Outreach Services

Outreach Services is a domiciliary care service providing support and personal care to people who live in their own homes. The service provides support to autistic people and people with a learning disability. At the time of our inspection there were 224 people using the service who lived across a large geographical area within the Northwest of England.

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.

Many of the people who received support lived in 'supported living' settings. People held an individual tenancy for their own property or lived in shared accommodation where they held a tenancy for their bedroom; and shared communal areas such as lounges and kitchens. Each 'supported living' service had designated space for staff to store their belongings, maintain records and when needed, provide sleeping in support.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

The provider was working to transfer a small number of Autism Initiative owned properties into alternative ownership. This would then ensure all people who used the service were supported in a way which fully met the principles of 'Right support, right care, right culture'.

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. People had a choice in who supported them; staff knew people well and trusting relationships had been formed.

Staff supported people to take part in employment and education opportunities and to pursue their leisure interests in their local area. The provider demonstrated a commitment to offering opportunities for people to reduce the risk of people experiencing social isolation.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity, understanding and responding to their individual needs. People could communicate with staff and understood information given to them because staff supported them consistently and understood their individual communication needs.

Right Culture:

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the registered managers and staff employed. People received good quality care and support and because appropriately trained staff could meet their needs and wishes. The provider had clear and effective governance systems in place which identified and managed risks through audits and action plans.

People receiving support, and those important to them, were involved in planning their care.

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 30 January 2018).

Why we inspected

The inspection was prompted in part due to concerns received about poor care, medicines and a lack of action by the management team to respond to concerns. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well led sections of this full report.

Follow up

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

The service was re-registered by CQC in March 2017 due to a change of address. This was the services first inspection under the provider’s new registration.

This service provides care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

People using the service lived in a single house in multi-occupation shared by no more than six people in one house. Houses in multiple occupation are properties where at least three people lived in one household shared a toilet, bathroom or kitchen facilities. However, other people lived in single occupancy flats, with a room for staff to use. Some of the houses had large shared communal rooms and grounds.

The service had 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. Registering the Right Support CQC policy

There was a manager in post at the time of this inspection who’s application to become registered manager was being processed by the Commission. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection, we received positive feedback from the local authorities regarding the service, and improvements they had made. There were still some concerns in one area, however, and the provider was working closely with the local authority in this area to ensure that improvements were sustained. We felt reassured speaking to the local authority and visiting some people’s homes in this area, that the provider was making good progress with their action plan. However we have requested to be kept updated with regards to this . The provider was open and honest about these concerns, the local authorities were positive regarding this service, and were happy to support the service to improve.

Everyone we spoke with said they felt safe and happy being supported by Outreach Services.

Staff we spoke with were clearly able to explain the course of action that they would take if they felt someone was being harmed or abused, and how they would report it, including whistleblowing to external organisations.

There was enough staff employed by the service to provide a good service, however in some areas, agency staff were being used. The provider explained the staffing situation and told us how they tried to minimise the impact of using agency staff on the people they supported. They told us they were deploying staff from one agency to provide consistency and familiar staff.

Medicines were well recorded and managed for people who required support. Assessments were being completed to support people with their medication needs.

Risk assessments were clear, concise and explained the impact of the risk as well as how the staff should support the person to manage the risk. Risk assessments were regularly reviewed with the input of the people who used the service and their families.

There where enough suitably trained staff to meet their individual care needs. Staff where only appointed after a thorough recruitment process. Staff where available to support people to go out on trips or visits within the local and wider community and to attend medical appointments.

Staff recruitment records showed that staff were recruited safely after a series of checks were undertaken on their character and work history.

Staff where supplied with personal protective equipment (PPE). This included gloves, aprons and hand sanitizer. Staff we spoke with told us they were always able to ask for more PPE when needed. Staff had completed infection control and prevention training and understood the importance of reporting outbreaks of flu and vomiting to the registered manager.

The manager and the staff understood the principles of the Mental Capacity Act 2005 and associated legislation and had taken appropriate steps to ensure people exercised choice where possible. Where people did not have capacity, this was documented appropriately including decisions made in their best interests. The best interests process was being documented to demonstrate the involvement of family members and relevant health care professionals where appropriate. This showed the provider understood and was adhering to the Mental Capacity Act 2005.This is legislation to protect and empower people who may not be able to make their own decisions.

The provider was meeting their requirements as set out in the Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005).

Staff undertook training in accordance with the providers training policy; we observed some training which had took place at the time of our inspection. Staff told us they enjoyed the training.

Core Skills training took place over the course of five four days as part of the twelve week induction programme, and this training was accompanied by assessments booklets for various subjects which staff were required to complete. Additionally, there were further subjects staff were required to attend training in, to ensure they were skilled enough to support people with different levels of understanding and diagnosis autism.

Staff where caring and supported people respectfully and kindly always upholding people’s dignity.

Support plans were exceptionally well written and where being fully utilised by staff, people themselves and their family members to ensure the best possible outcomes for people receiving a service from their support with Autism initiatives. Support plans with regards to people’s preferred routines and personal preferences were well documented and plainly written to enable staff to gain a good understanding of the person they were supporting. Support plans contained a high level of person centred information. This information and the way staff supported people had positively affected people and they shared some of these examples with us.

Activities were always meticulously planned and coordinated by the people themselves to ensure they had full control of their lives. The service worked well to ensure that strong community links were forged. This was clearly evidenced in some of the projects available for people to become involved in. We saw examples of how this had worked positively for people.

Complaints were responded to and recorded in line with the organisations complaints procedure. The procedure was also made available in an easy read format to help support people’s understanding.

A robust quality assurance system was in place and the manager looked at ways they could continuously improve the service people received.

Good partnership working was evident in recent pieces of work which took place outside of the organisation.