The Regard Partnership Domicilary Care South West

Some people are supported in their own homes, and others receive support within supported living settings. Supported living is where people live either on their own or with a small group of others, and have their own tenancy agreement. Care and support is provided in order to promote their independence. The care people receive in supported living settings is regulated by CQC, but the accommodation is not. The service supported some people on a 24-hour basis and others at specific times during the day and night.

At the time of the inspection The Regard Partnership Domiciliary Agency were supporting 12 people with personal care tasks either in their own homes or in a supported living setting.

We checked the service was working in line with 'Registering the Right Support' which makes sure services for people with a learning disability and/or autism receive services that are developed in line with national policy. For example, how the service ensures people care is personalised, maintains their independence and supports links with people's community.

At our last inspection we rated the service as Good. At this inspection we found the evidence continued to support the rating of good in the areas of Safe, Effective, and Responsive. We found further improvements had been made in relation to Caring and Well-led, and these areas were now rated as Outstanding. This means that at this inspection we have rated the service as Outstanding overall.

There was a very positive, open and inclusive culture within the service. The management team provided strong leadership and led by example. Relatives, staff and other agencies were very positive about the leadership of the service. Comments included, "Communication is spot on" and "The manager and the team follow advice and recommendations, and are always thinking about people's quality of life and independence". We observed positive and compassionate interactions between staff and people they supported. Staff said they loved their work and were passionate about providing an excellent quality service.

Exceptionally good governance of the service by both the provider and the registered manager benefitted people because it ensured the quality of care was maintained and enhanced. The registered manager was supported by the provider and effective governance of the service was visible with the registered manager, regional manager and regional director regularly involved and present within the service. Regular audits were carried out, which included checks of health and safety, staffing levels, training, and medicines. Checks were carried out by management and support staff to ensure records held in people's homes were appropriate, accurate and up to date. There was a computer system, which was kept up to date so the provider could see how the service was performing at any time.

The provider and registered manager recognised the benefits of multi- agency working and external agencies were very positive about the management and care provided to people. A professional from the local learning disability service said, "It was one of the best and smoothest young person's transitions I have ever worked with, they worked really well with the family, communication was spot on".

Information gathered about people was used to aid learning and drive continuous improvement across the service. The registered manager and provider had worked hard to learn from incidents, near misses and mistakes. Investigations were carried out when required and systems were in place to identify any trends or patterns, to help make changes when needed. The provider and registered manager promoted the ethos of honesty, learning from mistakes and admitted when things had gone wrong. They understood and reflected the requirements of the Duty of Candour. The Duty of Candour is a legal obligation to act in an open and transparent way in relation to care and treatment.

People were provided with sensitive and compassionate support by a kind, committed and caring staff team. We observed without exception staff treated people with the upmost patience and kindness. When we visited people in their homes we saw staff knew people well and had built positive and trusting relationships. Relatives and other agencies without exception praised the staff and management for their caring and compassionate approach to supporting people. Staff really respected people and recognised they were supporting people in their own homes. Staff referred to people's homes as "Their home" and reminded people who may not always recognise their environment as being their own home by, encouraging them to answer the door to visitors, holding their own key, and asking them for permission before using or moving people's personal belongings. One staff member said, "It is the person's own home where we come to support them, and not our workplace, it is important to remember that". The service had a culture which recognised equality and diversity amongst the people who used the service and staff. Staff were sensitive and respectful to people's religious and cultural needs. People were not discriminated against in respect of their sexuality or other lifestyle choices. The provider recognised the benefits of having a diverse community of staff and this was evident in their recruitment and the organisation of staff teams.

Personalised care was central to the services philosophy and staff demonstrated they understood this by talking to us about how they met people's care and support needs. Staff spoke about their work with commitment and passion and used words like "Individual", "Independence" and "Rights" when they talked about the people they supported. People's care records were personalised, which ensured care was tailored to meet their individual and diverse needs. We saw people were supported to live a happy, fulfilled life, to feel safe, enabled to try new opportunities and to maintain their independence as much as possible.

Relatives and other agencies said they felt people were safe using the service. We observed people were relaxed and comfortable with the staff supporting them. Staff had undertaken training and were clear about how to report any concerns relating to abuse or people's safety. Robust recruitment practices ensured staff employed by the service were suitable to work with vulnerable people.

Staff were employed in sufficient numbers to meet people's needs and to keep them safe. Staff teams were organised in a way that helped ensure consistency. Each person had a designated team of staff who they were familiar with and had formed strong and trusting relationships. Any changes to staffing were communicated clearly to people and relatives to ensure people remained safe and comfortable in their homes.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Risk

assessments had been completed thoroughly to ensure people were able to receive safe care, whilst also ensuring their choices and independence were promoted and maintained. A professional from the specialist learning disability team said they had been very impressed how the team had advocated positive and least restrictive risk practices for people. People's behaviours were understood and managed safely and appropriately.

People continued to receive their medicines safely. People's support plans clearly described the level of support required and how this support should be delivered. Staff who administered medicines had received up to date training, and competency checks were completed to help ensure their skills and knowledge remained sufficient and up to date.

Staff were well trained and training was relevant to their role and kept updated. The registered manager was passionate about developing the skills of the team and also kept themselves updated with best practice. All staff said they felt well supported, and had opportunities to discuss and reflect on their practice and incidents that had occurred.

People's health and dietary needs were understood and met. Staff ensured people had access to the food and drinks required to maintain good health. If concerns were highlighted about people's health or diet advice was sought and appropriate referrals made to relevant health services. Staff supported people to attend hospital and other healthcare appointments.

Management and staff understood their role with regards to the Mental Capacity Act (2005). People's consent was sought before care and support was provided. When people were unable to make decisions, discussions took place with relatives and other relevant agencies to help ensure decisions were made in people's best interest.

Further information is in the detailed findings below.

The five questions we ask about services and what we found