Background to this inspection
Updated
18 September 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
One inspector undertook this inspection.
Service and service type
This service provides care and support to people living in seven ‘supported living’ settings, so that they can live 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.
The service did not have a manager registered with the Care Quality Commission. However, a manager had been appointed and was in the process of becoming registered. This means that, once registered, they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. The manager was supported in their role by a service manager and an assistant service manager who managed the service on a day to day basis.
Notice of inspection
We gave the service 72 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who worked with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We met with two people who used the service and spoke with two relatives about their experience of the care provided. We spoke with the regional operations manager, the service manager, assistant service manager and 10 care workers. We also spoke with a professional who had recently provided support to the service.
We reviewed a range of records. This included two people’s care records and medicine records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, training records and internal quality assurance processes were reviewed.
Updated
18 September 2019
About the service
Totnes Domiciliary Care Service (South Devon Support Service) is a supported living service providing personal care and support to people with a learning disability who live in their own homes or supported living accommodation. The service supports some people on a 24-hour basis and others at specific times, enabling people to live independently. At the time of the inspection the service was supporting 12 people, seven of whom lived in two shared homes, and five lived in their own homes. Nine people required support with their personal care. Where staff were required to support people overnight, there were sleep-in facilities.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.
As part of thematic review, we carried out a survey with the management team at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.
People’s experience of using this service and what we found
People received a safe service. People were protected from the risk of abuse as staff received training in safeguarding adults and were aware of their responsibilities to protect people. During our visits we observed people to be relaxed in staff’s presence, and we saw they made eye contact with staff and smiled.
Risks associated with people’s care needs were assessed and management plans guided staff about how to mitigate risks and what action to take in an emergency. Where people exhibited behaviours that could place themselves or others at risk, they were supported safely without imposing unnecessary restrictions on them. People’s medicines were managed safely.
Staff were safely recruited and well trained. The services supervision and appraisal systems provided staff with opportunities to develop their career. People and relatives were involved in the selection of staff.
Care plans were detailed and described people’s support needs and how staff should provide care in line with their preferences and best practice. Staff worked closely with other healthcare professionals to ensure people’s needs were well understood and met.
The service respected people’s rights to make their own decisions and staff had a good understanding of the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were treated with respect. Staff told us the service was inclusive and supported people’s relationships with others, including those of same sex relationships.
People’s independence was promoted, and emphasis was placed oin developing people’s skills and confidence. People were supported to engage in hobbies and interests in the local community.
The service applied the principles and values apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. Staff spoke fondly of the people they supported and said their aim was to ensure people were as happy as possible and to give them a good quality of life.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
The service was managed well. Relatives and staff spoke positively about the management team and how the service was run. Feedback was used to improve the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 28 February 2017).
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.