SeeAbility - Devon Support Service

Updated 25 May 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The provider completed a Provider Information Return, (PIR) which we used to help prepare for the inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the information included in the PIR along with information we held about the service, such as contact from the service, members of the public and through notifications. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing any potential areas of concern.

Prior to the inspection, some concerns were raised with the Care Quality Commission (CQC) with concerns about lack of experienced staff. The concerns included risks for people with swallowing difficulties and standards of personal care. Prior to the inspection, the service notified CQC of two safeguarding incidents recently which were reported to the local authority, one of which was being investigated by the police. So in planning the inspection, we focused on how the service was managing and minimising risks for people, and on staff skills and training.

In preparation for the inspection, we sent two questionnaires to people identified as able to able to respond to questionnaires and received one response. We sent 12 questionnaires to staff and received three responses. During the inspection we met with five people in their own homes and with three people in communal areas. We spoke with three relatives to ask them their views about the service. Some people were not able to comment directly on their care. We spent time in in two people’s flats and in a communal area to observe interactions between people and staff. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk. We also spent time with people in a communal area to see how people interacted with each other and staff. These observations helped us make a judgment about the atmosphere and values of the service.

We looked in detail at two people's care records and at their medicine records. We met with the registered manager, deputy manager and the regional head of operations of SeeAbility, a housekeeper and with eight care staff. These included two agency staff and a member of bank staff. We looked at five staff files which included details of recruitment, training, supervision and appraisals. We also looked at staff meeting minutes, accident and incident reports, complaints and compliments. We looked at audits of medicines, care records and at checks carried out on staff providing care in people's homes.

We sought feedback from commissioners, Healthwatch England (the consumer champion for health and social care), as well as from health and social care professionals. We received a response from three of them.

Updated 25 May 2018

This comprehensive inspection took place on 4 and 5 April 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit. This was so we could arrange to visit some people in their own homes to hear about their experiences of the service. Also, to ensure the registered manager was available when we visited. We last inspected the service on 3 and 5 November 2015 and found the service was compliant with the standards and there were no breaches of regulations.

SeeAbility - Devon Support Service provides care and support to eight people living a ‘supported living’ setting at Windmill Court, Honiton, so that they can live in their own home as independently as possible. The service specialises in supporting people with sight loss with a learning disability, autistic spectrum disorder or acquired brain injury. The flats offer purpose-built accessible accommodation located around a central communal area, where people can meet up and socialise with neighbours and staff if they wish. All flats had two entrances, via a front door from the outside grounds, or via a door from within the communal area.

People’s care and housing were provided under separate contractual agreements. CQC does not regulate the premises used for supported living; this inspection looked at people’s personal care and support.

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.

The service had a registered manager who worked across two locations, in Honiton and Exeter. 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.

In 2017, Devon County Council undertook a review of people in supported living services across Devon. The review was to check individuals were actually getting the support they needed. Also, to clarify any shared support arrangements to make sure they were transparent and fair for everybody, represented a quality service and were value for money.

At Windmill Court, the review significantly reduced the one to one and staff support hours each person received and the shared staff hours. The registered manager said these changes were a very difficult and a worrying time for people and staff and meant people had to adjust to having less staff support hours than they had previously. In order to accommodate the funding changes, the service underwent major organisational change and introduced new ways of working. The registered manager confirmed since the changes were introduced in April 2017, gradually all but two of the original 26 staff team who worked at Windmill Court have left. People, relatives and professionals all commented on how the high turnover of staff had impacted on people.

One person spoke movingly about their sense of loss, when staff they knew well who had worked with them for years left. They said, “They were not just colleagues, they were my extended family.” Another person speaking about the changes said, “For me, it hasn’t been easy.” A relative of a person said, following the changes, it took them a while to settle at night, so they discussed and agreed for the person to have increased staff monitoring at night. When we visited people and staff were still working through those changes. A number of new staff had been recruited, although not all had stayed and there was a significant increase in the use of agency staff. Six staff were undergoing induction when we visited, with four more staff due to start. The registered manager anticipated they would have a full staff team by the end of April.

People felt safe and had their care needs met and there were no missed visits. However, the number of new staff and high agency use was adversely affecting some people’s experiences of care, although others had positively benefitted from staff changes. To minimise risk and improve continuity of care for people, several agency staff worked regularly at Windmill Court. So they had got to know people and about their needs.

Rotas were only available one or two weeks in advance and didn’t include named staff for all support visits planned, with people having less continuity of care staff. Speaking about progress in building a stable staff team, one person said, “The staff team are getting more settled, we are not there yet but we are getting there.” A relative said, “We are hoping things will settle down now.”

The risk of abuse was minimised because staff demonstrated a good understanding of what constituted abuse and knew how to report concerns within the service and to external agencies. Safe recruitment practices were followed before new staff were employed to work with people. People had a range of ways through which they could raise concerns. People’s concerns were listened and responded to.

People’s rights were protected because the service followed the appropriate legal processes. People received their medicines safely and on time.

People receive effective care from staff with the relevant qualifications, training and skills to meet their individual needs. New staff received a thorough induction and all staff had regular supervision and opportunities for further training and professional development. People were supported to see appropriate health and social care professionals regularly to meet their healthcare needs.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

People ate a well-balanced diet and received staff supported them to plan, shop and cook meals of their choice, according to their ability. Where there were any concerns about nutrition or hydration, staff sought professional advice appropriately and followed that advice.

Staff were considerate and caring in their manner with people and knew people’s needs well. People were partners in their care and were fully involved in decisions about their care and treatment. People and relatives said staff treated them with dignity and respect.

People received personalised care that responded to their changing needs. People's care records were detailed about their individual needs including their sensory needs related to their visual impairment. For example, to speak with the person as they approached, that a person was sensitive to bright lights. Information was provided for people in Braille, audio and easy read formats.

People were supported to live as independently as possible and were supported do their own cooking, shopping, laundry and housework, according to their ability. People had a wide range of hobbies and interest and were part of their local community.

The service was well led by the registered manager and deputy manager, who led by example. Robust quality monitoring systems were used to monitor and continually improve. People, relatives and staff were regularly consulted and involved in developing the service. Staff used evidence of what works best to continually review and improve their practice.