Archived: West Cornwall Support Service

West Cornwall Support Service provides personal care to people living in their own homes in the community. It is a supported living service which aims to support people to live 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. At the time of our inspection the service was providing support to 58 people with a learning disability living in Cornwall. The service provided support to people living in 15 different settings, three of which had previously been registered as care homes. On the days of our inspection 20 people the service supported were receiving personal care.

People told us they felt safe and well cared for. Their comments included, “I think the staff are wonderful” and “It’s nice and cosy[here].” While staff told us, “People are absolutely safe.” People’s relatives were also complimentary of the support the service provided and commented, “I know [Person’s name] is happy”, “The staff are all very caring” and “[My relative] gets on with the staff and laughs and jokes with them”.

All staff had completed safeguarding training and understood their role in protecting people from all forms of abuse and discrimination. Staff understood how to raise safety concerns outside the organisation but were confident any concerns they reported to their managers would be addressed.

The service employed sufficient staff to meet people’s needs and records showed planned levels of support had been provided. Staff told us, “There are enough staff” and “We tend to get cover even when staff are sick at the last moment.” Records showed the service was in the process of recruiting to fill staff vacancies. The majority of vacant shifts were normally covered by existing staff who knew people well.

Staff were well trained and knew how to meet people’s support needs. All new staff completed a comprehensive 12 week induction programme which incorporated the care certificate. Records showed training was regularly updated and staff told us, “The training has been good”.

Care plans provided staff with sufficient guidance to enable them to meet people’s support needs. Staff told us these documents were accurate and up to date. Staff comments included, “Care plans, I think they have all the information you need to work with people” and “There is enough information in the care plans for me.” However, we found people’s care plans included limited information about people’s life history and background. This issue had been identified by the service’s quality assurance system prior to our inspection and the registered manager told us this information was now being gathered from people and their relatives.

Risk assessments had been completed and identified the actions staff must take to ensure people’s safety. This included any environmental risks in people’s homes and any risks related to their care and support needs. Where risks had been identified in relation to people becoming anxious or upset, staff were provided with guidance on how to support people to manage these situations. Where appropriate staff had been provided training in the safe use of restraint. However, records showed these techniques were not regularly used and staff told us, “[Restraint] does not happen regularly. Staff would be very reluctant to do it. It would just be used to keep [the person] safe.”

All accidents and incidents that occurred were documented and reported to managers for further investigation. Records showed these investigations had led to changes to care plans and how support was provided. The service had learned from each incident and had made appropriate changes to its practices and people’s care plans to prevent similar incidents reoccurring.

Staff and managers understood the requirements of the Mental Capacity Act 2005 (MCA). Where people lacked capacity in relation to specific decisions these had been consistently made in the person’s best interest with appropriate involvement from relatives and health professionals. Some people who lacked capacity were unable to access the community without support from staff. The service had recognised these people’s care plans were potentially restrictive and had raised this with care commissioner for authorisation by the Court of Protection.

The service had robust recruitment procedures. Necessary checks had been completed to ensure prospective staff were suitable for employment in the care sector.

The staff team were well motivated and took pleasure in supporting people to live as independently as possible. Their comments included, “I think it works well as supported living” and “I enjoy working here it is a great team.” In one setting the service was supporting people to participate in a programme designed to develop bespoke assistive technologies to aid people’s wellbeing and increase independence.

Staff were well supported and had received regular supervision and annual performance appraisals from their managers. Staff comments in relation to their manager included, “[The service manager] is good, she is very ‘hands on’. I really like that if she says she is going to do something it gets done”, “[The service manager] is very good he knows his stuff” and “[The registered manager] is all right. She is really helpful. [The managers] are a good bunch always willing to help.”

There were effective quality assurance systems in place designed to drive improvements in the service’s performance. Regular audits had been completed by service managers and where any issues were identified, action plans were developed to ensure these issues were addressed and resolved

People and their relatives understood how to raise complaints and there were systems in place to ensure all complaints received were fully investigated and resolved. One person commented, “If any ‘funny business’ starts [the service manager’s name] sorts it out.”

West Cornwall Support Services is a domiciliary care agency that provides personal care and support to people with a learning disability in their own homes. It is part of the Royal Mencap Society which has oversight of the service. At the time of our inspection the service was providing a service to 53 people, 15 of those were receiving personal care. The Care Quality Commission has responsibility for regulating personal care and this was the area of the service we looked at. Some people were receiving a 24 hour supported living service. A supported living service is one where people live in their own home and receive care and support to enable them to live independently. People have tenancy agreements with a landlord and receive their care and support from a domiciliary care agency. As the housing and care arrangements are separate, people can choose to change their care provider and remain living in the same house. Other people were receiving smaller packages of care with the smallest package being 30 hours per week.

There was a registered manager in place. 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.

Some people receiving support from West Cornwall Support Service had complex health needs and were unable to verbally express their views of the service. We saw people were relaxed with staff and interactions were positive and friendly. Staff ensured people were involved in our conversations and helped us to engage with people meaningfully. They were aware of people’s preferred methods of communication and used this knowledge to support our interactions with people. Relatives and an external healthcare professional told us they considered the service to be safe.

Staff had received training in safeguarding adults and children and were aware of the service’s safeguarding and whistleblowing policies. No-one reported any concerns about people’s safety. Staff were confident they would report any worries they had to their manager and they would deal with them appropriately.

Care plans contained risk assessments which were reviewed every six months or sooner if people’s needs changed. There was clear guidance for staff on how to support people when they became anxious or distressed to help calm them and prevent any situation from escalating.

There were sufficient numbers of staff available to keep people safe. People were supported by teams of care workers who knew them well and had a good understanding of their needs. There was a robust recruitment process in place to help ensure staff had the appropriate skills and knowledge required to meet people’s needs.

Staff were supported by a robust system of induction, training, supervision and appraisal. Team meetings were held regularly to allow staff to raise any areas of concern. There were well established lines of communication at all levels of the service. Staff told us they were kept well informed of people’s changing needs and had plenty of opportunities to discuss any issues or working practices. Service managers told us they retained a degree of flexibility when planning care to help ensure they were able to meet people’s needs at all times.

Managers had a clear understanding of the Mental Capacity Act 2005 (MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. Care plans contained evidence to show people, or their relatives if appropriate, had consented to the planning and delivery of care.

People’s relationships with friends and family were recognised and respected. Relatives told us they were involved in care reviews and kept informed of any developments or changes in people’s health.

Care plans were individualised and described people’s needs across all areas of their lives. They were reviewed and updated regularly and accurately reflected people’s current needs. There was evidence to show external healthcare professionals had been involved in care planning when appropriate.

There was a satisfactory complaints policy in place. No complaints had been received at the time of the inspection.

Staff and relatives told us they considered the agency to be a well led service. The registered manager knew people well and had a good understanding of what was happening on a day to day basis. There was effective and well structured oversight of the service from Mencap. The registered manager was well supported and kept informed of any developments in the care sector.

We saw there was appropriate referral and care planning documentation used in respect of people who received support. We looked at a range of care documentation which supported the view that people's needs were well understood and staff acted with respect and care in supporting people appropriately.

We reviewed the system used by the service to recruit staff. This was robust and demonstrated every measure was taken to ensure recruitment of suitably qualified staff.

We talked with staff and reviewed rota arrangements for staffing the service and were satisfied there were sufficient numbers of staff employed to ensure the support needs of all people who used the service.

The service had an effective complaints system which identified, handled and responded appropriately to complaints and comments made by people who used the service.