My Support and Care Services (West Country) Limited is a specialist domiciliary care agency based in Honiton that provides personal care and support for people with complex needs. This includes people with learning disabilities and associated needs such as autism, Asperger syndrome, sexualised behaviours and mental health needs. Some people the agency support may be subject to community treatment orders or guardianship arrangements. The purpose of guardianship (under the Mental Health Act 1983) is to enable people to receive care in the community.
The agency provided support for people in supported living settings, hours ranged from eight hours a week, up to 24 hour support. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and a separate agreement to receive their care and support from the domiciliary care agency. As the housing and care arrangements are entirely separate, people can choose to change their care provider without losing their home. Staff who provide people’s support were known as personal assistants.
The inspection took place on the 23 and 29 July 2015 and was announced. This was the first inspection since the service registered with the Care Quality Commission in October 2013. At the time of our visit, the agency provided 212 hours of care for three people, who shared a house. A fourth person the agency supported to live independently was currently in hospital. We visited the supported living setting, and met two of the three people who lived there. Each person had their own bedroom and shared other parts of the house.
A registered manager is in day to day charge of the service. 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.
People’s legal rights were not fully protected because staff did not demonstrate a good understanding of the Mental Capacity Act 2005. Staff promoted choice and sought people’s consent for all day to day support and decision making. However, where people appeared to lack capacity, mental capacity assessments were not undertaken. This meant there was a lack of clarity about each person’s ability to make decisions for themselves and what decisions people might need support with.
A range of risk assessments for each person were undertaken and regularly reviewed. This included risks for the person, staff, people in the wider community and environmental risks. Staff were proactive at recognising and helping individuals to reduce risks. They recognised and communicated increased risks to the person and within the team which ensured risks were responded to promptly and in a consistent way. Staff knew the signs of abuse and the correct procedures to follow if they thought someone was at risk of abuse.
People were treated with dignity and respect, staff involved them in discussions and decisions about their care. They felt confident to raise concerns, were listened to and actions taken in response.
People received care and support that met their individual needs. They were supported by a regular team of staff they knew well and had developed strong relationships with. People’s health care needs were assessed and support plans included detailed information for staff about how to meet them. Staff accessed advice from health professionals as needed to ensure people’s physical and mental healthcare needs were met. People received their medicines on time and in a safe way.
Health and social care professionals confirmed staff from the agency worked closely with them to support each person, including undertaking bespoke training to meeting people’s individual needs and help reduce their risks.
People’s care was based around their individual needs and aspirations and support plans described in detail their individual needs and how to meet them. These were reviewed and updated regularly as their needs changed. Each person had a ‘My plan’ which communicated their needs and expectations of the service in their own words.
People were supported to have a wide variety of social and leisure activities in their local community. They led busy and active lives and were encouraged to become increasingly independent. This included pursuing work experience and employment opportunities. The service had developed creative ways of ensuring people led fulfilling lives. People were encouraged to make friends, learn new skills and be involved in their local community, as well as to get work experience and employment.
People knew how to complain and raise concerns, but said they had no complaints about the service. They said they wouldn’t hesitate to speak to staff or the registered manager if they had any problems and were confident they would be dealt with. At the time of our visit, there was one ongoing complaint by relatives, who were not satisfied with the response they had received from the agency. A face to face meeting was planned with the registered manager, relatives and a representative of the local authority to discuss. No other complaints had been received since registration.
The provider promoted a positive culture whereby staff took their lead from the person about how they wished to use their support hours. Staff demonstrated positive regard for people they supported and promoted a service tailored to people’s individual needs. People were positive about the service they received, they were consulted and involved in the running of the service; their views were sought and acted on.
People, staff and health and social care professionals had confidence in the leadership of the registered manager. The service had some simple quality monitoring systems in place, although some of these were not formally recorded.
We identified one breach of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.