Choice Supported Living - East achieved a Good rating across all five key questions at its February 2020 inspection, maintaining its previous 2017 Good rating overall. The service demonstrated strong person-centred practice, safe medicines management, effective staff training and a transparent, well-governed culture aligned with Registering the Right Support principles.
Strengths
· People felt safe and staff demonstrated clear knowledge of safeguarding reporting procedures including external escalation to local authority and CQC.
· Person-centred care plans reflected individual goals, history and interests, including supporting a person to fulfil a dream of flying from England to France.
· Staff received regular supervision, annual appraisals and tailored training matched to people's needs, including involvement of people using the service in Makaton training.
· Medicines were managed safely with staff competency checks, protocols for 'as required' medicines and investigation of any incidents.
· Strong open culture with positive staff morale, clear management structure and quality assurance systems including audits of care and medicine records.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to live healthier lives and access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA)Good
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships; support to follow interests and activitiesGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles; understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care, working in partnership with othersGood
Excel Support Services Limited - South East achieved an overall Good rating at its first inspection in April 2017, with an Outstanding rating for caring driven by exceptional communication support, independence promotion and meaningful involvement of people in running the service. Minor shortfalls were noted in accident/incident record-keeping, supervision frequency and medicine recording, all of which the provider was actively addressing.
Concerns (4)
moderateGovernance: “One local authority had issues around quality, care practices, record keeping and communication in relation to the support people who lived alone received.”
minorIncident learning: “records did not show clearly the overall investigation process and the actions to be taken to minimise the risk of recurrence...Managers did not always sign the accident and incident forms”
minorRecord keeping: “The service had recorded 18 medicine errors since registration In October 2016. None of the errors caused harm and were generally based around record keeping.”
minorSupervision / appraisal: “one to one meetings with staff (supervision) had not happened as regularly as the supervision policy stipulated it should since October 2016.”
Strengths
· Exceptional person-centred communication support including individualised picture/photographic boards, communication charts and tailored formats for each person
· People actively involved in service planning and governance via service user committees, expert auditors and local learning disabilities partnership board membership
· Outstanding support for independence, with people achieving goals such as self-medication, independent community access and meal preparation
· Strong safeguarding culture including a quarterly safeguarding adults forum and people trained in 'keeping me safe' self-protection programme
· Robust quality assurance including monthly spot checks, cross-service audits, a dedicated quality team and landlord environmental visits