, and a plan was in place to address this.
New systems, policies and procedures had been developed to make sure that any unsafe practice was identified and people were protected. The workforce had been restructured and was in transition at the time of inspection. Recruitment for new roles was in progress and additional training had been delivered and arranged for the future. This was designed to develop the enabling ethos of the service and ensure people's needs were always met.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to how staff were deployed.