Supported living Plymouth and Devon

Updated 1 February 2019

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on the 8 and 11 January 2019 and was announced. The provider was given 24 hours’ notice because the location provides a domiciliary care service and we needed to ensure that someone was present in the office. One adult social care inspector undertook this comprehensive inspection. At the time of the inspection, the service was supporting 27 people with personal care tasks.

Prior to the inspection we reviewed the records held on the service. This included the Provider Information Return (PIR) which is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed previous inspection reports and notifications the provider had sent us. Notifications are specific events registered people have to tell us about by law.

On the first day of the inspection we visited the head office and met the registered manager, chief executive for the organisation and the operations executive. We also met and spoke with two members of the care team. We viewed the premises to see if the location was fit for purpose and to see if information about people was stored and managed appropriately. We looked at a sample of records relating to the service and people being supported. This included support plans, risk assessments and daily records. We also looked at a sample of records relating to the running of the service including, staff recruitment records, policies and procedures and incident reports.

On the second day of the inspection we visited people who were receiving a service. We visited three people who shared one large house. Each person had their own separate self- contained flat and care was provided on an individualised basis. People shared a communal hallway, garden and also had access to a small communal lounge if they chose to use it. In supported living settings the accommodation and landlord was separate to the care provided and people had their own tenancy agreements. We also visited two other people who were supported within their own homes. During our visits we were able to speak to some people about the care they received. Some people were unable to tell us about their experiences, so we spoke to staff and observed the care and support being provided. During our visits to people’s homes we spoke with five care staff and two relatives.

Following the inspection we contacted two relatives and five health and social care professionals.

Updated 1 February 2019

Supported Living Plymouth and Devon provides personal care and support to people living in their own homes. The registered provider for this service is Havencare (Southwest) Limited, a registered charity that operates as a provider supporting people with learning disabilities and autism. Supported living is where people live either on their own or with a small group of others, and have their own tenancy agreement. Care and support is provided in order to promote their independence. The care people receive in supported living settings is regulated by CQC, but the accommodation is not. The service supported some people on a 24-hour basis and others at specific times during the day and night. At the time of the inspection 27 people were being supported by the service with personal care tasks.

We checked the service was working in line with ‘Registering the Right Support’ which makes sure services for people with a learning disability and/or autism receive services that are developed in line with national policy. For example, how the service ensures people care is personalised, maintains their independence and supports links with people’s community.

At our last inspection in July 2016 we rated the service as Good. At this inspection we found the evidence continued to support the rating of good in the areas of safe, effective, responsive and well-led. We found further improvements had been made in relation to caring and this area is now rated as outstanding.

There was a positive, open and inclusive culture within the service. The management team provided good leadership and led by example. Relatives, staff and other agencies were positive about the leadership of the service. Staff said they loved their work and were passionate about providing good care to people.

People were provided with sensitive and compassionate support by a kind, committed and caring staff team. We observed without exception staff treated people with the upmost patience and kindness. When we visited people in their homes we saw staff knew people well and had built positive and trusting relationships. Relatives and other agencies praised the staff and management for their caring and compassionate approach to supporting people. Staff really respected people and recognised they were supporting people in their own homes.

All the staff we spoke with were able to tell us about the values of the organisation and said they were informed of them and their importance during the recruitment process and as part of on-going training and discussion. It was very clear staff had adopted these values in relation to the support they provided. It was reflected in the way staff spoke about the people they supported, in the practices we observed, and in the feedback we received about the way people were cared for and treated.

The service had a culture which recognised equality and diversity amongst the people who used the service and staff. Staff were sensitive and respectful to people’s religious and cultural needs. People were not discriminated against in respect of their sexuality or other lifestyle choices.

Personalised care was central to the service philosophy and staff demonstrated they understood this by talking to us about how they met people’s care and support needs. Staff spoke about their work with commitment and passion and used words like “Individual”, “Independence” and “Rights” when they talked about the people they supported. People’s care records were personalised, which ensured care was tailored to meet their individual and diverse needs. We saw people were supported to live a happy, fulfilled life, to feel safe, enabled to try new opportunities and to maintain their independence as much as possible.

The provider and registered manager recognised the benefits of multi- agency working and external agencies were very positive about the management and care provided to people.

Staff were well trained and training was relevant to their role and kept updated. The registered manager was passionate about developing the skills of the team and also kept themselves updated with best practice. All staff said they felt well supported, and had opportunities to discuss and reflect on their practice and incidents that had occurred. Staff were employed in sufficient numbers to meet people’s needs and to keep them safe. Staff teams were organised in a way that helped ensure consistency.

Relatives and other agencies said they felt people were safe using the service. We observed people were relaxed and comfortable with the staff supporting them. Staff had undertaken training and were clear about how to report any concerns relating to abuse or people’s safety. Recruitment practices helped ensure staff employed by the service were suitable to work with vulnerable people.

Management and staff understood their role with regards to the Mental Capacity Act (2005). People’s consent was sought before care and support was provided. When people were unable to make decisions, discussions took place with relatives and other relevant agencies to help ensure decisions were made in people’s best interest.

People’s health and dietary needs were understood and met. Staff ensured people had access to the food and drinks required to maintain good health. If concerns were highlighted about people’s health or diet advice was sought and appropriate referrals made to relevant health services. Staff supported people to attend hospital and other healthcare appointments.

People continued to receive their medicines safely. Staff who administered medicines had received up to date training, and competency checks were completed to help ensure their skills and knowledge remained sufficient and up to date.

Good governance of the service by both the provider and the registered manager benefitted people because it ensured the quality of care was maintained and enhanced. Regular audits were carried out, which included checks of health and safety, staffing levels, training, and medicines. Checks were carried out by management and support staff to ensure records held in people’s homes were appropriate, accurate and up to date. As a result of audits and reviews of the service recent improvements had been made in relation to staff recruitment, incident reporting and staffing. Staff said the addition of an extra tier of management within people’s staff team had improved communication and consistency of care.

Information gathered about people was used to aid learning and drive continuous improvement across the service. Investigations were carried out when required and systems were in place to identify any trends or patterns, to help make changes when needed. The provider and registered manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. They understood and reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment.