3 County Care

The service was registered to provide support to people living with a learning disability, although no one had a diagnosis at the time of the assessment. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence, and good access to community facilities. We were assured the provider and staff demonstrated these principles.

The service is also registered as a supported living service, although at the time of our assessment there was no one receiving a regulated activity. We therefore did not assess this part of their registration.

Key findings

This service was previously rated as good. We carried out this assessment to confirm whether the rating of good remains accurate. This report does not provide detailed information on areas where we found practice continues to meet a good standard. Instead, our findings focus on any areas where the service needs to improve or where we found exceptional practice.

People received support from staff who understand their individual needs and preferences, alongside a commitment to help them remain independent within their own homes. One person told us, “I find everyone so accommodating and caring. I have contacted them about changing the time of the call and they are sorting that out; they are very quick at suiting each individual.”

Care plans reflected people’s needs, wishes and preferences. These included the support people required with day-to-day tasks, such as ordering medicines, managing appointments, food shopping and maintaining their home. There was detailed information about people’s religious beliefs and cultural preferences, including how they wished to engage with their faith. Staff and leaders understood people’s protected characteristics and describe how care was adapted to meet people’s needs. For example, scheduling care visits around prayer times and religious observances.

Home environmental risk assessments were completed to identify potential hazards that could affect people’s safety and wellbeing. Leaders used information from accidents and incidents to identify opportunities for learning and improvement. Leaders worked with people, relatives and healthcare professionals to review risks and plan ahead for the future. This included obtaining appropriate equipment and supporting people to make changes to their home environment to ensure they remained safe as their health conditions progressed. For example, the provider supported changes to rooms layouts and thresholds between different types of flooring. One relative told us, “I find that [The Registered Manager] will make suggestions before I have even thought of the issue; I don’t know what I don’t know, so this is really useful as they have experience across the sector.”

Staff spoke about people with kindness, compassion and respect. Staff promoted people’s right to make their own choices and ensured concerns were recorded promptly and accurately. Leaders supported appropriate actions and worked with healthcare professionals to ensure people received timely access to additional services.

Care plans contained clear guidance for staff on actions to take should there be a change in people’s health. People received care and support that was informed by best practice guidance and tailored to their individual preferences and needs.

Staff also worked closely with healthcare professionals when people’s needs changed to ensure they received timely support. For example, staff monitored people’s skin and promptly reported concerns. Where damage was identified, referrals were made and staff followed guidance to promote healing and reduce the risk of further deterioration. Staffing arrangements were planned around people’s assessed needs, and training and competency processes helped ensure staff were equipped with skills and knowledge required to provide safe care. One relative told us, “When the staff are with [person] it is all very relaxed; it is all very equal, very inclusive. The staff are grounded in their knowledge of dementia; they will make sure they sit with [person] at eye level and explain things to them.”

Medicines were managed safely, with systems in place to monitor administration processes and address any concerns. One relative told us, “The staff remind [person] to take their tablets and the dosage can change. They will let us know if there are any issue with the tablets and if they think that [person] is having a relapse in their health.”

Leaders were visible and approachable. They promoted a clear vision centred on providing person-centred care and a positive working culture. One staff member told us, “[The Registered Manager] is very supportive with all the staff. They are open and honest. We communicate together as a team, if someone goes off, we help each other, cover the calls. It is one the best teams I have ever worked for.”

Governance arrangements provided effective oversight of the service’s performance. Leaders used regular spot checks and feedback from people to review care arrangements and opportunities to improve people’s quality of life. Schedules were reviewed and adjusted to provide flexibility, enabling people to attend activities at their local day centre, shopping or meeting other people for coffee. These changes reduced isolation and enabled people to maintain interests and relationships.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. This can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. At the time of assessment, no one was deprived of their liberty or had any restrictions placed on them.