Extra Care

About the service

Extra Care supports people to live in their own homes. People using the service lived in flats across 7 schemes, across the County Durham area. The service provides personal care and support to people who may be living with dementia, of older age, a learning disability or autistic spectrum disorder, a physical disability, sensory impairment or mental health needs. At the time of the inspection, the service was providing care to 210 people.

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

Right Support:

Risks to people's health, safety and well-being were effectively managed. Medicines were administered safely. The provider had effective infection prevention and control systems in place.

People were supported to access specialist health and social care support where appropriate. People told us they felt safe when receiving support from staff. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Care:

People told us staff arrived on time and they received support from the same group of staff, which promoted good continuity of care. People's needs were assessed prior to the commencement of the service. The assessment included people's health, physical, emotional and communication needs. Care provided was personalised and supported people’s preferences and wishes. Care plans had been reviewed regularly to ensure they were accurate.

People were encouraged to be independent and to carry out tasks without support.

Right Culture:

The provider had recruitment processes in place to ensure suitable staff were employed. New staff we spoke with said this process was clear, inclusive and supportive.

People and staff spoke positively about the management of the service and their openness to feedback. The management team was approachable, maintained regular communication, and listened to the views of others.

Systems to monitor the quality and safety of the service were in place. The registered manager was a positive influence, open and aware of their legal responsibilities.

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.

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 (published 26 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Extra Care on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This service provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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.’

The provider had policies and procedures in place to keep people safe. Staff were trained in safeguarding. The registered manager maintained a log of all accidents, incidents and safeguarding concerns. They ensured lessons learnt were disseminated to staff as part of supervision and team meetings.

Risks to people were assessed with control measures in place for staff support and guidance.

Medicines were managed safely by trained staff whose competency to administer medicines was checked regularly.

The provider ensured staffing levels met the needs of people who used the service. Staff were appropriately trained and received regular supervisions and appraisals.

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.

Staff supported people with their nutritional needs to maintain a healthy varied diet. People had access to health care professionals when necessary.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. People told us staff supported them to uphold their privacy..

Care records were written in a person-centred way. People’s individual wishes, needs and choices were considered. People’s care and support was reviewed on a regular basis.

People were supported to attend activities and entertainment within the setting.

The provider had an effective complaints procedure in place and people who used the service and relatives were aware of how to make a complaint.

The provider had accessible information in different formats for people if requested.

The registered manager and staff worked with other stakeholders such as healthcare professionals. Community links were maintained with people accessing local amenities such as shops and churches.

The provider had an effective quality assurance process in place. Staff said they felt supported by the management team.

We carried out this announced inspection on 14, 15 and 16 March 2016. We met with the registered managers and staff on 14 March and also spoke with people using the service and we looked at records on the 15 and 16 March.

We met with both registered managers of the Reablement South and Extra Care service. Both had been in post since the services began and had many years of service with in the local authority. 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.

For the reablement service, a team of supervisors and support officers were based in the office location with team leaders and reablement workers providing the direct service in people’s own homes.

For the Extra Care Service supervisors were employed at all seven of the service’s schemes around County Durham and they facilitated the day to day running of the extra care services and liaised with the housing provider where needed.

People we spoke with who received personal care felt the staff were knowledgeable, skilled and the care package met their needs. In the Extra Care service staff knew the people they were supporting well. People who used the told us they felt comfortable with the members of staff who were supporting them. Staff told us people received good care and support.

Staff undertook the management of medicines safely. There were procedures in place to support staff and staff we spoke with told us they were trained and felt confident in medicines management.

People told us they felt confident that should concerns be raised these would be dealt with appropriately. People told us they could contact the registered managers or staff at the service if they needed to discuss anything. People said they had the opportunity to talk about their opinions of the service during reviews and through meetings.

People were supported to maintain good health and had access to healthcare professionals and services. Where needed people were seen or referrals were made to the GP, district nursing service, occupational therapist, community physiotherapist and dietician.

People told us they were supported to prepare food and drinks of their choice. This helped to ensure that nutritional needs were met. People told us they were encouraged and supported to be independent with meal preparation.

People told us staff respected their privacy and dignity. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

The registered managers and staff we spoke with told us they had attended training in the Mental Capacity Act (MCA) 2005. MCA is legislation to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances.

Records we saw confirmed Durham County Council had effective recruitment and selection policies in place which ensured staff members were of good character and had the required skills to perform their work.

Staff we spoke with told us they felt supported and they spoke highly of the training provided by the service. We saw that meetings with staff both individually and collectively were positive and well recorded.

We saw support plans and risk assessments were developed with the person and staff were able to show us that they were clear and easy to follow.

There was a robust quality assurance process carried out by the service and registered provider as well as close monitoring of accidents and incidents. We saw the service had responded to any learning and improvements it needed to make to its service.

We found personal care was planned and delivered in a way which ensured people's safety and welfare. One person said, 'I can't tell you how good this is. I have regular help with exactly what I need and if I need more, it's at the press of a button.'

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse. One person told us she had confidence in the carers support. She said, 'I'm safe, cared for and I have a community and friends around me.'

We found staff received appropriate professional development. People told us they were happy with the support they received. One person told us, 'The staff are very good, well trained and knowledgeable.'

People who used the service and their representatives were asked for their views about the service. We saw their responses were acknowledged and acted on. In a survey of both services almost all of those who responded said the quality of their lives had been improved.

We found care and treatment was planned and delivered in a way which ensured people's safety and welfare. One person told us, 'They stepped in as soon as I got out of hospital. They sorted out my tablets and helped me... as I got better, I told them I didn't need the visit."

The provider had made suitable arrangements to protect vulnerable people and respond appropriately to any allegation of abuse. One person told us he had confidence in the carers support. She said, 'It's the little things like knowing someone will definitely be calling that helps you not to worry that you will be neglected.'

We found staff received appropriate professional development. People told us they were happy with the support they received from staff. One person using the service told us, 'The staff seem well trained, know what they're doing and are confident. Their confidence helps you feel confident.'

People who used the service, their representatives and staff were asked for their views about the care offered. We saw their responses were acknowledged and acted on. One person told us, 'If something's not to your liking you just pick the phone up and talk to them. And when they visit they're always asking if everything's alright.'