New Key provides care and support to people living in a number of ‘supported living’ settings in Torquay, Totnes and Kingskerswell, so that they can live in their own home 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 time of the inspection New key was providing support to 33 people. Only 11 of these were receiving personal care therefore we only looked at the care and support received by those people.

Under the supported living arrangements people had exclusive access to their own bedrooms where they shared accommodation with other people. People who shared accommodation told us they had been able to choose who they lived with. We saw that people’s homes were personalised to meet their needs and were comfortable and homely.

At the last inspection in August 2015 the service was rated Good and the key question ‘Is the service well led’ was rated as ‘outstanding. At this inspection in November 2017 we found the service remained Good overall and the key question ‘Is the service well led’ remained ‘outstanding’.

Why the service is rated Good.

The service has built on their previous success and maintained a good model of care and support provided to people. The registered provider, registered manager and support staff continued to find innovative ways to improve the service and remained driven by their passion for supporting ‘people to live independently and assist them to live the lives they want’.

The service continued to demonstrate an outstanding commitment to providing high quality, well-led and inclusive support to each person receiving support from New Key. Staff continued to provide person centred care helping people live the life they chose and fulfil their dreams. Staff had a good understanding of people's needs and were imaginative in the way they provided person centred care which put people at the heart of the service. People were supported to use their budgets creatively and spend their money as they chose.

The service continued to have a strong emphasis on fostering ways to empower people to be involved in the running of the service. For example, people using the service were included in the interview process for new staff where they wished to. They told us their views were listened to as part of the process. A robust recruitment and selection process was in place. This ensured any prospective new staff had the right skills and were suitable to work with people.

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. One person had decided they would like to raise money for charity and had approached the service about the idea. Staff had supported them to organise a coffee morning which was well supported by people from the local village. The person had raised several hundred pounds for their chosen charity.

Relatives confirmed they were happy with the way staff supported their relations. Following the inspection relatives emailed to tell us “They (staff) are accepting of my son as a person and individual in his own right and give him respect. I am extremely grateful for the value New Key puts in continuity of support. The support team listen to my suggestions and make valuable contributions to improving my son's ability to express himself” and “I am very happy with [person’s name] care with New Key. Her health and wellbeing are important to her support workers and they always have her interests in mind when helping her plan her days.”

We received many positive comments from visiting professionals about the openness and transparency of the service. One visiting professional told us “You get what it says on the package.” They told us the service was very transparent an

People we spoke with told us that they were pleased with the service provided. One person said "they are good, they don't let us down". Another person told us "I am impressed by the staff, they are very professional".

People we spoke with told us that staff were respectful and supportive and understood the needs of the whole family.

We looked at staff files and noted that they had received appropriate training and that this was updated as necessary.

The staff we spoke with were able to explain to us their understanding of safeguarding and how to make an alert if necessary. They told us about the different types of abuse and how to recognise if abuse was happening.

People knew how to provide feedback and make complaints, although the people we spoke with had not felt it necessary to complain.

People we spoke with told us that the service staff are pleased to listen to comment and respond positively to any suggestions made.

New Key provides a supported living service to people with a learning disability. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. At the time of our inspection, although the service provided support to 26 people living in their own homes, only eight required support to meet their personal care needs. Therefore we only looked at the care and support received by those people. The support provided by New Key was dependent upon each person’s needs and could be up to 24 hours a day.

We carried out this announced inspection on 11, 13 and 14 August 2015 in response to information we had received regarding risk management and people’s safety. The last inspection took place in January 2014 during which we found no breaches in the regulations.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they 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.

The registered provider, registered manager and the management team demonstrated their commitment to providing high quality, well-led and inclusive support to each person receiving a service from New Key. They had effective systems in place to assess people’s needs, recruit and train dedicated staff and to monitor the quality of the support services they provided.

People either told us directly, or indicated through sign language, they felt safe, were happy and the staff were caring. We saw people approaching staff with confidence and accepting appropriate prompts from the staff indicating they felt safe in their presence. We saw staff treating people with respect, kindness and patience.

People received support from New Key to live as independently as possible in their own homes. Support was developed with the person’s abilities, needs and goals in the forefront of planning and decision making. Great emphasis was placed on people’s rights as citizens and in developing the staff team to deliver high quality, person-centred support. The service promoted improving people’s independent living skills to become less dependent upon staff and to become more involved in leisure and educational activities enabling people to enjoy a more fulfilling life. For example, people were supported to prepare meals for themselves, use public transport and attend community leisure and educational events. This was supported by the relatives we spoke with who praised the support provided by the staff. One relative said “they provide excellent emotional and physical care for (relation). He is exceptionally well cared for and supported.” Health and social care professionals told us the service was “outstanding” in their support of people and had provided professional support to people with very complex care needs. They described the service as being committed to providing person-centred support and championing the rights of people with disabilities.

Support plans were developed with the person and people who knew them well. They were personalised and contained a range of formats including symbols, pictures and words to help the person understand their plan. The plans described in detail the support people needed to manage their day to day needs. They included who and what was important to the person, how to keep them safe, their individual preferences, their interests as well as their future ambitions. Staff said they supported people to be as independent as possible. They recognised that being able to do something, such as making a drink or a meal, gave the person a sense of achievement and self-worth.

The service recognised the “Circles of Support” already established in the person’s life. A Circle of Support is the group of people known to the person, including family and friends as well as staff, who meet together on a regular basis to help the person accomplish their goals in life. Where a person did not have a Circle of Support prior to commencing a service from New Key, the service endeavoured to develop one to provide the person with support other than from staff.

People were supported to have a presence in their local community and to develop relationships with people outside of their staff team. Families and friends were invited to work with staff in Community Mapping, that is, identifying community resources that would be of interest and benefit to people.

The service supported people to use innovative assistive technology, such as training videos on a handheld computer, to help them become more independent and not rely as much on staff support.

Risks to people’s safety and well-being were clearly identified and management plans had been developed to ensure staff knew how to support people safely and in a way that was personal to that person. Some of the people supported by New Key could at times display behaviours that may place either themselves or others at risk of harm. Support plans were detailed about these behaviours and staff were guided on how to reduce the risk of a situation escalating. Health and social care professional spoke positively about the service’s ability to meet the needs of people who had very complex support needs. They confirmed the service did not use sedative medicines or physical restraint if at all possible. Accident and behavioural incidents that may place someone at harm were reviewed and management plans were updated to mitigate risks. Medicines were managed safely. Health and social care professionals told us the service managed risks well. We saw no evidence people’s safety was compromised due to poor risk management.

Staff were safely recruited, well trained and knew the people they support well. The registered provider and registered manager said they placed great emphasis on providing training and support for staff. Staff were supported to develop “career pathways” and their skills and interests were recognised by the service. Staff told us they were proud to work for New Key as it was an organisation that was “passionate about the care we provide and what we do.”

Staff told us the vision and values of the service were to “respect people”, “uphold dignity” and “promote independence.” They said these values were discussed at every opportunity. A Culture for Care toolkit for developing a positive workplace culture from Skills for Care was used to assess the service’s performance and to share the service’s commitment to developing and improving the support provided.

A number of staff had taken on the role of “I Care Ambassadors”, visiting schools, colleges and job centres to inspire others to work in adult social care. New Key’s training and support of staff’s development had been accredited with Investors in People, a nationally recognised organisation which helps services develop their staff and recognises their good practice in doing so. Relatives described the staff as “first class” and “excellent”.

Staff had received training in, and had an awareness, of the Mental Capacity Act 2005. People were supported to make decisions about where and how they wished to be supported. Where people were not able to make decisions about certain aspects of their care and support, best interest meetings had been held with them and the people who knew them well to decide on the most appropriate support.

People were involved in developing the service and were supported and encouraged to share their views about the support they receive. The registered provider told us they monitored the quality of the service provided in a variety of ways including meeting with people individually as well as management, staff and relative meetings. Surveys were also used to gain people’s views and “Quality Checkers”, an independent quality checking service run by people with a learning disability, were invited to meet with people who used the service and to review the outcome of the surveys.

People had access to the complaints procedure. People told us they met with the managers and office staff and confirmed if they were unhappy they would tell the staff. The service had made arrangements with other local service providers to support each other in investigating complaints. This ensured people could be confident their complaint was dealt with openly and objectively. No complaints had been received over the past twelve months.

Health and social care professionals told us they had a very good relationship with the management team and the registered provider. They were described as an “honest” and a “listening and learning” organisation. They said they were open and transparent in their communication and weren’t afraid to challenge others, such as social workers and families, if it was in the person’s best interests. Equally so they were not afraid to admit when things had not gone well and to learn from this.

The registered provider had signed up to Department of Health’s initiative, “The Social Care Commitment”. This is the adult social care sector's promise to provide people who need care and support with high quality services.