Shrewsbury is a domiciliary care agency. The agency provides a service to 67 people with learning disabilities and autistic spectrum disorder who live in supported living schemes. This service provides care and support to people living in 35 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. There were systems in place to identify and manage risks and to protect people from harm or abuse. People received their medicines when they needed them and medicines were stored and managed in a safe way.

People continued to receive effective care. People were supported by staff that were well trained and competent in their roles. People’s health care needs were monitored and met. 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.

The agency continued to provide a caring service to people. Staff were kind, considerate and patient when they supported people and people responded positively when staff interacted with them.

People received care which was responsive to their needs and preferences. Staff were skilled in recognising what a person wanted or was feeling even though people were unable to communicate their needs. People were supported to maintain contact with their family and friends and to take part in their preferred activities and social events.

The agency continued to be well led. The registered manager knew people well. Staff told us the management within the service were open and approachable. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

Perthyn Shrewsbury is located in Shropshire. It is a domiciliary care agency which provides support to people in their own homes. It supports people with learning disabilities and autistic spectrum disorder. On the day of our inspection, there were 20 people using the service.

There was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People who used the service, family members and external agencies were very complimentary about the quality of support provided. The registered manager and staff involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests.

People were supported to lead fulfilling lives. People were helped to try new activities and make changes in their lives. The registered manager and staff had a good understanding of managing risk and supported people that had previously challenged other services to reach their full potential and to keep them safe.

Staff developed ways to address the fluctuating needs of people ensuring their full inclusion at all times. Over time people were supported to progress and their support plans adapted and developed to promote their independence.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people who used the service. People were actively involved in the interviewing process for potential employees.

The registered manager ensured that staff had a full understanding of people’s support needs and arranged training to equip them with the skills and knowledge to meet them.

There was a well-established management structure in place which ensured that staff at every level received support when they needed it. Staff were clear about their roles and responsibilities and how to provide the best support for people.

People had assessments of their needs and care was planned and delivered in a person-centred way. People led fulfilling lives and they were supported to make choices and have control of their lives. People and their family members were fully consulted and involved in assessments and reviews.

People’s nutritional needs were met and they had access to a range of professionals in the community for advice, treatment and support. Staff monitored people’s health and wellbeing and responded quickly to any concerns.

Management of people’s behaviours that may challenge the service and others was based on the least restrictive best practice to support people’s safety. This supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

There was a positive culture within the service. The management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. There was an emphasis on exercising choice and developing independence, supporting people with their right to an ordinary pattern of life within the community.

Systems to continually monitor the quality of the service were effective and there were ongoing plans for improving the service people received. The provider gathered information about the quality of the service from a variety of sources including people who used the service, their family and professionals. The service had developed and maintained links with professionals. This provided a multidisciplinary approach in supporting people using best practice.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us and the records we looked at. Perthyn Shrewsbury provides personal care and support to people living in their own homes.

Is the service safe?

One person told us, “Staff are very nice, I feel safe here”. We saw that risks to people's safety and wellbeing were assessed and measures put in place in order to reduce these. Risk assessments were up-to-date. Health and safety audits were carried out by staff from the health and safety department.

Staff were up-to-date with their training considered to be mandatory by the provider. Topics included manual handling, safeguarding vulnerable adults and health, safety and hygiene. This enabled staff to carry out their role safely.

Staff told us that they had received induction training at the start of their employment so that they would be clear about their roles and responsibilities towards people in their care.

Is the service caring?

People told us that they were well supported by the staff team. They confirmed that staff treated them well and that they were treated with dignity and respect. One person told us, “Staff treat everyone with respect”. People told us that staff would listen to them if they had a problem.

Is the service responsive?

People who used the service were asked for their views about their care and treatment and they were acted on. People told us that they would feel confident talking to staff if they were unhappy with aspects of their care. This meant that the service was responsive to the needs and views of people.

Is the service effective?

People we spoke with told us they were satisfied with the service provided and that their needs were met. People's needs were assessed and care was planned and delivered in line with each individual care plan. Staff we spoke with understood people's care needs and the support they were to provide.

Staff had developed close and positive working relationships with health and social care professionals such as the district nurse and GP. This ensured they worked in people's best interests and were able to continue to meet people's changing needs.

Is the service well led?

The service had an experienced registered manager in post. Most staff felt well supported. Improvements were noted in the arrangements for staff training and supervision. Some staff however felt that the communication and support from the management team could be improved.

The provider had an effective system to regularly assess and monitor the quality of service that people received. This ensured people received a service which was of high quality and met their needs.

People we spoke with told us they felt well supported by staff and were satisfied with the service that they received. One person told us, “Staff are very helpful.” Another person told us, “The support is very good”.

People's needs were assessed and care was planned and delivered in line with their individual care plan. People we spoke with told us they had a care plan in place and had felt involved in putting the plan together.

The recruitment and selection processes were sufficiently robust to assure the safety of people that used the service. Some staff were not up-to-date in training considered to be mandatory by the provider. There were also gaps in some of the staff’s supervision. This meant that staff were not always supported to carry out their work.

There was a system in place for assessing and monitoring the quality of the service, which involved people who used the service. This ensured people received a service which was of high quality and met their needs.

Due to the complex support needs of the people supported by Perthyn Shrewsbury most people we met were supported by staff to share their views and experiences.

Two people told us that they always made their own decisions about how they lived their lives. Staff told us how they supported people to make choices and decisions and how they used other agencies when appropriate.

People said they were happy with the support they received and we saw that people had a good rapport with support staff. Staff were knowledgeable about people’s needs, preferences, likes and dislikes. Staff told us that support plans were comprehensive and gave them all the information they needed to meet people’s needs effectively.

Staff told us that medication procedures were comprehensive. They said that they were regularly assessed for competency and that they received excellent training and support to administer mediation effectively.

The agency had a complaints policy that was available in different formats. Staff told us how they supported people to make complaints when appropriate. One person told us they had effectively used the procedure. People said they would be confident to share their worries and concerns with staff or managers.

We saw that staff files were well organised and reflected a thorough and robust recruitment process. Newly appointed staff told us that they had been well supported and this enabled them to be confident in their support role.

We spoke with five people who received a service, one relative and eight staff.

People lived very active lives with varying levels of support. People took part in a range of leisure and social activities, both at home and in the local community. The level of support people required varied. One person told us that they had two hours a day. Some people had 24 hour support for seven days a week.

People were involved in developing independent living skills as far as they were able. People told us that they liked doing things for themselves but had help if they needed it.

People told us that they were very happy with the support they received from Perthyn. People told us that staff met all of their care and support needs in ways that they preferred. One person told us “the support I'm getting is fantastic”.

Only one person had issues in relation to missed calls. They told us that these had impacted upon their daily plans. The manager told us that they knew about this and had adressed the issue.

Given that the registered manager was not at the office on the day of our visit we only had limited access to information in relation to people's care and supoprt needs. There was, however, a copy of one person’s plan available to review. We were told that this plan reflected current arrangements for that person. We saw that risks had been assessed and guidelines were available to show how the person preferred to have their care and support needs met. Staff told us that everyone had a detailed care plan and up to date risk assessments. They found them to be “useful”. People we spoke with confirmed that they had plans of care and three people said that they had been involved in developing them. Other people did not comment. Staff told us how they assessed risks before activities to ensure that as far as possible people were protected from harm whilst doing the things that they enjoyed.

People were supported by a knowledgeable and well trained staff team who knew people’s care and support needs well. Perthyn offered staff a range of training opportunities that were specifically designed to meet the needs of the people that they supported.

Perthyn had systems in place to seek the views and opinions of people who received a service. Staff told us that the service is totally “client led”. One staff member told us,

“Everything is centred on the individual”.

Perthyn also had a comprehensive quality monitoring tool to ensure that they maintained good quality and safe care.

Perthyn effectively ensured that people’s views were considered and listened to in relation to the running of the service. People were very familiar with Perthyn’s complaints procedure and had used it effectively to improve the service that they received. Staff told us that it was a strength of the service that they were “totally transparent”. People felt able and empowered to speak out about issues and they knew that they would be investigated and dealt with openly.