FitzRoy Supported Living - Cambridgeshire

FitzRoy Supported Living - Cambridgeshire is a domiciliary care agency providing supported living to adults with learning disabilities and/or autism in their own homes. Everyone who used the service received personal care. The agency was also funded to provide social care and support people in all aspects of daily living, such as meal preparation and household chores.

At the time of the inspection the service was supporting eight people. Four people were sharing a bungalow, called Mayfield. Four other people were living in their own bungalows or houses. Mayfield had an office and staff sleeping-in room in the bungalow’s converted garage. Each of the other bungalows and houses had a sleeping-in room for staff.

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 were happy receiving a service from FitzRoy Supported Living - Cambridgeshire and relatives were effusive in their praise of the service for the support it gave them and their family members. One relative wrote, ‘I want to record…the tremendous gratitude and thanks that [name] and their family owes every member of staff…It is unusual to find such a dedicated and caring place as Mayfield… The staff have seen [name] through some very dark times, but with care and professionalism have guided them and kept them safe and happy.’

Staff were very knowledgeable about how to keep people safe from avoidable harm and abuse; they gave people their medicines safely and followed good infection prevention and control procedures. The provider ensured that lessons were learnt when things went wrong.

Staff had undertaken training and received support from senior staff to ensure they could do their job well. People enjoyed food that they had chosen.

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 had very good relationships with the staff and received kind and compassionate care and support. Staff knew people well and respected people’s privacy and dignity. People were involved in all decisions about their care and staff supported them to be as independent as they wanted to be.

Each person had a detailed, fully personalised support plan, which guided staff on the support the person wanted. Staff worked extremely hard to offer people a wide range of opportunities to try new activities or do things they had previously enjoyed. Staff supported people in totally person-centred ways to lead full and meaningful lives and to maintain or develop relationships.

Relatives were confident their views would be listened to and complaints would be addressed.

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.

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 was requires improvement (published 19 November 2018) and there was a breach 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 was a planned inspection based on the previous rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for FitzRoy Supported Living - Cambridgeshire on our website at www.cqc.org.uk.

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.

FitzRoy Supported Living - Cambridgeshire provides care and support to people living in two supported living settings, so that they can live as independently as possible. It provides a service to people with a learning disability and autism. 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.

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.

FitzRoy Supported Living - Cambridgeshire provides a service to people with a learning disability, people with a physical disability, older people, people living with dementia, younger adults and people with sensory impairments.

At the time of our inspection there were eight people using the service who received the regulated activity of personal care.

A registered manager was in post. The registered manager was on leave at the time of the inspection and an interim manager who knew the service well was available throughout the inspection. 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.’

The service was not always well-led. The registered manager and provider had not always ensured we were notified about events that by law we must be notified about. The provider did not always follow their policies.

People, relatives and health professionals had a say in how the service was run. Staff upheld the provider’s and values to make a positive difference to people’s lives. Staff worked as a team to help people and each other. Quality assurance, audits and spot checks undertaken and these helped find improvements which were acted on. An open and honest staff team culture was in place. Staff were given support in a positive way. The interim manager and staff worked in partnership with others including health care professionals.

The service was safe. People were safeguarded from harm by staff who knew how to report and act on any concerns. The provider’s representatives identified risks to people and managed each risk safely. Sufficient staff were in post and the recruitment process for new staff helped ensure that only suitable staff were employed. Lessons were learned when things had not gone well and prompt action was taken to keep people safe. People had their medicines as prescribed and only competent staff undertook this task. Medicines were managed safely. Staff helped people to maintain a safe and clean home.

The service was effective. People’s needs were met by staff with relevant training and skills to do this effectively. People were supported to have enough to eat and drink and have a healthy balanced diet. Staff supported people to access health care services to maintain their health. People were given choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The manager worked with other organisations involved in people’s care to help ensure that when people used the service they received consistent care.

The service was caring. People were cared for with kindness, compassion and sensitivity by staff who made sure people lived life to the fullest. People’s privacy was promoted and their dignity was respected whatever people’s needs were. People had access to advocacy services when needed. People were involved in deciding how their care was provided.

The service was responsive. People’s care was person-centred and at the heart of the service. Technology enhanced the quality of people’s lives, this made them more fulfilling. People were enabled to raise concerns and they were acted on. People, relatives and family members were involved as much as practicable in deciding people’s end of life care wishes.

We found one breach of the Care Quality Commission (Registration Regulations) 2009. You can see what action we told the provider to take at the back of the full version of the report.

Further information is in the detailed findings below.

This unannounced inspection took place on 17 May 2016.

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.

Staff’s training and knowledge in protecting people from harm meant that appropriate reporting and actions were taken to help ensure people’s safety.

The provider’s recruitment process and pre-employment checks ensured that staff were safely recruited and deemed suitable to work with people using the service. There was a sufficient number of suitably qualified and experienced staff to support people and meet their needs.

A process was in place that ensured staff were trained and assessed as being competent before they were authorised to safely administer people’s prescribed medicines. People’s medicines were administered and managed safely.

Risk assessments were in place to help manage each person’s assessed health risks. Staff used recognised national standards of de-escalation to support people with behaviours which could challenge others.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service’s registered manager and staff were knowledgeable about when an assessment of people’s mental capacity was required. Staff were aware of the circumstances and conditions when an application to lawfully deprive any person of their liberty was required. Appropriate applications had been made and acknowledged to lawfully deprive some people of their liberty.

Staff were supported with regular supervision to develop their skills, increase their knowledge and obtain additional care related and management qualifications.

People’s care was provided with consideration of people’s needs and this was done compassionately by staff who people well. People were supported to improve their independent living skills and staff respected their choices.

People used their preferred means of communication to inform staff of their preferences and needs. Relatives, care staff, health care professionals and social workers contributed to people’s to the assessment of people’s care needs. People’s care plans were in a format that enabled people to be part of the planning of their care.

People were supported to access a range of health care professionals including dieticians, occupational therapist and GP services. Staff adhered to the advice and guidance provided by health care professionals.

People were encouraged to eat sufficient quantities of a healthy and balanced diet which was appropriate for their needs.

Easy read/pictorial format of care plans enabled people’s involvement in planning their care. The registered manager was proactive in taking preventative action to prevent the potential for any recurrences. Staff knew when people were happy with their care.

The provider, registered and deputy manager had effective audits and quality assurance in place. These audits were used as a means to drive improvements.

Is the service caring?

We observed how members of staff cared for and treated people. We saw that this was done well and in a respectful way. We saw that staff provided effective reassurance when people became anxious until the person became calm once again.

Is the service responsive? We saw that people's care was assessed, reviewed and changed to ensure that people were provided with individual and person centred care and support. This ensured that people's needs were assessed and met. People were able to choose what they wanted to do, the support they wanted and the way they liked to spend their day.

Is the service safe?

People's safety was considered by the provider to be paramount. People were supported to take risks to improve their independence where this was safe to do so. Risk assessments regarding people's individual activities had been completed to ensure that measures were in place to minimise these risks. Action had been taken following accidents and incidents to ensure that the potential for any recurrence was eliminated or significantly reduced.

Is the service effective?

During our observations we found that members of staff clearly knew how to effectively support people with their individual needs. We saw that staff ensured that people had a good experience of using the service. We saw that people's independence had grown and that they were supported with their social activities and education. One relative told us, "Once the staff get to know my son, they are really good in meeting his needs."

Is the service well led?

Staff said that they felt supported and trained to safely do their job. Improvements had been made since our last inspection to ensure that people who used the service received support and care from staff that were supported, trained and competent to safely do their job. Quality assurance systems were in place and people were listened to and were safe from the risk of unsafe and inappropriate support and care.

Relatives we spoke with said that they were happy with the care and support their family member received. One relative told us the service is:'Excellent. They [the staff] have made a proper home for [their relative]'. It's the young men's place.'

Support plans were person centred and provided staff with information about how to meet people's care and support needs. However, it was not clear from some records when a person's care had been reviewed and if any changes had been made as a result. This meant that there was a risk that they had not received the care and support they needed.

During our inspection we found the provider's recruitment procedure had not always been followed to ensure that only people suitable to work with vulnerable people were employed. We have asked the provider to take action to improve this.

Staff we spoke with felt well supported by their manager and told us they had received the training they needed to meet people's care and support needs. Staff talked knowledgeably about the steps they took to protect vulnerable adults from abuse.

The provider had a system in place to assess and monitor the quality of the service provided to people who used the service.

People were supported to maintain their health and well being. This was because of the available range of social activities. A stakeholder told us that the Deputy Manager had set up an activity pilot scheme with them to help people gain access to the local community within safe boundaries and this had now run successfully for over two years.

People were also supported to access health care services and a professional told us that there was a. "Really positive focus on service users when facilitating hospital visits". Staff also supported people with their personal care needs in an appropriate and safe way.

Effective staff recruitment were in place to make sure that people who used the service received support and care from suitable, skilled and knowledgeable staff.

We also observed quality assurance systems in place meant that people could be assured that their support and care was reviewed and monitored as an ongoing quality assurance measure.

You can see our judgements on the front page of this report.