Archived: St Christopher's Trust

St Christopher’s Trust is a domiciliary care service which provides personal care to people with a range of support needs. Some people using the service had learning disabilities and/or autism. People lived in ‘supported living’ settings, so they could live as independently as possible. At the time of this inspection, the service was providing personal care to 25 people.

Not everyone who used the service received the regulated activity of personal care. The Care Quality Commission (CQC) only inspects services where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do receive personal care, we also consider any wider social care provided.

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.

People’s experience of using this service and what we found

People felt safe. Risks to people were assessed and minimised and people were protected from abuse. There were enough staff available to provide personalised care to people. People received their medicines, as prescribed, from staff who were trained to provide this support safely. People were protected from the spread of infection.

People were supported by staff who were competent and skilled. Staff asked people for their consent before providing them with any care. 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 told us staff were kind and caring. People said they felt well-treated by staff and we observed people were continually involved in decisions about their care. Staff supported people to maintain their independence. People’s privacy was respected.

The service applied 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.

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.

People were told how they could complain about the service, if they had any concerns. People were supported to maintain relationships with their family and friends and take part in activities that were meaningful to them. People were supported by staff who could communicate effectively with them. People had access to a range of communication tools, to help them make decisions about their care.

People, their relatives and staff all told us they thought the service was well-run. Everyone told us the registered manager was supportive and operated an 'open-door' policy. The registered manager and staff were keen to deliver a high-quality, person-centred service. The registered manager completed a range of checks on the safety and quality of the service on an ongoing basis, to ensure any necessary improvements were identified and implemented.

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 19 December 2016).

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.

Thematic review

The Secretary of State has asked 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 registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

There was a registered manager at 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.

St. Christopher’s Trust is a domiciliary care service which supports people with a learning disability to live in the community, in houses and bungalows owned by the provider. At the time of our inspection, 26 people were receiving care and support from the provider.

The day-to-day management of the service and staff was carried out by the registered manager, who was supported by a management team. The registered manager and management team had worked at the service for many years and had a sound knowledge about the people who used the service. The service was focused on the needs of individuals and there was a commitment by the registered manager and the staff, to ensure people received the care and support they wanted and needed.

The service was focused on each person and accounted for personal likes, dislikes, needs and preferences. Staff encouraged people to make their own day to day decisions and staff respected those decisions whilst ensuring and being aware of people’s safety.

Staff were aware of the need to keep people safe and to protect them from the risk of avoidable harm. Staff and the registered manager understood procedures in relation to safeguarding and ensured any allegation of abuse was recorded and reported in the appropriate manner.

People were cared for by staff who had demonstrated their suitability for their respective role. Recruitment procedures were safe and included Disclosure and Barring service (DBS) checks.

People’s medicines were managed safely and in accordance with current regulations and guidance. There were auditing systems in place to ensure medicines records were completed; staff were trained in medicines administration and competency assessments were carried out.

Staff cared for each person in a supportive manner and were aware of promoting people’s independence. People were encouraged and supported to take part in activities of their choice.

Staff participated in training and supervision; they understood their roles and responsibilities in relation to the Mental Capacity Act 2005 (MCA). Capacity assessments and best interest decisions were available in people’s care plans.

People’s right to privacy and dignity was respected by the staff. Staff were kind, caring and compassionate; they promoted and supported people to remain as independent as possible.

Staff received training to ensure they were providing appropriate and effective care and support for people. People were involved in the assessment and planning of their care and care plans; we saw information was provided to people in different formats, to ensure they were included.

Staff felt they were supported by the management team and there was good team work being carried out. The registered manager had effective auditing systems in place to assess and monitor the quality of the service. People who used the service were asked for their opinions and views.

People we spoke with said that they were highly satisfied with the service. A person using the service told us, "I like living here with my friends. We go to lots of places. There is nothing that I don't like." A relative told us, "X is very happy. The place is marvellous for (them). We have no complaints."

We saw that people were given choices in everyday life. Assessments of capacity had been reviewed regularly. Best interest meetings had been arranged where needed. A relative said, "I am kept well informed. I have been involved in best interest meetings. I am included in all discussions."

The format for care records, risk assessments and health action plans had been changed and reviewed to accurately reflect people's personal and health care needs as stated in the provider's action plan received following the last inspection.

Medicines were stored in people's bedrooms, giving them privacy and choice in the way they received their medicines.

Staff had received all required training and were well supported with regular supervision, appraisals and team meetings. There was access to senior staff at all times for advice. Staff told us they felt well supported by senior staff.

The provider had a system in place to regularly review the quality of the service provided.

We found that people were consulted about their care, and that they were treated with dignity and respect by their staff team. Staff were knowledgeable and trained in relevant subjects to their role, and said they were well supported by managers. Procedures for recruitment enable St. Christopher's Trust to get the right kind of people to work at the service.

We saw that complaints were dealt with effectively, and staff were aware of how to safeguard people from abuse.

We found that although care files were very personalised, and many areas were detailed, some important information was missing and not all risks were adequately assessed. This meant that a risk was present to the care and welfare of people using the service.