Advance Support and Enabling Service

Supported living

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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The service supported people in their own homes, often with 24 hour support. At the time of the inspection 17 people were receiving personal care. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate people received care support. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going with people. People with a learning disability were supported to live as ordinary a life as any citizen.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People's experience of using this service: The service was focussed on placing people at the heart of the service and its values. It had a strong person centred and local community-based ethos. Staff and the service's management told us how they were passionate about providing true person-centred care to people when they needed it.

People's needs, and wishes were met by staff who knew them very well. We saw and were told of many examples of staff helping and supporting the people they cared for so they could live their best lives.

Staff had received training to support their role, often bespoke so that it was relevant to the needs of the people being supported. People and their families were also able to access training to promote consistency for people in all settings. The provider/registered manager said, "Overall the impact of happy relaxed staff, families and relatives is happy people which is why we place such emphasis on supporting everyone."

Staff had received regular supervision and appraisal. Staff performance was closely monitored in a supportive way. The provider/registered manager had fostered a culture of openness and professional challenge. This ensured all staff understood and were motivated to meet the high standards of quality expected of them. They all told us the people they supported were truly at the centre of all they did and people told us they were very happy.

Quality assurance measures were extremely robust and well embedded into everyday practice. Staff reviewed the quality and safety of care delivered in an in-depth way on a regular basis.

People had good health care support from professionals. The provider and staff worked in partnership with health and care professionals. The service was led by a passionate provider/registered manager who was dedicated to the health and wellbeing of people they supported. They had worked tirelessly to identify each person's risks, needs and preferences, including investigation into the impact of health issues on people's physical and mental wellbeing. Staff had ensured they collected data to act as people's advocates and help provide information to health professionals. This had led to diagnoses and positive health interventions. This enabled each person to have an improved quality of life, where their independence was promoted. Best practice standards and professional research was used to implement high quality, effective care.

There was a consistent staff team, many of whom were very long-serving and knew people very well. Staff showed very caring, thoughtful and compassionate care to each person. Staff used different communication methods with each person and were able to interpret fluently what people wanted. This meant that people, some of who had little or no verbal communication, were very well understood and supported. Each person had a highly individualised communication and support plan taking into consideration all their communication methods. This was also shared with people they came into contact with in the community, again to promote people's independence.

Support plans described the risks, needs and preferences and how staff should work with each person to ensure the person was able to lead as fulfilled and independent life as possible. Staff were aware of people's life history and preferences. They used this information to develop positive relationships with people and staff and people and their families and deliver person centred care. People felt very well cared for by staff who treated them with respect and dignity. There was a clear commitment to support people at difficult times with compassion, respect and affection.

People were supported to access a range of leisure pursuits and participate in the community they lived in. New ideas for activities were explored and trialled to keep people occupied in a meaningful and enjoyable way. Staff found individualised ways to enable people to access the activities they wanted, sometimes working discreetly to promote independence. Although the provider was not responsible for the environments which people lived in they had put in place arrangements to work with the housing providers to ensure they met people's needs.

People, and their families, were involved as much as possible in their care and support which helped to give them choice and control in their lives. People's families spoke very highly of the quality of care and of the approach of the provider/registered manager and staff in supporting their relative. Relatives and professionals held the service in very high regard. Health professionals praised the service describing the

positive outcomes and benefits to people due to the way staff advocated for each person using evidence to support their proposals.

People said they felt very safe. Risk assessments were very thorough, individualised and flexible. They were devised and shared with people so that they could develop action plans together with staff that promoted independence safely. Staff knew how to keep people safe both from the risk of abuse and from assessed risks. There was enough staff to support people and staff were flexible in their approach and positive risk taking. Efforts were made to ensure people knew who would be supporting them, often matched with support staff with similar ages and interests.

People were supported to have nutritious meals according to their likes and dislikes and their dietary needs had been catered for. This information was detailed in people's care plans. Staff followed guidance provided to manage people's nutrition and enabled people to manage their diet as informed and independently as much as possible.

Care plans contained excellent information about people and their care needs. People were fully involved and care plans were working documents, used and reviewed to reflect each person's current needs. This included celebrating achievable goals and progress towards independence.

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.

Medicines were administered by staff who were well trained and competent. There were robust systems to ensure medicines were received, stored, administered, recorded and returned safely.

Arrangements were in place to manage and prevent cross infection and ensure good infection control systems were in place.

When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.