Havencare Plymouth

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 in July 2016 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, responsive and well-led. We found further improvements had been made in relation to caring and this area is now rated as outstanding.

There was a positive, open and inclusive culture within the service. The management team provided good leadership and led by example. Relatives, staff and other agencies were positive about the leadership of the service. Staff said they loved their work and were passionate about providing good care to people.

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 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.

All the staff we spoke with were able to tell us about the values of the organisation and said they were informed of them and their importance during the recruitment process and as part of on-going training and discussion. It was very clear staff had adopted these values in relation to the support they provided. It was reflected in the way staff spoke about the people they supported, in the practices we observed, and in the feedback we received about the way people were cared for and treated.

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.

Personalised care was central to the service 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.

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.

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. 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.

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. Recruitment practices helped ensure staff employed by the service were suitable to work with vulnerable people.

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.

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.

People continued to receive their medicines safely. 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.

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. 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. As a result of audits and reviews of the service recent improvements had been made in relation to staff recruitment, incident reporting and staffing. Staff said the addition of an extra tier of management within people's staff team had improved communication and consistency of care.

Information gathered about people was used to aid learning and drive continuous improvement across the service. 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.

The five questions we ask about services and what we found