This inspection was carried out by a social care inspector over two days. We were accompanied by staff from the local authority to two of the projects managed by the service, following an allegation of concern about short staffing arrangements. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;
' Is the service safe?
' Is the service effective?
' Is the service caring?
' Is the service responsive?
' Is the service well led?
Due to the complex needs of the people using the service we were unable to gain some people's views. We therefore used a number of different methods to help us understand their experiences. This included observing how staff supported people, speaking with staff and checking records. If you want to see the evidence supporting our summary please read the full report.
Below is a summary of what we found.
Is the service safe?
We observed care and support was delivered to people who used the service in a safe way by staff who had received appropriate training.
We saw that systems were in place to make sure managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helps the service to continually improve.
There was evidence that robust background checks were carried out on new staff before they were employed, to make sure they were suitable to work with vulnerable people. We saw that checks with the Disclosure and Barring service (DBS) were renewed for staff every three years.
The service had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure people's human rights were protected. Relevant staff had received training on this to enable them to understand when an application about this should be made and how to submit one. This meant that people's rights would be safeguarded as required.
Is the service effective?
We found people were encouraged to express their views about their support and be involved in making decisions about this. Staff we spoke with gave us examples of how people were involved in making decisions about their care and support.
We saw that people's health and support needs were assessed on a regular basis. We found that people who used the service and their relatives had been involved in the development of their plans of support and these were reviewed and updated.
Staff received appropriate professional development. We saw that staff had access to a variety of appropriate training to help them meet the needs of the people they supported.
Is the service caring?
We observed staff interacted with people in a kind and friendly manner and had a good understanding of people's individual needs. We observed people appeared comfortable and at ease with the staff.
We observed care staff were considerate of people's needs and responded to them in a compassionate and professional manner. We saw care staff communicated sensitively with people using a variety of signing and touch when required, giving them time to respond.to what was being asked. We saw that people were provided with support that was appropriate for their needs and that encouragement was provided to help them be as independent as possible.
Care files contained detailed information about people's needs, including what was important to them and how to support their personal aims and goals. We saw that care and support was provided to people in accordance with their individual preferences.
Satisfaction surveys and review meetings were used by the provider to enable people and their representatives to share their views on the quality of the service provided. This helped the provider to assess the quality of support people received.
Is the service responsive?
Care records demonstrated that when there had been changes in people's needs, outside agencies had been involved, to make sure people received the correct care and support.
Records showed people had access to a variety of social activities. During our visit we observed people being supported to go out into the community and participating in stimulation activities.
The service had a complaints procedure which was available to people who used and visited the service. There was evidence the provider listened to people's views and followed up their concerns appropriately to put things right.
Is the service well-led?
Whilst we saw that learning from incidents / investigations took place, there was evidence the quality assurance system for this could be further improved. We saw medication omissions had been previously identified from audits of the service and that a new medication strategy implemented following this. We checked the medication records in one of the projects and saw evidence that recent audits of these had failed to identify when staff had not signed appropriately for these. We also found evidence, in one of the projects, that staff were not providing the specified hours commissioned for one individual and were unable to find evidence this had been reported to the provider.
Staff were clear about their roles and responsibilities. We saw that staff had access to policies and procedure to inform and guide them in their work. There was evidence staff training and development needs were assessed by the provider to ensure staff were able to meet people's needs and help the provider to arrange future training when this was required.
The service worked well with other agencies and external services to ensure people who used the service received care in a joined up way.
What people who used the service, and those that matter to them, said about the care and support they received:-
A relative told us they, 'Couldn't be more satisfied' with the service provided and that staff had 'Given structure and put boundaries in place.' They told us the service maintained good communication with them about their member of families complex needs. They said, 'All credit to the carers'they take advice and are open and welcoming.' The relative told us they were included in decisions about support that was given and 'Feel part of the team.' They told us they had, 'An open relationship with Creative Support and staff.'
Another relative told us, 'We are very pleased with the service'.xxxx loves it there.' 'It was the best thing we ever did.' They told us, 'Staff look after xxx very well' and trusted the staff.
Relatives all told us they had confidence in the provider to put things right when required and knew how to make a complaint if this was needed. One told us they, 'Speak up if needed' whilst another told us, 'They listen to us and keep us informed 'issues are dealt with quickly.'
We saw recent comments from a social care professional in a recent survey that stated, 'I raised my concerns with the manager and felt they were listened to and compromises made to make things better.'