New Direction Support

The service has two separate departments, one managed the domiciliary care and the other managed the supported living service. As both services are registered at one location this inspection covers both departments. The agency is based in Plymouth and provides a service to people living in Plymouth and the surrounding area. At the time of this inspection they provided personal care to 43 people using the domiciliary care service and 31 people in supported living receiving support with personal care tasks. Supported living is where people live either on their own or with a small group of others, and have their own tenancy agreement. Care and support is provided in order to promote their independence. The care people receive in supported living settings is regulated by CQC, but the accommodation is not.

We checked the service was working in line with ‘Registering the Right Support’ which makes sure services for people with a learning disability and/or autism receive services that are developed in line with national policy. For example, how the service ensures people care is personalised, maintains their independence and supports links with people’s community.

At our last inspection we rated the service as Good overall. The evidence continued to support the rating of Good overall and 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.

At this inspection we found the service remained Good.

Why the service is rated Good.

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. The registered manager had overall responsibility for both services but there was another manager who ran the domiciliary care service (DCA) on a day to day basis. (The report refers to the registered manager- for supported living and overall responsibility and the manager for the DCA).

People told us they felt safe. Care was taken to recruit and select the right staff for the job. Recruitment processes helped the provider choose applicants with the right values and caring qualities for the job. Staff had received training on safeguarding and knew how to identify and report any concerns about potential abuse.

Risks to people's health and safety had been assessed and staff had been given information and training about these as well. Staff understood specific health conditions and knew how to recognise signs of illness and when to seek medical intervention. People were supported to manage their medicines safely.

People told us the service was effective. Comments included, "I think they have enough training they are very skilled”, “They make sure she’s got her shoes and socks on and that she’s warm and cared for, brilliant!” and “Very satisfying, I have no complaints.” People received a reliable service from small teams of staff who knew them well and understood their needs. Staff were well trained and well supported. Staff had the skills and information they needed to ensure people's needs were fully met. People said, “They always come on time and we have a chat and they make me smile which is good”, “All the girls do a fantastic job” and “I get regular carers, they’re really good, do anything I want. They always make sure I’m ok, they are friendly and kind to me. Sometimes it’s a bit of company, they will sit and chat with me and that makes me feel good.”

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. Consent to care and treatment was always sought in line with legislation and guidance. The service understood their legal responsibility to ensure they complied with the Mental Capacity Act. People receive support from staff who respected and promoted equality and diversity.

People told us the staff were always caring. Comments from people included "No worries, they are really friendly”, “Get on well with them all, no problems happy with care”, “They know how to protect my Mum’s dignity, they are very good that way, always taking time and chatting so she understands” and “It’s the little personal things that they do that make a difference.”

Staff were compassionate and understood the things that mattered to people. We heard examples of how they had made a positive difference to people's lives and how the staff sometimes went above and beyond their regular duties to make sure people were happy and safe.

People received a service that was responsive to their changing needs. People received personalised and responsive care from staff who knew and understood their needs. For example, the manager said, “They may want a cup of tea but we know they would like it in a particular cup. Everybody is different. Some people are very specific, I want to capture everything.” Support plans were drawn up and agreed with people before the service began. The plans were regularly reviewed and updated to ensure staff always had access to up-to-date information about all aspects of the person's needs. People were given information about the service, including a copy of their support plan.

People told us the service was well managed. The provider was very involved in the service, visiting the office regularly and had quality monitoring processes in place to ensure the service was constantly improving. Spot checks were carried out regularly by a member of the management team to check the quality of the care staff provided to people. This also meant the management team were very knowledgeable about people’s needs.

The provider's electronic care system enabled the management team to monitor the service throughout each working day. For example, to see which ‘run’ staff were doing and which people they were supporting as well as where vacancies were available.

The views of people who used the service, relatives and staff had been sought in various ways and these were acted upon. Concerns and complaints, however small, were responded and listened to and used to improve the quality of care. For example, a recent survey had noted that sometimes care workers did not always put the bin bags in the bin and this had been dealt with immediately.

Further information is in the detailed findings below.

Premier Care (Plymouth) provides individually tailored care and support to people with learning disabilities. At the time of the inspection, the service was providing personal care to 14 people.

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. People and their relatives told us staff were caring and kind. Staff demonstrated kindness and compassion for people through their conversations and interactions. People’s privacy and dignity was promoted. People were actively involved in making choices and decisions about how they wanted to live their life. People were protected from abuse because staff understood what action to take if they were concerned someone was being abused or mistreated.

People received care which was responsive to their needs. People and their relatives were encouraged to be part of the care planning process and to attend care reviews. This helped to ensure the care being provided met people’s individual needs and preferences. Support plans were used to help people focus on their future goals as well as recognising their strengths and achievements.

Risks associated with people’s care were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. The provider wanted to ensure the right staff were employed, so recruitment practices were safe and ensured that checks had been undertaken. People’s medicines were managed safely.

People received care from staff who had undertaken training to be able to meet their unique needs. People’s human rights were protected because the registered manager and staff had an understanding of the Mental Capacity Act 2005 (MCA). People’s nutritional needs were met because staff followed people’s support plans to make sure people were eating and drinking enough and potential risks were known. People were supported to access health care professionals to maintain their health and wellbeing.

The service was well led by a registered manager who demonstrated the provider’s values. There were quality assurance systems in place to help assess the ongoing quality of the service, and to help identify any areas which required improvement. The provider and registered manager promoted the ethos of honesty, learned from mistakes and admitted when things had gone wrong. The service was constantly striving to improve.