Coquet Trust

Coquet Trust is a supported living service and a domiciliary care agency providing personal care and support or enablement to autistic people and people with a learning disability and/or mental health needs. At the time of the inspection 104 people were receiving support.

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

People told us they felt safe and trusted the staff who supported them. Staff had attended safeguarding training and understood how to report concerns. Risks had been assessed and positive risk taking was supported.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care maximised people’s choice, control and independence. Support was person-centred and promoted people’s dignity, privacy and human rights. The ethos, values, attitudes and behaviours of leaders and support staff ensured people using services lead confident, inclusive and empowered lives.

People were supported to live healthy lives and access medical and health care services when needed. Staff were well supported and had attended training to enable them to meet people’s needs.

There were two registered managers in post who worked closely with the nominated individual to develop and improve the service following a robust quality assurance procedure.

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 (report published 9 January 2020) and there were two breaches of regulation, which related to staff support and good governance. 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.

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.

Coquet Trust provides personal care and support or enablement to people with learning disabilities, autism or associated related conditions and/or mental health needs. 49 people received support with personal care. Although after the inspection, the management team confirmed this figure was to be reviewed as it was thought more people received personal care than they originally advised. CQC only inspects where people receive personal care. This is defined as help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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 received a caring and responsive service, but other aspects required improvement. There were issues and gaps in records which had not been effectively identified and addressed by the provider's quality assurance system.

Staff had not always received the support they needed, including regular supervisions or annual appraisals. Some staff had not received competency checks to ensure they were following safe working practices. There were enough staff to support people. However, we have made a recommendation regarding reviewing the number of hours staff work to ensure it is not excessive.

Medicines management needed some improvements, including in connection with recording medicines applied in the form of creams or ointments. The provider confirmed these issues were to be addressed immediately.

People were protected from abuse and staff advised they would report any concerns. Risks had been assessed for people and the provider was working through paperwork to ensure these were all up to date and relevant.

People were treated with kindness by caring staff. Care was person centred, but records needed to be further reviewed to fully reflect this. People were supported to maintain social inclusion.

Arrangements were in place for people and their relatives to raise complaints. We noted the associated policy needed to be updated.

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. Some best interest decisions records needed updated and reviewed. We have made a recommendation about the records in relation to keeping copies of lasting power of attorney or court of protection.

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 skills and become more independent. However, outcomes were not always recorded fully or reflective of support or opportunities provided.

There was a registered manager formally registered with the service but they were no longer working for the provider and had not requested the CQC cancel their registration at the time of the inspection.

We found two breaches of regulations in connection with staffing and good governance.

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 good (published 18 May 2017). The service has now deteriorated and is rated as overall required improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up:

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

At the last inspection in December 2014 we had rated the service as 'Good'. At this inspection we found the service remained 'Good' and met each of the fundamental standards we inspected.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. People told us they were safe. There were enough staff to provide individual care and support to people.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions themselves. There were other opportunities for staff to receive training to meet people’s care needs.

People were involved in decisions about their care. They were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Information was made available in a format that helped people to understand. This included a complaints procedure. Complaints were taken seriously and records maintained of the action taken by the service in response to any form of dissatisfaction or concern. People we spoke with said they knew how to complain.

People had food and drink to meet their needs. Some people were assisted by staff to plan their menu, shop for the ingredients and cook their own food. Other people received meals that had been cooked by staff. People were appropriately supported to maintain their health and they received their medicines in a safe way. Those who were able, were supported to manage their own medicines.

People were provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were supported to contribute and to be part of the local community. Staff had developed good relationships with people, were caring in their approach and treated people with respect. People and relatives were positive about the care provided. One relative told us “I would recommend it to anyone.”

A range of systems were in place to monitor and review the quality and effectiveness of the service. People had the opportunity to give their views about the service. There was regular consultation with people or family members and their views were used to improve the service.

Further information is in the detailed findings below

Some of the people who used the service had complex needs and were unable to tell us about their experiences. We carried out an observation of care delivery to help us understand their experiences of the care they received. During our observations we found people appeared calm and happy. Staff were polite, patient and treated people in a respectful way.

We saw people were treated with respect and they were involved in all decisions with regard to their daily living needs. Information was made available to people in various formats appropriate to each person's communication needs.

Staff we spoke with said it was a good organisation to work for and there were excellent training opportunities. One person said: "Training is on-going. There are loads of opportunities."

Staff said they were well supported to do their job. They all said they thought communication was effective and they were kept informed of people's care and support needs.

We saw appropriate checks were carried out to look at a person's suitability before they began work for the service.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.

Comments included:

'I'm happy here.'

'Everybody is kind to me.'

"I'm looking forward to going away at the weekend to Blackpool."

We found staff received professional development and they were well trained to help them understand the care and support needs of the people they worked with. People who used the service told us staff were very kind and caring.

We saw the provider had systems in place to gather feedback from people, who used the service, and to regularly assess and monitor the quality of service people received.