Archived: Accredo Support and Development Limited

This is the second comprehensive inspection of the service. This inspection took place on 29 and 30 May 2018 and was announced. At this inspection we rated the service overall as ‘Good’.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to people living with a learning disability and autistic spectrum disorder.

The service is divided into three areas; supported living, alternative day services and outreach support. This service provides care and support to people living in 10 supported living settings, so that they can live in their own home 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection 35 people were receiving personal care and support. A registered manager is a person who has registered with the Care Quality Commission to manage the service.

A registered manager was in post. 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.

The management and staff team continued to demonstrate an outstanding commitment to providing a caring service which put people at the heart of everything. Staff were mindful of promoting people’s independence and respecting their privacy and dignity. People were supported to be actively involved in decisions about their care.

People were involved all aspects of their care. Risks to people had been assessed and managed, which took account of people’s preferences, diverse needs including those in relation to a person’s culture or belief. People were supported with their medicines and encouraged to take positive risks to promote their independence. People were supported to live healthier lives and were supported with their health care needs when required.

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. The provider, registered manager and staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and gained people's consent before providing their support.

Systems and processes were in place to safeguarding people from abuse; these covered staff recruitment practices and staff training and knowledge on safeguarding procedures. Staffing levels were kept under review to ensure people received sufficient staff support. Systems also ensured accidents and incidents were recorded and analysed and steps to improve and learn were identified.

Staff continuously provided the person-centred care and support people needed to ensure that people lived as fulfilled and enriched lives as possible. They respected people’s individuality and enabled people to express their wishes and make choices for themselves about their lives and aspirations. Staff had a good understanding of people's needs and preferences to ensure they were responsive. Positive relationships had been developed and staff were committed and passionate about promoting people’s independence and achieving positive outcomes for them.

People received care and support that enhanced their sense of well-being and quality of life because staff worked flexibly to enable people to have meaningful experiences and to become active members of the local community.

People, relatives and staff had opportunities to engage and be involved in the development of the service. People knew how to raise a concern or make a complaint and the provider had effective systems to manage any complaints they received.

The registered manager led and inspired the staff to deliver person centred care, which had achieved consistently outstanding outcomes for people. Systems and processes were in place to assess, monitor and improve the quality and safety of services. The service was focussed on achieving good quality outcomes for people using the service and worked in partnership with other health and social care professionals to ensure people received appropriate care.

Accredo Support and Development is registered as a domiciliary care service to provide personal care for people living in their own homes. Their service is divided into three areas; supported living, alternative day services and outreach support. The provider mainly provided support to people living with learning disabilities and autistic spectrum disorder.

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 felt safe using the services of Accredo Support. They felt safe because they were confident that staff had the skills required to protect them from harm when they supported them in their own home or in the community. Staff knew how they would keep people safe from harm and abuse. They supported people to understand any risks to their own safety. They also provided opportunities for people to raise any concerns they had about their safety. People’s risk assessments were comprehensive and enabled them to remain as independent as possible.

People had the appropriate level of staff support to meet their assessed needs. The provider completed relevant pre-employment checks which assured them that staff were safe to work with people.

People received their medicines as prescribed by their doctor. They were involved in completing their own records. Records showed that people’s medicines were administered correctly.

Staff received the training they required to provide support that met people’s individual needs. Staff were supported to reflect on their practice in order to challenge themselves to provide a good quality of care to people. They were supported to reflect on their practices by using the Care Quality Commission’s key questions to ensure that people received a safe, effective, caring, responsive and well-led service. Staff had regular supervision and were confident in the training and support they received.

People were supported in a way that met the requirements of current legislation and guidance. Staff creatively involved and sought people’s consent in their care and support.

People were supported to remain healthy and well. Staff empowered people to be involved and take ownership of their own health needs. They achieved this by supporting people to make healthy food choices and undertake exercising. Staff sought prompt support from healthcare professionals where this was required.

Staff were kind and compassionate when they supported people. People complimented the care they received. They told us it made a positive difference in their lives and that they felt that they mattered. Staff provided the information and support that people required to make their own choices. They worked collaboratively with other professionals to develop creative methods which enabled people to make decisions about their own care and support.

People were actively involved in the development of their own care plans. Their care plans included comprehensive details of how they would like to receive their care and support. Staff supported people as they had chosen in their care plans. People’s support was regularly reviewed and staff readily adapted to any changes in people’s needs. People had access to a variety of activities in the community. They had opportunities and the support they required to follow their interests.

People and their relatives had various opportunities to raise any concerns they had about the service they received. We saw that staff actively encouraged people to do so.

People had confidence in the registered manager and how the service was run. People who used the service were empowered to be involved in the running of the service. The provider had a clear culture that people were at the heart of the service it offered. Staff had a shared commitment to make sure that people were empowered to live as independently as possible and be included in the local community. There was robust quality assurance systems in place to monitor the quality of service people received. The manager took prompt actions to address areas where improvements were required.

We were not able to speak to most people using the service because they had complex needs which meant they were not able to tell us their experiences. We gathered evidence of people's experiences of the service by speaking with two people who were able to communicate their views to us verbally and by speaking by telephone with three relatives of people who used the service. We also spoke with four staff employed by Accredo as support workers or team leaders.

Care and support plans gave information about peoples' preferred routines, likes, dislikes and needs. One person told us, 'They give me this information so I can plan and prepare. That is what I need to be able to do. It is good for me.'

Staff supported people to maintain a healthy diet by offering a balanced menu. People received their medication reliably. Arrangements for PRN (taken when required) medicines were in place, describing how each person's PRN was managed.

Newly appointed staff commenced in post after satisfactory checks had been received, including references from previous employers and criminal records checks. Any complaints were investigated and a written response was provided.

The provider had improved the format of care plans and completed an assessment of need for each person using the service.

A new mechanism had been introduced to record and monitor staff training. This showed that staff had attended essential training to equip them in their roles, and further training was planned for new employees as well as refresher training for existing staff.

During our inspection we found that the information contained in people's assessments and care plans varied considerably. Some were well detailed but others lacked sufficient information and assessments of need had not always been completed.

People using the service told us they were satisfied with the care and support they received. They felt staff treated them well and were reliable.