Archived: Seeability Surrey Support Service

People supported by the service had varying degrees of sight loss, learning disabilities and physical disabilities. The service provided a waking night and sleep in where appropriate for each home. People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people's health needs and behaviour presented challenges and was responded to with one to one support from staff.

The care service has 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.

The inspection took place on 3 October 2018 and was announced. 48 hours' notice of the inspection was given because we needed to be sure that the registered manager was available as they manage two services in different locations.

The service was run by a registered manager, who was present on the day of the inspection visit. 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.

Why the service is rated Good.

Policies, procedures and staff training were in place to protect people from avoidable harm and abuse. Staff had identified risks to people and these were managed safely. People were protected from the risk of infection. Recruitment processes were followed to ensure suitable staff worked at the service. Staffing levels were sufficient to ensure people’s safety. Arrangements were in place to receive, record, store and administer medicines safely and securely.

People were cared for by staff who had received comprehensive training, support and supervision in their role. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were supported to eat and drink sufficiently for their needs. Staff supported people to see a range of healthcare professionals in order to maintain good health and wellbeing.

Risks to people’s safety were identified and action taken to keep people as safe as possible. Accidents and incidents were reviewed and measures implemented to reduce the risk of them happening again. People’s care would not be interrupted in the event of an emergency as there were contingency plans in place and people were made aware of fire procedures.

People’s rights under the Mental Capacity Act 2005 were respected. Staff understood the importance of gaining people’s consent to their care and how people communicated their decisions. The provider had supported safeguarding to make applications for deprivation of liberty orders where restrictions were imposed upon people to keep them safe.

Staff treated people with kindness. Staff supported people to make choices about their lives. Staff treated people with respect and upheld their dignity and human rights when delivering their care. People had a comprehensive assessment of their support needs and guidelines were produced for staff about how to meet people’s individual needs and preferences. Support plans were reviewed with people and their families and relevant changes made where needed. Staff encouraged people to be as independent as possible. Staff encouraged people to connect with their local community on a daily basis.

Processes were in place to enable people to make complaints. The provider had effective governance processes in place. People, their families, staff and professionals were encouraged to be actively involved in the development and continuous improvement of the home. People benefitted from living in a well organised, forward thinking service where their needs were always at the centre. The culture of the service was open and people felt confident to express their views and opinions. The registered manager provided clear leadership and direction to staff and were committed and passionate about providing high quality services to people.

The provider had robust quality assurance systems which operated across all levels of the service. Staff had worked effectively in partnership with other agencies such as social workers, occupational therapists, physiotherapists, GP's, and pharmacies to promote positive outcomes for people.

Further information is in the detailed findings below.

Seeability is a domiciliary care agency (DCA) and supported living service which provides support to people at two houses. The DCA provides personal care to one person who lives in their own home. Some people had profound physical and learning disabilities with sight loss. Whilst other people living in another service had sight loss, learning disability and some physical disabilities. Supported living and the DCA provide a waking night and sleep in where appropriate for each home.

People had varied communication needs and abilities. Some people were able to express themselves verbally; others used body language to communicate their needs. Some of the people’s health needs and behaviour presented challenges and was responded to with one to one support from staff.

This inspection took place on 28 January 2016 and was announced. 48 hours’ notice of the inspection was given because the needed to be sure that the registered manager was available as they manage a number of services in different locations.

The service was run by a registered manager, who was present on the day of the inspection visit. ‘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 and associated Regulations about how the service is run. Each house had a deputy manager that was responsible for the day to day management. Whilst the registered manager provided support to all the services.

Some people’s human rights may have been affected as the requirements of the Mental Capacity Act 2005 was not always followed. Where people were assessed to lack capacity to make some decisions, people did not always have a mental capacity assessment or best interest meeting. Staff were heard to ask people for their permission before they provided care.

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

Staff had written information about risks to people and how to manage these. We found the registered manager considered additional risks to people in relation to community activities and changes had been reflected in people’s support plans.

The service was creative in the way it involved and worked with people, respected their diverse needs, and challenges discrimination. It seeks ways to continually improve and puts changes into practice and sustains them.

Staff had received training in safeguarding adults and were able to evidence to us they knew the procedures to follow should they have any concerns. One staff member said they would report any concerns to the registered manager. They knew of types of abuse and where to find contact numbers for the local safeguarding team if they needed to raise concerns.

Care was provided to people by a sufficient number of staff who were appropriately trained. Staff were seen to support people to keep them safe. People did not have to wait to be assisted.

People who may harm themselves or displayed behaviour that challenged others had shown a reduction of incidents since being at the home and the number of staff on duty were adequate for their individual needs.

Processes were in place in relation to the correct storage of medicine. All of the medicines were administered and disposed of in a safe way. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

At one of the houses people were provided with homemade, freshly cooked meals each day and facilities were available for staff to make or offer people snacks at any time during the day or night. At the other house people were supported to be independent in their choice of food, and supported to shop and cook when they needed to. We were told by the registered manager that people could go out for meals if they wished.

People were treated with kindness, compassion and respect. Staff took time to speak with the people who they supported. We observed positive interactions and it was evident people enjoyed talking to staff. People were able to see their friends and families as they wanted and there were no restrictions on when people could visit the home.

People were at the heart of the service; and took part in a wide range of community activities on a daily basis; for example trips to the shops, and attending college. The choice of activities was specific an innovative to each person and had been identified through the assessment process and the regular house meetings held.

People had an individual support plans, detailing the support they needed and how they wanted this to be provided. We read in the support plans that staff ensured people had access to healthcare professionals when they needed. People’s care had been planned and this was regularly reviewed with their or their relative’s involvement. A relative told us “We have meetings with the staff regarding their care and we are asked about our opinions.”

The registered manager and deputy managers told us how they were involved in the day to day running of the home. It was clear from our observation that the managers knew people very well and that people looked at them as a person to trust. Staff felt valued under the leadership of the registered manager.

The home seeks ways to continually improve and puts changes into practice and sustains them.

The had a robust system of auditing processes in place to regularly assess and monitor the quality of the service or manage risks to people in carrying out the regulated activity. The registered manager had assessed incidents and accidents, staff recruitment practices, care and support documentation, medicines and decided if any actions were required to make sure improvements to practice were being made.

The service notified the Care Quality Commission of any significant events that affected people or the service and promoted a good relationship with stakeholders.

Complaint procedures were up to date and people and relatives told us they knew how to make a complaint. Complaints had been responded to in line with the service’s complaints policy. Confidential and procedural documents were stored safely and updated in a timely manner.

Staff were aware of the home’s contingency plan, if events occurred that stopped the service running. They explained actions that they would take in any event to keep people safe.

People’s views were obtained by holding regular meetings and by communicating on a daily basis.