Care at Home (Swindon)

At the time of the inspection, 39 people were receiving personal care in eight different supported living settings. We visited some people who lived in adapted houses where people had their own bedrooms and sometimes individual or shared bathrooms, as well as shared communal areas. People received a variable number of care hours per week, depending on their assessed needs.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support Two out of three premises had deregistered from residential to supported living and did not always maximise people's choice and independence. There needed to be more focus on continuously developing meaningful activities, independence and quality of life. The provider had identified this and employed an external consultant to help drive improvement with staff in the way of 'on the job' training, guidance and role modelling to ensure improvements were made.

Some features in these premises were similar to a 'care home' and did not meet guidance in respect of having good access to the local community and its amenities. They were geographically isolated and the lack of public transport and staff who were drivers meant people were not always supported to be as independent as they could be. The provider was undertaking improvements in two of the settings to improve accessibility such as new kitchens.

There were not always enough staff to meet people's preferences with how they wanted to spend their day and do things they wanted outside of their homes. At one of the settings, the provider was delivering the support hours currently commissioned, but had requested, and were awaiting outstanding needs

assessments for people from all relevant funding authorities. This was to ensure staff numbers accurately reflected people's needs including social preferences, so they had support to do things they wanted outside of their homes.

At two of the three previous care homes that had now become part of the supported living scheme, we found people were sometimes placed at risk of avoidable harm. Risk assessments were inconsistent and did not always detail the relevant information staff would need to meet people's assessed care and health needs. The provider had put processes in place to address these areas of concern, but not all had been identified prior to the inspection. A new manager was in post and an action plan was being worked through to address the concerns. The provider was updating all relevant bodies of actions taken.

Right Care We found no evidence that people had been harmed, however, there were failures to record, monitor and improve the quality and safety of the service, and failure to maintain accurate records. We also identified concerns around the safe management of medicines and risks in two of the supported living premises. The provider was addressing these concerns and an action plan in place to track improvements.

We observed positive interactions between people and staff. People were comfortable approaching staff when they needed support and we observed staff respected people's choices.

People or their relatives felt comfortable in raising issues or concerns. There were systems and processes in place to safeguard people from abuse.

People were not always supported to have maximum choice and control of their lives. The practices in some supported living settings did not always support people in their best interests.

Right culture The provider had not always evidenced that leadership had ensured people were supported in a culture that supported leading inclusive and empowered lives. However, the provider had identified the need to improve the culture in one of the supported living settings and was in the process of embedding improvements with the aim of embedding these to ensure consistent high-quality care. The provider was working with external stakeholders to improve people's lives consistently across the service. The provider had also appointed a Regional Operations Director and Operations Support Manager to ensure that a significant amount more oversight was available in the settings to ensure that the settings delivered in line with the providers minimum expectations of good.

All staff we spoke with displayed caring and person-centred values and a commitment to make the necessary improvements.