Options for Supported Living

Options for Supported Living is a supported living service offering care and support to people living within their own homes. The service supports children and adults, most of whom live with a learning disability and/or autism. 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. 96 people were being supported with personal care at the time of our inspection.

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

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of good for the safe, effective and caring domains. There has however been a change of rating for the service to Outstanding based on our findings for the responsive and well-led domain.

The culture of the service ensured the provision of support as individual as the person receiving it. Management and staff displayed a clear vision and, consistent values in relation to the provision of care and support. People were supported and empowered by staff to control their own lives and live a life which was meaningful to them.

People were treated with the utmost dignity, respect and empathy and empowered to make choices to live a life of their choosing.

People had a say in who they wanted to support them, and took an active part in staff recruitment processes. Staff completed a thorough induction and undertook regular training to meet the requirements of their role. Some staff had undergone additional training to meet the specific needs of the people they supported.

Care and support requirements were recorded in a truly person-centred way, with strong emphasis on how people wished and needed to be supported. Staff fully involved people and/or relatives with support plans and reviews. People were actively encouraged to make decisions about how their support was provided and staff were respectful and understanding of people’s rights and choices.

Support plans and risk assessments were detailed, reflected people’s individual needs, preferences, daily routines, and were regularly reviewed to ensure the most up-to-date information was available for staff to follow. People's individual communication needs were recorded and understood, and information provided in a format appropriate for them, which meant they could participate fully.

People participated in activities and occupations of their choice. Staff encouraged people to lead healthy and active lifestyles and supported people in trying new things. People were supported and encouraged to maintain contact with friends and relatives and be a part of their local community.

People and their relatives were very complimentary regarding the supportive and caring nature of the staff team. Staff went out of their way to build up close supportive relationships with the people they supported, that were based on trust and the promotion of people’s independence and self-worth.

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 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 were protected from the risk of harm and abuse. Clear policies and procedures were in place, staff had received training and felt confident to raise any concerns they had.

Medication was managed safely. Staff had access to medicines policies and procedures as well as best practice guidelines.

The service had a designated health lead with vast experience of supporting people with learning disabilities. They worked closely with other health professionals to ensure the delivery of effective care.

People’s privacy and dignity was respected, and their independence promoted. Without exception, relatives spoke positively about the staff and management team.

People, relatives and staff views were regularly sought. The service often implemented change as a direct result of people’s feedback.

The service used innovative methods, such assistive technology, to help improve the quality of people’s lives.

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 (report published January 2017).

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.

Options for Supported Living is a domiciliary care agency that provides personal care and support to people in their own homes. The agency is based in Liverpool city centre and provides care and support to people throughout the Merseyside area.

There was a registered manager in post. 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. At the time of our inspection the registered manager was on leave, however we spoke to the deputy chief executive.

People and their families told us that they felt safe and secure knowing the staff from Options were supporting them. Staff were able to describe the action they would take if they felt someone using the service was at risk of harm or abuse.

Risk assessments were well written and gave a thorough and detailed explanation of how to support people, including what action the staff must take to help minimise the risk in the least restrictive way possible. Staff understood the concept of what was acceptable risk taking in order to promote positive experiences for people.

There were procedures in place relating to the safe management, storage, and administration of medication. People told us they received their medications on time and there was training in place for staff with regards to safe medication administration and this was reviewed regularly.

Incidents and accidents were analysed and a ‘debrief’ of each incident and accident was recorded in people’s files including any remedial action that had been taken as a result.

Staff were recruited safely and checks were carried out on staff before they started work at the service to ensure they were suitable to work with vulnerable people.

Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves. Staff understood the importance of gaining consent from people and the principles of best interest decisions. Routine choices such as preferred daily routines and level of support from staff for personal care was acknowledged and respected.

Staff were trained in a range of subjects in accordance with the provider’s training policy and the staff’s training and development needs. Staff told us they felt the training was of good quality and they were able to request additional training when they felt they needed it. Staff told us training was discussed with them as part of their supervision. Staff were supported to complete an induction and there were shadow shift opportunities so people and staff could get to know each other.

People were supported to maintain their nutritional wellbeing by staff and some people were supported to cook for themselves to maintain their independence. Some people lived at home with family members so staff were not always required to cook meals with or for people. People told us staff helped them prepare meals and supported them to shop for ingredients to plan meals.

People were supported to maintain their health needs and all medical appointments were well logged in people’s ‘Health Action Plans’.

People told us and we observed that staff treated them with kindness and respect in their own home and when supporting them in the community. Relatives of people who used the service spent time talking with us and explaining how the staff support was having a positive effect on their family member.

People and their families were fully involved in all decisions regarding their care and support. These decisions ranged from what staff supported them, to how they spent their time and what their care plans looked like.

Staff respected people’s privacy and dignity and treated them with respect. This involved making sure people’s homes, possessions and privacy were respected.

There was a procedure in place for addressing and responding to complaints and we saw that all complaints had been responded to in line with the organisation’s policy.

People and family members told us that the person centred approach taken by the organisation was exceptional and had made a difference to their lives. We saw numerous examples where person centred thinking and approaches had positive effects on people’s lives. This was clearly evidenced in people's care plans, and person centred plans, which were completed to a high standard and kept under constant review. We saw that outcomes and achievement's were celebrated with people, empowering them to take control of the support they received from Options.

The vision of the service was clearly implemented in all of organisation’s policies, processes and support plans. Staff told us they liked working for the company and were proud to be doing their jobs. Staff were rewarded and recognised for their accomplishments and achievements. Staff were complimentary about the team leaders, and the development managers.

There was a clear management structure in the organisation and everyone was aware of their roles within it. Team leaders told us they were well supported by development managers, who in turn told us they were supported by the chief executive. The organisation regularly sent out newsletters and articles to keep people updated with what was going on, both for the staff and for the people using the service.

We found there were effective systems to assess and monitor the quality of the service, which included feedback from people and their relatives. People using the service, their relatives and all staff were actively encouraged to contribute to the evaluation of the service and make recommendations for improvement. Results of surveys showed a very high rate of satisfaction with the service, the activities, the staff and registered manager. Where improvements could be made these had been considered and action taken. We saw that the provider had taken an innovative approach to this, and also developed a new system for more thorough auditing.

There was an effective and thorough quality assurance system in place. We found regular quality audits and checks were completed to ensure any improvements needed within the service were recognised and the necessary action was taken to implement any changes. We saw the staff were part of this review.

People who use the service told us they were happy with the support they received. One person said, "Options provides an excellent service. The team that look after my son are marvellous." People told us their needs had been discussed and they had agreed to the support to be provided. They told us their carers provided sensitive and flexible personal care support and they felt well cared for.

We looked at how the service was being staffed and reviewed staff training and supervision records. We saw there was sufficient staff with a range of skills and experience. Staff told us they felt supported, had regular meetings with the provider and their training was kept up to date.

There were a range of audits and systems in place to monitor the quality of the service being provided.