Supporting People Service Review

Service: B&NES Supported Living Service. Service Address: Connections Day Service, Frome Road, Writhlington, Radstock, BA3 3LL. Service ID: 10063. Service Provider: Bath & N E Somerset Council. Service Provider Address: Adult Care & Commissioning, P O Box 3343, Bath, BA1 2ZH. National ID Number: 10008670. Date: June 2007. Review Officer: Caroline Clark and Helen Thompson on behalf of Bath & NE Somerset Supporting People Team.

3. Brief History

The services were last reviewed in 2004 by Simon Dicker of the Supporting People Team.  At that time ESIT and OWLS operated as two independent schemes and were therefore reviewed separately.

The OWLS service provided medium to high level supported living placements for 20 people with learning difficulties in and around the Writhlington/Radstock area of NE Somerset.  The scheme was based in an office at Manor Park, adjacent to accommodation of some of the higher support clients.  The service was assessed at level C in all QAF objectives and it was recommended that an evidence file be developed to enable easier QAF validation in future. 

The ESIT service provided approximately 26 units of floating support across all tenures.  An initial visit in March 2004 set specific targets to ensure compliance with the 4 QAF standards in place at that time.  A follow up visit in 2005 found that the service was highly motivated to improve its QAF scores and had achieved level B in the areas of Needs and Risk Assessment and Support Planning and level C in all other areas.

Feedback from service users at both schemes was positive with no complaints.  Awareness of support planning was quite low, as was the level of participation by users in the support planning process.  The review recommended the use of support plans as a tool for support workers and service users to use together to plan how support is delivered to reflect the aspirations of the service user.

Both reviews found a very clear contribution from the services to the Valuing People agenda but found that the intensity of support was in excess of the parameters outlined in the developing eligibility criteria.   As a result the review recommended a staged reduction in contract value to a level of 20% of overall costs.

A CSCI inspection carried out in May/June 2006 scored the service as ‘good’ against the standards for Managers and Staff, ‘adequate’ around Organisation and Running of the Business, User Focused Services and Protection and ‘poor’ around Personal Care.  The report set out a number of actions needed to meet statutory requirements including:

• Reviewing the suitability of the office base at Manor Park
• Update the service user guide
• Implement risk assessments around management of service users monies and manual handling arrangements for supporting individuals
• Update staff files and staff training records
• Produce a staff handbook
• Implement specific policies and procedures including confidentiality, money handling and lone working.

6.         Strategic Relevance

The B&NES Supporting People Five Year Strategy has a number of strategic objectives in addition to specific aims for individual service user groups.  In the context of this review the Supported Living Service is able to demonstrate that its service meets a number of strategic objectives and service user aims.

Objective 3 – working towards the provision of a wider choice and a range of high quality services.

The service provided by the SLS allows service users to live in their own homes whilst providing support and security which for some service users is the option of choice.

Objective 7 – providing a range of options for vulnerable people which reduce the need for acute or crisis interventions

The service maintains members’ stability and wellbeing to such an extent that tenancy breakdown or the need for acute interventions are rare occurrences.

The B&NES Housing and Support Strategy for People with a Learning Difficulty aims “to increase the range of local housing options” available to people with learning difficulties in the area.  The B&NES Commissioning Strategy for Adults with Learning Difficulties (2006-2010) sets out a number of targets and actions to help people to live in their own homes.  These include reducing expenditure on residential care and developing up to 30 new supported living placements as part of the commitment to ‘Develop supported living as the option of choice for people with learning difficulties…”  within Bath and North East Somerset.  The Supported Living Service clearly contributes to this objective.

Legal/DCLG Guidance for service user groups

There has been no specific guidance from DCLG on services for People with Learning Difficulties.  “Valuing People – A new strategy for Learning Disability in the 21st Century” (March 2001) is a Department of Health White Paper that sets out an evaluation of the current position for this client group, and an agenda for “Better Life Chances for People with Learning Disabilities”, with further guidance on delivering change.  Valuing People sets out the objective “to enable people with learning disabilities and their families to have greater choice and control over where and how they live”.  The review has found support for the fact that the SLS contributes to this national agenda by providing a model of supported living for people with learning difficulties.

8.      Consultation

Staff A total of 7 staff were interviewed as part of the review process.  These included the Service Manager, 1 Deputy Manager, 3 senior support workers and 2 support workers

All staff had a good awareness of how their role fit into the overall team structure.

• Staff are generally well qualified and enthusiastic and all staff undertake LDAF (Learning Disability Award Framework) training as part of their induction.  Seniors are also expected to have achieved NVQ3.
• Relevant staff undertake more specialised training.  For example, some staff have recently done a course about Asperger’s Syndrome.
• The manager supervises the two deputies who in turn supervise the senior support workers.  Supervision is given/received monthly.
• Staff confirmed that support plans are based on care plans with changes made as required.  The format of these support plans has recently changed and they now provide much more detail.  Most members of staff found the support plans really useful documents to work from and felt they were particularly useful to new staff or those who might be working with a different client.
• The response to support planning from service users varies depending on their level of understanding.  Some take an active role and contribute readily while others either aren’t particularly aware of the process or are not really interested.
• Training on the support planning process has been informal through a team away day and it was felt that it would be good to include further training as part of the induction process and through supervision.
• Levels of awareness of health and safety issues were varied.  Support workers weren’t really sure where to find the health and safety manual or what was in it although they were all clear about what to do if an incident occurred.  All were able to demonstrate a good understanding of the subject and provide examples of how health and safety incidents were dealt with.
• Health and safety is a standing item at supervision and team meetings.
• Out of hours calls are put through to Manor Park which is staffed 24 hours.  These calls are logged in the communication book at Manor Park and in the office diary.
• Although all staff have been provided with mobile phones to allow them to call in regularly, reception is not good and they are often unable to contact the office.
• All staff have received training in Protection of Vulnerable Adults.  Support workers have done the alerters course while the manager and deputy managers have done the investigators course.   It is planned that seniors will also carry out the investigators training at some point.
• The Code of Conduct is included in the staff handbook together with information about whistle blowing and all staff were clear about the key points of the policy.
• Staff receive equality and diversity training as part of their induction and this is backed up by B&NES policies and procedures.
• Referrals from the CLTD come through the Team Manager of the Adult Disability Team and all referrals are assessed according to need.  Staff confirm that key documents are converted into accessible formats where possible and that diversity is looked at in relation to the needs of individual clients as part of the support planning process.
• All staff had a good understanding of the complaints procedure and confirmed that they encourage clients to complain and help them with the process.  Information about how to complain is included in the client handbook.
• Staff have received training about how to deal with complaints and were aware that copies of correspondence relating to complaints was kept in individual client’s files although there was confusion about whether or not a complaints log exists.
• Opinions on professional development varied.  Some felt it was “really good” while others described it as “not great”.  The feeling generally was that in house training is very good but that there is limited external training available and opportunities for promotion are limited.
• Overall staff felt that the service has benefited from the merger of ESIT and OWLS although the period of change was not easy.  The combined service has now been in place for approximately 18 months and it was felt that the new structure is more organised and that communication is better.  Staff feel that they provide a very good, flexible, forward thinking service which meets the needs of their clients.

Service Users

A total of 12 service users were consulted as part of the review.  Service users were helped to complete feedback questionnaires by staff from the CDLT.

• Most service users were aware of their support plans and confirmed that they keep copies in their flats.   There was however confusion between the Supported Living Service support plans and the community care forms used by social services.
• Service users didn’t know when their support plans were due for review but knew that they would be reminded beforehand.
• All clients were happy with the support staff and reported a good relationship with them.  Those who had expressed a preference over the type of person they wanted to support them felt that they had been listened to although it was not always possible to meet their request.  For example one service user would prefer to have a male support worker but there isn’t always one available.
• Service users were confident that they knew when to expect a visit and which support worker it would be.  If their usual support worker was not available they would be advised beforehand and a different support worker would turn up.
• Involvement in the local community varies greatly between service users with some doing very little while others have much greater involvement.  Most make regular use of local shops and services.  All service users felt that they got on well with their neighbours although some of those living at Pennard Court found it difficult to communicate with their neighbours who are deaf. 
• Most had not had any bad experiences in the local community in the last year although one service user reported having keys and a plant taken at Pennard Court and another described being intimidated by passengers on a local bus.
• Most were happy that all their support needs had been identified and were being met by the service.  Some would have liked staff to assist them with going on trips and one said that she would like cuddles although she knew that this isn’t allowed.
• Most service users also receive informal support from friends and family with others receiving help from other organisations such as church groups and Keyring Living Support Network.
• Of the 12 service users consulted 11 were very happy with their current accommodation and had no desire to move.  One was hoping to move to a new flat and was being supported to do so.
• Most thought that they had been told about individual budgets and direct payments and were aware that they could change to a different support provider if they wanted.
• 11 of the 12 service users consulted said that they were either extremely ‘satisfied’ or ‘satisfied’ with the Supported Living Service with the other having no strong views either way.

Other Stakeholders

Additional feedback was received from 2 social workers and 2 assessment and reviewing officers from the CLDT and a member of the Community Day Services Team based at Carrswood in Twerton.

• It was felt that demand is generally moderate to high for this type of service and that it was important that service users are able to choose from a range of supported living providers.
• All those spoken to knew how to make referrals to the service. Clients have little involvement in the referral process although they have to consent to information being exchanged. Service users are able to meet with the Supported Living Service before agreeing to a referral being made.  This gives them the opportunity to decide if this is the right service for them.
• There was a mixed response when stakeholders were asked about how well they are kept informed about how their clients are getting on at the scheme.  One social worker had referred a service user in the past and assumed that everything was going well.  At a later date it became clear that the service user was not engaging with the service and often failed to turn up for appointments but the care management team hadn’t been informed.
• One social worker felt that that provider could be better at helping service users move towards independent living and felt that support workers were not always aware of up to date information regarding clients.  Some support workers were better at this than others.  Another review officer praised the service for the work it has done with one service user who has been supported to develop independent living skills while living in the family home.
• When asked about how well the provider works with service users to consider all future housing options the response was again mixed.  One stakeholder felt that the service does this “extremely well” while two others felt that they are not always good at this and tend to leave it to social services.  One commented that she might find out about a vacancy in a supported living scheme and the SLS would then support the individual with the interview and application process.  She was not aware of the SLS proactively identifying successful accommodation options themselves.
• It was felt that SLS staff generally have a good knowledge of other support services available although this varies between support workers.
• Information sharing is generally good and social workers and reviewing officers confirmed that they do joint support planning and attend joint meetings.
• Some service users have not got on well with the service because of the high number of staff who work there although other service users find it a positive thing as it expands their social network.
• It was felt that the merger of OWLS and ESIT has been a positive move and that it is good to have one manager and support team for the whole service.  One stakeholder described them as “a very professional and dedicated team, who work very hard to empower/support the clients to move towards independence”.

Continued