IntegraCare (Supported Living)

This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Some of the people supported were living at home with their families. On the days of the inspection there were 29 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good overall however the Responsive key question had improved to outstanding. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service was extremely person-centred. Person-centred means ensuring the person is at the centre of any care or support and their individual wishes, needs and choices were considered.

The service went the extra-mile for the people they supported and was extremely responsive to people’s changing needs. People were protected from social isolation and had become an integral part of the local community.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place to mitigate these risks. The registered manager understood their responsibilities with regard to safeguarding and staff had been trained in safeguarding vulnerable adults.

Appropriate arrangements were in place for the safe administration of medicines.

The provider had an effective recruitment and selection procedure in place and carried out relevant vetting checks when they employed staff. Staff were supported in their role via appropriate training and regular supervisions.

People were supported with their dietary needs. Care records contained evidence of people being supported during visits to and from external health care specialists.

People and family members were complimentary about the standard of care provided by IntegraCare (Supported Living). People were given information in a way they could understand. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

People and family members were aware of how to make a complaint. The provider had a robust quality assurance process in place. People, family members, staff and visiting professionals were regularly consulted about the quality of the service.

The last inspection took place on 8 October 2013 and the service was meeting the regulations we assessed at that time.

The service provides supported living to people in their own homes. People who use the service have learning disabilities, autism, physical or mental health difficulties. At the time of our inspection the service supported twenty five people who lived in either single occupancy properties or shared houses.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At this inspection we found the service was being managed and operated in line with their legal responsibilities.

Staff told us the manager, director and other senior staff, employed by the service, were supportive and approachable. They also confirmed to us that the on call arrangements were well organised, and that they could seek advice and help out of hours if necessary. This meant there was good oversight of the issues across the service, and staff were confident about the management structures.

Audits were robust and this enabled us to get a sense of the issues within the service and how these would be addressed.

There had been a period of staff turnover but this had settled down and there were sufficient staff employed to cover the number of hours provided across the service. The service was keen to retain staff and staff told us they stayed because they felt valued and appreciated. This meant that people who used the service were provided with a consistent service and were supported to take part in their individually planned activities, which made a positive impact on their general well-being and quality of life.

When new staff were recruited we saw the service had robust checks in place to ensure people employed were suitable to work with people who used the service.

People who used the service and their relatives told us they felt safe and staff knew how to protect people from avoidable harm. Risk assessments and risk management plans were in place. They contained detailed guidance for staff about how to minimise the risk of harm.

Medicines were safely managed. Records were completed correctly, and a stock check took place in people’s homes on a regular basis. This meant if any errors were noticed they could be addressed quickly.

Staff described feeling well supported. We saw evidence of supervisions taking place on a routine basis. This meant staff had the opportunity to reflect on and develop their practice.

People received support from staff who had access to appropriate training and knew how to meet people’s needs.

Staff had a sound understanding of the Mental Capacity Act and we saw consent was sought routinely. People had been supported to make their own decisions wherever possible, and staff had taken steps to support people to do this. Where people were unable to make a decision there was a best interest decision recorded within their support plan and we saw the person and relevant people had been involved in making this. This meant people were given the opportunity to be involved in decision making and decisions were made in the person’s best interests.

People had access to appropriate healthcare professionals and had a health action plan. This meant people’s health care needs were being appropriately supported.

There was access to varied and balanced diets, people were involved in planning and, where possible, making meals.

People knew staff well, including the registered manager and director of the service. Staff were described as, “helpful, kind, dedicated and amazing.” Staff knew people well and ensured their preferences for support were met. Support plans contained detailed person centred information, which provided staff with instructions about how to support people, but also gave them a sense of what was important to the person.

People were supported to be as independent as they could be and some people worked in local community organisations. Activities were planned and person centred, and everyone had equal access to individual activities.

People and their relatives understood how to make complaints. There had been no complaints in the last two years.

People who used the service generally lived together in shared houses and were provided with twenty-four support. We visited three people who shared a house together and met with another person at the agency office.

People experienced care, and support that met their needs. People told us they were very satisfied with the care support they received. Comments from people included 'the staff are grand they help me out.' And 'I really like the staff they help me with shopping and going out and about.'

The agency had systems in place for supporting people with medication and staff were trained in the safe handling of medicines.

The provider had a robust recruitment process in place. This meant that only suitable people who had completed appropriate employment checks worked for the agency. All of the staff we spoke with told us their induction they had been a good grounding and relevant to their role.

The provider had effective systems in place to assess and monitor the quality of service that people received. These ranged from annual surveys completed by staff and people who used the service, to daily and weekly checks to maintain a good standard of support.

Records were well maintained,up to date and kept securely.