City Care Partnership Limited

City Care Partnerships is a domiciliary care agency. It provides personal care and support to people living in their own houses and in five ‘supported living’ settings. They support autistic people and people with a range of complex learning disabilities. At the time of the inspection 16 people were being supported by the service.

People’s experience of using this service:

The service had improved its overall rating of good awarded at the last inspection in 2016 to Outstanding.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and this had led to highly person-centred care and support. The principles reflected the need for people with learning disabilities and autistic people to live meaningful lives that include control, choice, and independence.

People’s lives were greatly enhanced by innovative and creative person-centred support that maximised their opportunities for self-development and growth.

People told us the support from staff was ‘fantastic’ and ‘amazing’. Relatives told us that the staff team were “phenomenal” and “absolutely fantastic” in their understanding of supporting autistic people. They described the input of the service as being 'life-changing'.

Staff were passionate and really cared about making a difference to the people they supported so that they could lead the best lives possible. People were supported to lead fulfilling, active lives and to be active citizens within the local and wider community. This had led to people’s aspirations and dreams being realised.

Great emphasis was placed on people being physically and mentally active to promote well-being. Yew Tree Hub, the provider’s unique activity hub complex, was a key feature of the services success. People worked at Yew Tree dog kennels, helped to run a stable and livery centre and to grow and sell organic farm produce. Expressive arts were a major focus with many opportunities for dance, song, music, art and drama. This had led to long-term employment and volunteering opportunities that people and their relatives had previously not thought possible.

The service had a proven track record of providing exceptional care and specialist support. This was achieved through input from the providers Central Support Team (CST) employing a clinical psychologist, a speech and language therapist and trained behaviour specialists. Great emphasis was placed on analysing and using data to understand people’s behaviours that maybe challenging and communication needs.

The staff team were highly trained and this had led to a major reduction in behaviours that may challenge the service and the need to use physical interventions with people. People were exceptionally well supported when transitioning between services, especially for people whose previous placements had broken down. As a result people’s outcomes and quality of life had been significantly improved through this exceptional support planning.

People were expertly 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 were key to this practice.

People we spoke with and staff told us the leadership and management was inspiring. The service acted as a role model for other services sharing ideas and best practice and had been nationally acknowledged as a leader in the learning disability sector.

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 August 2016).

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.

This was an announced inspection on the 04 October 2016. Two days prior to the inspection, we contacted the provider and told them of our plans to carry out a comprehensive inspection of the service. This was because we needed to be sure that someone would at the office.

The service had a registered manager in place at the time of our inspection. 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.

Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. Staff were able to tell us how to identify and respond to allegations of abuse. They were also aware of their responsibility to ‘whistle blow’ on colleagues who they thought might be delivering poor practice to people.

We found recruitment procedures were robust, people and family members were involved in the selection process which meant new staff should be suitable to look after the people who used the service.

People were encouraged to self-medicate if they could. Staff were trained in medicines administration and had policies and procedures to follow good practice. The administration of medicines were safe.

Risk assessments did not prevent people from enjoying their lives but helped them keep safe.

Staff were trained in techniques to de-escalate any behaviours that challenged to help keep people who used the service safe.

People who used the service told us they liked where they lived and were involved in running the home. This included having their say in meetings and also keeping the home clean, shopping and cooking.

People were supported to take a nutritious diet and sufficient fluids to remain healthy.

New staff were inducted to the service and enrolled on the care certificate. Staff who had completed this induction or worked at another service had their abilities assessed and enrolled on any training to support them to look after the people who used the service. Training was extensive, tailored to staff and people who used the services needs and relevant to the role they performed. Supervision and appraisal was ongoing and tied to the services quality assurance framework to provide a better service for people.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards.

We observed that staff knew the people they looked after well and had a good rapport with them.

The service matched people who used the service with a staff member who had similar interests which enabled them to do what they liked together.

We saw that the religious needs of people who used the service were recorded and people had the opportunity to follow their faith if they wished.

People were able and encouraged to attend activities in a group or as individuals. We saw the service took care in helping people with Autism or learning disability to attend new activities in a planned way to ensure all went well. There were many records of what people enjoyed. People were given opportunities to attend work or college if they wished.

Staff were able with training and specialised equipment to support people who had problems with verbal communication.

People who used the service told us they felt able to complain. The complaints procedure was available in an easy read format and there were photographs and contact details of managers, which gave people a clear message who they could complain to.

The assessment process helped ensure people who used the service were aware of what was happening and they were given sufficient time to become used to moving into supported living.

Plans of care were extensive, holistic and reviewed regularly to keep their health and social care needs up to date.

There were systems in place to monitor the quality of service provision. The service had a planned development plan which laid out how they intended to improve the service.

People who used the service and staff told us managers were approachable and supportive.

People who used the service, staff and relatives were able to attend meetings to help decide how the service was run.

People spoken with told us they were happy with the service provided and they were encouraged to make choices about how they spend their time. They told us that they felt well supported and listened to by staff and they liked the staff.

We reviewed the care records for two people. We found that care records were detailed, comprehensive and clearly identified the needs of the person in relation to their learning disability and the support they required to develop their independent living skills.

We looked at the way complaints were handled by the agency and saw that people were listened to and appropriate responses were given.

We looked at staff records and saw that staff had been robustly and appropriately recruited.

All staff spoken with were positive about the standard of care provided by the agency and the support they received from the management team.

We looked at a variety of records at the office and saw that these were regularly updated and stored appropriately.

One person using the service told us, 'I think the service is brilliant. I am very happy with the support I get from my support workers, they are great. We talk about my health plan and things I want to do all the time. I also have a job which I really like.' Another person told us, 'I wasn't happy a while back about the support I was getting so I told them about it. It was all sorted and now things are really good.' We asked this person if they would have the confidence to raise concerns again if they weren't happy and they told us 'I certainly would.'

Each person using the service had their own support plan. These support plans were known as an 'Essential life plan' (ELP) and consisted of eight files of different information that collectively made up the persons care plan and provided staff with detailed guidance on how each person was to be supported. For example, as well as the ELP the files held risk assessments, behavioural strategies, daily logs (communication records) and health action plans.

We found that people using the service were safeguarded from potential abuse.

We found that staff received appropriate training.

The provider had systems in place to monitor the quality of service.