HF Trust - North Cornwall

People’s experience of using this service: People were supported to develop and maintain their independence and have choice and control over their daily lives. Staff supported people according to their individual preferences and needs. There was a drive to deliver person centred care which focused on getting the best outcomes possible for people.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; independence, choice and control over day to day routines and inclusion and involvement in the local community. People's support focused on them having as many opportunities as possible for them to gain new skills and develop and maintain their independence.

People were supported in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff told us they were well supported through supervision and staff meetings. They commented on the availability of registered managers for support, advice and guidance at all times. Training covered a wide range of areas and was regularly refreshed. Staff were able to request additional training to meet people’s specific needs.

Where restrictions had been put in place to keep people safe this had been done in line with the requirements of the legislation as laid out in the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards. Any restrictive practices were clearly recorded and regularly reviewed to check they were still necessary and proportionate.

People were involved in planning their care and decisions about how care was delivered. Easy read information was provided to help people make informed decisions. Where necessary other supporting information was provided such as visual and audio materials. We observed people were in charge of their routines and were able to request support when they needed it.

The service was exceptionally well-led. Staff told us they enjoyed working at the service and that HF Trust was an excellent organisation to work for. Staff were encouraged to develop their skills and contribute to the running of the service. The registered managers were enthusiastic and keen to share their experiences with us. They had high expectations for people and this was shared with the staff team.

At our previous inspection the service was rated Good. (Report published 27 September 2016)

Why we inspected: This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned based on the rating. If we receive any concerns we may bring our inspection forward.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was a registered manager in post who was responsible for the day to day running of the service. 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.

People told us they were happy with the support they received and felt safe. We observed people as they were being supported by staff. We saw they were relaxed and comfortable in their home and with the staff supporting them. Staff were warm and empathetic in their approach to people and there was laughter and gentle teasing between people and staff. Relatives told us they were confident their family members were safe and one commented; “We all work together, they know [person’s name] and me and my family.”

Staff knew the people they supported well and had a good understanding of their needs. Sometimes agency staff were used and there were systems in place to help ensure they had access to all important and relevant information to enable them to support people according to their plan of care. Recruitment practices were robust and people were involved in the process in a meaningful way. The induction process covered all relevant training and this was refreshed and updated regularly.

Staff were positive when talking about the people they supported and spoke of them with affection. This was reflected in the written documentation which emphasised people’s abilities and positive characteristics. People were supported to access the local community and take part in activities, work placements and attend college. Technology was used to help people develop and maintain their independence. For example, one person had automated alarms on their doors to enable them to be on their own without support when they wished while staying safe.

Some people had restrictions in place in order to keep them safe. The registered manager had a clear understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Mental capacity assessments and best interest meetings had been carried out as required. Senior staff had identified where it might be necessary to apply to the Court of Protection to authorise a deprivation of liberty and highlighted this to the local authority.

Care plans were kept on HF Trusts electronic system. These contained a great deal of information which was often repetitive and might be difficult for staff to assimilate. Accompanying ‘Who Am I’ documents were more succinct and relevant to people’s everyday needs. Paper copies of these were kept at people’s homes as working files which staff could refer to at any time.

There was a management structure in place which provided clear lines of responsibility and accountability both at local and regional level. There had been recent changes to the way the staff team was structured within the supported living settings. Although staff had concerns about the impact of this they told us that it would be reviewed and were confident any concerns would be listened to and addressed.

The manager and staff monitored the quality of the service by undertaking a range of quality audits and speaking to people to help ensure they were happy with the service they received. In addition regular audits were carried out by HF Trust’s head office.

Everyone we met looked well cared for. Typical comments from people who used the service included, 'the staff are very helpful, they are very nice people and they support me when I ask for their help.' We saw that people who used the service had given consent to their care.

Documentation regarding the service was to a good standard. For example care plans provided clear information regarding care and what support staff needed to assist people with. Medication practices were completed in line with policies and procedures.

Staffing levels were good, and there was evidence that staff had received training and support.

A satisfactory quality assurance system was in place.

We met one person who had spoken out about someone who had sent them abusive messages on a social networking site. They showed us a presentation they had given to a large meeting encouraging people not to agree to communicate with strangers on networking sites.

We saw people using a day care service. Some people were playing music, others were painting and there was a discotheque which people told us they were enjoying.

One person told us they had recently moved house. They had been unhappy and felt socially isolated. They felt able to voice their unhappiness at a 'speak out' event which was held weekly, facilitated by staff from the trust.