Advance Support and Enabling Service

Updated 10 September 2019

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

Inspection team: The inspection was conducted by one adult social care inspector and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. On this occasion they carried out telephone calls with two people using the service, four relatives and two staff following our site visit. Enthusiasm for the service shone through in the way all respondents were so open and spontaneous to praise it.

Service and service type: Advance Support and Enabling Service is a domiciliary care agency. It specialises in mainly providing support to people living with a learning disability under supported living schemes. The Care Quality Commission (CQC) only inspects the part of the service which provides 'personal care'. Where a person receives personal care such as physical help or any supervision and prompting to carry out daily living tasks themselves, we also consider any wider social care provided.

The service had a manager registered with the Care Quality Commission, who was also the provider. This means that they are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection: This inspection was announced. We gave the provider 48 hours' notice of the inspection to seek permission for us to visit the people being supported and ensure that people were at home.

What we did: Prior to the inspection, we reviewed information we already held about the service.

We asked the provider for a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We visited the registered office of to review records, policies and procedures. We spoke with the provider/registered manager, office manager and the services manager/deputy. We also spoke with two senior team leaders and a support worker. We reviewed three people’s care records, three staff personnel files and records related to the safety and quality of the service. We also visited four people in their own home. After our site visit, we received emails from eight members of staff sharing positive views of the service and their employer. We also asked two external professionals for their feedback.

Updated 10 September 2019

About the service: This service is a domiciliary care agency. It provides personal care to 17 people living in their own homes under supported living schemes in four shared houses. It also provides other support to people living in the community with mental health needs.

Supported living

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.

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.

The service supported people in their own homes, often with 24 hour support. At the time of the inspection 17 people were receiving personal care. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate people received care support. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. People with a learning disability were supported to live as ordinary a life as any citizen.

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.

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. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's experience of using this service:

The service was focussed on placing people at the heart of the service and its values. It had a strong person centred and local community-based ethos. Staff and the service's management told us how they were passionate about providing true person-centred care to people when they needed it.

People's needs, and wishes were met by staff who knew them very well. We saw and were told of many examples of staff helping and supporting the people they cared for so they could live their best lives.

Staff had received training to support their role, often bespoke so that it was relevant to the needs of the people being supported. People and their families were also able to access training to promote consistency for people in all settings. The provider/registered manager said, “Overall the impact of happy relaxed staff, families and relatives is happy people which is why we place such emphasis on supporting everyone.”

Staff had received regular supervision and appraisal. Staff performance was closely monitored in a supportive way. The provider/registered manager had fostered a culture of openness and professional challenge. This ensured all staff understood and were motivated to meet the high standards of quality expected of them. They all told us the people they supported were truly at the centre of all they did and people told us they were very happy.

Quality assurance measures were extremely robust and well embedded into everyday practice. Staff reviewed the quality and safety of care delivered in an in-depth way on a regular basis.

People had good health care support from professionals. The provider and staff worked in partnership with health and care professionals. The service was led by a passionate provider/registered manager who was dedicated to the health and wellbeing of people they supported. They had worked tirelessly to identify each person's risks, needs and preferences, including investigation into the impact of health issues on people's physical and mental wellbeing. Staff had ensured they collected data to act as people’s advocates and help provide information to health professionals. This had led to diagnoses and positive health interventions. This enabled each person to have an improved quality of life, where their independence was promoted. Best practice standards and professional research was used to implement high quality, effective care.

There was a consistent staff team, many of whom were very long-serving and knew people very well. Staff showed very caring, thoughtful and compassionate care to each person. Staff used different communication methods with each person and were able to interpret fluently what people wanted. This meant that people, some of who had little or no verbal communication, were very well understood and supported. Each person had a highly individualised communication and support plan taking into consideration all their communication methods. This was also shared with people they came into contact with in the community, again to promote people’s independence.

Support plans described the risks, needs and preferences and how staff should work with each person to ensure the person was able to lead as fulfilled and independent life as possible. Staff were aware of people's life history and preferences. They used this information to develop positive relationships with people and staff and people and their families and deliver person centred care. People felt very well cared for by staff who treated them with respect and dignity. There was a clear commitment to support people at difficult times with compassion, respect and affection.

People were supported to access a range of leisure pursuits and participate in the community they lived in. New ideas for activities were explored and trialled to keep people occupied in a meaningful and enjoyable way. Staff found individualised ways to enable people to access the activities they wanted, sometimes working discreetly to promote independence. Although the provider was not responsible for the environments which people lived in they had put in place arrangements to work with the housing providers to ensure they met people's needs.

People, and their families, were involved as much as possible in their care and support which helped to give them choice and control in their lives. People's families spoke very highly of the quality of care and of the approach of the provider/registered manager and staff in supporting their relative. Relatives and professionals held the service in very high regard. Health professionals praised the service describing the positive outcomes and benefits to people due to the way staff advocated for each person using evidence to support their proposals.

People said they felt very safe. Risk assessments were very thorough, individualised and flexible. They were devised and shared with people so that they could develop action plans together with staff that promoted independence safely. Staff knew how to keep people safe both from the risk of abuse and from assessed risks. There was enough staff to support people and staff were flexible in their approach and positive risk taking. Efforts were made to ensure people knew who would be supporting them, often matched with support staff with similar ages and interests.

People were supported to have nutritious meals according to their likes and dislikes and their dietary needs had been catered for. This information was detailed in people's care plans. Staff followed guidance provided to manage people's nutrition and enabled people to manage their diet as informed and independently as much as possible.

Care plans contained excellent information about people and their care needs. People were fully involved and care plans were working documents, used and reviewed to reflect each person’s current needs. This included celebrating achievable goals and progress towards independence.

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.

Medicines were administered by staff who were well trained and competent. There were robust systems to ensure medicines were received, stored, administered, recorded and returned safely.

Arrangements were in place to manage and prevent cross infection and ensure good infection control systems were in place.

When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.

Rating at last inspection: Good (Report Published 31 January 2017).

Why we inspected: This inspection was carried out based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit in line with our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk