Vision Homes Association Supported Living Services

Vision Homes Association Supported Living Services is a domiciliary care agency providing the regulated activity of personal care to people living in their own houses or flats. The service provides support to younger adults who have a learning disability, autistic spectrum disorder, physical disability and/or sensory impairment. At the time of our inspection there were 6 people receiving the regulated activity of personal care.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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. Risks were assessed, monitored and managed with the involvement of people so they were protected, informed and their wishes respected. This meant people were enabled to have appropriate discussions about positive risk taking and enjoy their lives safely. People were supported to access the local community and to do the things they wanted to do.

Right Care:

People received support which was tailored to meet their needs and preferences. People were supported to be as independent as they could be. Staff treated people with respect and ensured their protected characteristics were understood and respected. People were supported by staff who knew them well and who were trained and competent in their role. Staff had been trained in safeguarding adults from abuse and understood when and how to report concerns.

Right Culture:

The registered manager and staff team were committed to achieving the best outcomes for people with a focus on supporting them to live the best life possible. Staff had the knowledge, skills and attitude to provide responsive and compassionate care tailored to people's needs and aspirations. The provider’s systems to monitor the quality and safety of the service provided had improved. The views of people, their relatives and staff were valued. The registered manager worked with other agencies to achieve good outcomes for people. There was an open and honest culture and learning from when things when wrong.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service at the previous premises was requires improvement (published 11 September 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Holcombe House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Holcombe House is a domiciliary care agency that supports people who have learning disabilities and/or autistic spectrum disorder and are living in their own homes.

Not everyone who used the service received personal care support. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, the service supported seven people with their personal care.

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

The systems to check the quality and safety of the service, had not always been effective in identifying areas for development. Actions following checks had not always been completed in a timely manner. Some elements of the safeguarding process had not been robust.

Staff had not consistently had their competency assessed or completed training on topics such as safeguarding, moving and handling practical and infection control.

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 did not always support this practice. We made a recommendation about the completion of mental capacity assessments.

People received their medicines as required. Some people had managed to reduce or stop taking medicines for periods of anxiety and distress, with the support of the staff team. People received support from a consistent team of staff, which enabled positive relationships.

People and their relatives praised staff’s approach in how they cared for people. Staff knew the needs of the people they supported and were keen to continually find ways to promote their independence. People were encouraged and supported to make their own decisions wherever possible.

People engaged in a wide variety of activities according to their own interests. Information was available to guide staff about the support people needed and wanted. People and their relatives were encouraged to be involved in writing their care plans. Support was continually reviewed to ensure it was meeting the person’s needs and outcomes.

The provider and registered manager wanted people to receive good, person-centred care; a value they shared with the staff team. The management team were approachable and ‘hands on’ in the support they provided. Staff felt supported and valued in their role.

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.

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 26 October 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the governance of the service at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The inspection of this service took place on 22 August 2016 and was announced

There was a registered manager in post and they were present at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, registered managers 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 were supported by staff who knew how to keep them safe and free from harm. They knew how to recognise and report any risks, problems or potential signs of abuse.

People were supported to live full and independent lives. Risks were assessed prior to activities taking place and guidelines were developed to ensure that people could learn new skills safely. Regular reviews ensured that risks were updated as people achieved their goals.

Some people required support to take their medicines. They were protected by safe systems in place for administering, storing and recording medicines. Robust training was in place to enable staff to safely support people to take their medicines when required.

People were supported by sufficient staff to meet their needs safely and effectively. People received flexible and responsive support. Staff were recruited through safe recruitment practices meaning that only people suitable to work in the role were appointed.

People were supported by staff who had the knowledge and skills to provide effective support. They received good training opportunities and training had been developed around the individual needs of the people who used the service. Staff competency was regularly reviewed and knowledge was updated to ensure it continued to reflect current best practices and legislation. Staff felt very well supported by the registered manager and their colleagues.

Staff understood their roles and responsibilities and worked well as a team to ensure people’s needs were met. People’s rights were protected under the Mental Capacity Act 2005 and staff understood how to protect people’s human rights. The registered manager and the staff team were committed to offering a service that was centred on meeting people’s individual needs. People were offered choices as to how they lived their lives and staff recognised the importance of people having the right information and support to enable them to make their own decisions

People received support to ensure they enjoyed a balanced and nutritious diet. Staff worked with healthcare professionals to ensure people’s continued good health and wellbeing.

People were supported by staff who were caring and understood the importance of delivering person centre care that promoted and developed people’s independence. People’s privacy and dignity was respected as was their individuality, which was recognised and celebrated. People were supported to maintain and develop positive relationships with people who were important to them.

People enjoyed living the lives they chose and this involved having active social lives. Activities were developed around individual preferences, likes and hobbies. Staff recognised the importance of social engagement and contact and encouraged it in daily planning. Staff were creative in developing activities designed around people’s abilities, cultures and preferences.

People who used the service, and their friends and relatives, shared information effectively with the registered manager and the staff team to ensure they received a responsive service. People told us they were able to raise concerns and felt these would be acted on by the registered manager. The provider had a system to deal with any complaints. People were regularly asked if they were happy with the service provided. There were systems in place to ensure that people’s views and opinions were heard and their wishes acted upon.

The registered manager provided positive leadership. The service promoted an open culture where the people who used the service were supported to live the lives they chose with the support they required. Staff were well supported. There were systems in place to monitor the quality of the service provided. Surveys, questionnaires and audits all demonstrated that the service delivered a responsive and effective service which was centred on people’s individualised care and support needs.

We were not able to speak with either of the people who received a service because of their disabilities, but we did speak with the relative of one. They were very pleased with the service. They told us, 'It's as good as it gets', and that it was, 'An absolutely positive experience'.

We found that staff supported people to be as independent as possible. Staff understood the people they cared for very well and respected their decisions and choices.

Care plans were very person centred and had been produced with input from the people concerned and their relatives where appropriate. We saw good evidence of regularly reviewed risk assessments to help keep people safe.

We found that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent it from happening.

We saw evidence of a good induction programme for new members of staff and a comprehensive package of ongoing training for all staff.

We were satisfied that the provider had appropriate systems in place to monitor and assess the quality of the service it provided.

People's relatives were complimentary about the service and told us that people felt safe with the staff. Relatives were involved in care reviews and meetings to make best interest decisions. They commented, 'X leads an active life', 'X's home is always clean', 'The staff have a good attitude and are well trained', and "Good financial records are kept."

Individual needs were met as people preferred, respecting their lifestyles, interests and beliefs. People's health and wellbeing was monitored and staff had specialist training to meet people's health needs. Managers carried out regular spot checks to ensure that people were appropriately cared for and hygiene standards were maintained.

Staff worked in dedicated teams and people helped to choose their staff. The provider made appropriate checks that staff were safe and fit for their roles before they started to work with people. Staff had ongoing training and were confident about reporting concerns of abuse should they arise, to managers and other agencies. Managers acted upon and staff learned from comments or complaints people and their representatives had made.