This inspection took place on 20 and 22 September 2016 and was announced.Care Forum (MK) provides care for children and young adults with physical and learning disabilities, who may also exhibit behaviour which challenges. Care is provided in both the community and in people's own homes across Bedfordshire, Milton Keynes, Northamptonshire and Buckinghamshire. On the day of our inspection approximately 80 people were receiving a service which involved a regulated activity.
The service had 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.
People’s experiences of care were overwhelmingly positive. They told us that they were consistently looked after by staff that were exceptionally caring, understanding and compassionate. People felt like they mattered, they told us that staff were patient, and demonstrated empathy in how they spoke with people. The service had received numerous compliments for their caring ethos, which meant that people felt part of an extended caring family. Staff supported people and their relatives to fully engage in discussions about their care and support. They worked proactively to help people to make choices and decisions about their care and lifestyle, to be as independent as possible, find work and learn new skills. Staff knew each person as an individual and what mattered to them.
Privacy and dignity was respected by staff with whom positive relationships had been formed and who promoted individuality. Staff were committed to taking action, to uphold the ten good practice steps of dignity in care to demonstrate compassion and respect for people. Information was produced in easy read format to enable people to participate fully in their care. Staff intuitively explored alternative communication methods for those people who were non-verbal to enable them to be involved in their own care planning.
People’s needs were comprehensively assessed and intervention and treatment plans gave clear guidance on how people were to be supported. Care was personalised so that each person’s support reflected their preferences. We saw that people were at the centre of their care and found clear evidence that their care and support was planned with them and not for them. People were supported to attend a range of educational, occupational and leisure activities as well as being able to develop their own independent living skills. The service was flexible and adapted to people's changing needs and desires, enabling positive outcomes for all concerned. Each person was treated as an individual and as a result their care was tailored to meet their exact needs.
People, relatives and staff were very positive about the leadership of the service and about the support they were able to provide for people with complex healthcare needs. Staff demonstrated a passion and commitment to providing excellent care that supported people to be independent. People told us the service engaged consistently and meaningfully with families. Relatives reported feeling involved and being part of an extended family. They told us that the service was responsive, open and transparent and they felt actively involved in all aspects of their family members care. We found the service had a positive culture that was person centred, inclusive and empowering.
The service was exceptionally well led by a dedicated registered manager, who was very well supported by a forward thinking and self-motivated management team. The culture and ethos within the service was transparent and empowering; staff told us that they were hugely proud to work for the service and wanted it to be the very best it could be.
Best practice guidelines were followed and the service used innovative approaches in its efforts to support people. The whole staff team was inspired to do their best and were very committed to their work, facing up to any form of challenge and finding ways to combat these. They advocated on behalf of the people they supported and obtained excellent results on their behalf. Staff used these qualities to deliver holistic and personalised care to each person they supported. Each member of the provider team had exceptionally strong values, with a shared vision to ensure people had the best possible quality of care.
The registered manager had a clear vision for the service and the direction of its future development. They wanted the service to be influenced by the needs of the people it supported, not financially driven and were committed to providing high quality care that was personalised to people’s needs. Visions and values were cascaded to staff who attended regular meetings, which gave them an opportunity to share ideas, and exchange information about possible areas for improvements to the registered manager. Ideas for change were always welcomed, and used to drive improvements and make positive changes for people.
The service had a strong focus on protecting people from possible harm or neglect. Staff knew how to report any concerns about people’s welfare to the appropriate authorities and worked in conjunction with a variety of agencies to ensure that people were safeguarded. Staff followed local authority policies and procedures in respect of both children and adults. Safeguarding concerns were taken seriously. People were empowered to take positive risks, to ensure they had greater choice and control within their lives. The positive risk taking approach demonstrated by the service showed that staff respected people’s right for independence in conjunction with their entitlement to balance risks with their wishes and desired outcomes.
Staffing levels were sufficient to provide the level of care that people required. Arrangements were in place to cover staff sickness or absence and flexible working was encouraged to ensure that staff had a good work life balance and that the needs of people were met. Robust recruitment processes were in place to help ensure that staff were suitable to work with children and young adults. People were given the chance to be matched with carers who shared similar likes which demonstrated the provider's commitment to people's inclusion within their care planning.
There were suitable arrangements in place for the safe management of medicines. Staff were trained to administer medication and received regular checks on their competency to administer medication.
Staff received a good and robust induction programme with regular support. This included core training and shadowing which enabled them to be knowledgeable about their roles and responsibilities. They were also provided with on-going training to update their skills and knowledge to support people with their care and support needs. Further encouragement was given to enable staff to undertake additional qualifications, including Qualification and Credit Framework (QCF.)
People’s consent to care and treatment was sought in line with current legislation. People were supported to eat and drink sufficient amounts to ensure their dietary needs were met. Staff supported people to attend healthcare appointments when required and liaised with their GP and other healthcare professionals as needed.
The service responded to complaints within the agreed timescale and the service encouraged formal feedback, using this to drive future improvement and make positive changes.