The inspection of Community Support Services took place on 24 February and 3 March 2015 and was unannounced. At the previous inspection on 11 February 2013 the regulations we assessed were all being complied with.
Community Support Services provides two bespoke services to people under the East Riding of Yorkshire Council’s (ERYC) registration with the Care Quality Commission for the regulated activity of personal care. These bespoke services are Short Term Assessment and Re-ablement Service (STARS) and Carer Relief. The majority of the carers are registered for Carers Emergency Cover Services which is provided when an emergency or carer crisis occurs. It is available until alternative care arrangements can be made for a maximum of 72 hours. Around 350 carers are registered with the Dementia Sitter Service which gives the carer the opportunity to go out or attend appointments and is available throughout the year, However, there are limitations on the number of visits that can be allocated to each individual carer.
STARS main focus is re-ablement, which is short term practical and emotional support to assist people to gain confidence in living skills, so they can remain at home or move back home with as much independence as possible. People are assessed regarding their re-ablement needs and a support plan with specific goals are agreed with them.
However due to the Local Authority’s duty of care, the STARS team also acts as the provider of ‘last resort.’ When independent providers have no capacity to provide the service requested, STARS have to look at the availability to take on these packages of care. This provision by STARS is usually short term and an interim measure until independent providers have capacity to take these services back.
Carer Relief comprises of ‘carer relief sitting service’ and ‘carer emergency cover’ as well as ‘flexible breaks’ for carers. This service is designed to offer relief to carers who provide support to someone who displays dementia due to underlying conditions or diseases. It offers care to people with dementia so that their carers can have relief from caring or when they may be unable to care for the person with dementia because of an emergency.
STARS has up to 100 people at any one time who may actively receive a service. This is a client group that changes regularly because of the success of the service. Carer relief has around 3000 people that are carers to a relative or someone they know and are registered with the service. The majority of these carers are registered for Carers Emergency Cover Service which is provided when an emergency or carer crisis occurs. It is available until alterative care arrangements can be made for a maximum of 72hr. Around 350 carers are registered for a Dementia Sitter Service which gives the carer the opportunity to go out or attend appointments and is available throughout the year however there are limitations on the number of visits that can be allocated to each individual carer.
Community Support Services has 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.
We found that people that used the service were protected from the risks of harm or abuse because the provider had ensured staff were appropriately trained in safeguarding adults from abuse and the provider had systems in place to ensure safeguarding referrals were made to the appropriate department.
People were safe because whistle blowing was fully understood by staff and was appropriately addressed and investigated by the service where appropriate, or by another Local Authority department if not. Risks to people in their homes were reduced because the service had completed risk assessments on their environment and any activity they undertook.
The staff that worked for the service were in sufficient numbers to meet people’s needs and everyone we spoke with felt the level of support from staff was good and it was always on time. We found that staff recruitment followed safe policies and practices because the service followed procedures that took into consideration the requirements of our regulation on recruitment. We found that the management of medicines and infection control practices were safely carried out.
All of this meant people were protected from the risks of harm that they could be exposed to if staff had not been knowledgeable in safeguarding, were not employed in sufficient numbers, were unsuitable for their roles and if poor practices in medication and infection control were carried out.
People that used the service told us they were cared for and supported by skilled, knowledgeable staff who had undertaken induction and training for their roles. Staff had been appropriately supervised. They adhered to ‘best practice’ as adopted by ERYC and they communicated well to ensure the rights of people were upheld with regard to their mental capacity and any deprivation of their liberty. People were supported with nutrition and achieving optimum health.
This meant that people were well supported and had their needs met with regard to their personal care when needed. It meant they were supported with maintaining their living skills and were encouraged to live healthily. It meant those on the Carer Relief scheme were supported well or just had someone to guide them in the absence of their full time carer, when needed.
People told us they found the staff to be very pleasant, caring and knowledgeable. From the examples that staff related to us about how they had assisted people, we got a good sense of the attitudes and approaches to people that staff had in their caring roles. We found in people’s care files that there was suitably recorded information available to staff to know how best to support them.
Staff displayed empathy, compassion and understanding within their roles and were conscientious about striving to provide an excellent service.
This meant that people were treated with care and consideration, so that they felt the staff were like extended family. This meant they were valued and respected.
People had assessments of need, risk assessments and care plans in place to aid staff in providing the best possible care to them. Social activities were not facilitated by the service but staff did aid people to acquire new or regain old living skills abilities. Staff assisted people with returning to independence.
Everyone that used the Community Support Service had a system in place to follow in the event they wished to make a complaint.
This meant that people received support from staff that was responsive to their individual needs of care.
People received a service that was well managed. It was tailored to their individual needs and times and it was checked on a regular basis regarding the quality of service provision. There was an experienced registered manager in post who was deputised by an equally experienced deputy manager.
This meant that people had the benefit of a well-managed and run service of support. They either achieved the goals of their care plan and returned to independent living or they were signposted to appropriate independent domiciliary care services. Those whose main carer was listed on the Carer Relief register were given the level of service they required in the absence of those carers.