Positive Support for You

Introduction

Skills for People Quality Checkers were asked by Positive Support for You (PSFU) to carry out a quality check of the support provided to four people who live at Cresswell, Northumberland.   The Quality Check would form part of the organisations commitment to driving up quality.  PSFU use the Driving up Quality Code http://www.drivingupquality.org.uk/ a self-assessment guide, to help them work out what they need to get better at.  The aim of the Driving Up Quality Code is to avoid what happened at Winterbourne View ever happening again.

PSFU is committed to driving up quality in the organisation by using the code and carries out regular self-assessments of its practice.  PSFU publishes its action plan on their website. Using the code helps to ensure the organisation is being open and transparent,.

To assist them, PSFU always seek the input of independent Experts by Experience to support them in this important work.  Experts by experience are people with learning disabilities and autistic people who can provide an independent view. Experts by Experience speak to people using services and their family or organisations that support them. They observe how the service is delivered and speak to staff. 

About Quality Checkers

The Quality Checkers are a team of people with learning disabilities and their supporters, who want to make improvements so that people are supported to live full and healthy lives in their communities.  They are experts on how support should be because most of the team has first-hand experience of receiving support services. This means they can give a view which is often missing from other types of reviews.   Our aim is to enable people supported to have an impact on how organisations develop to ensure they offer high quality, personalised support and services.

The Quality Check visit to Cresswell was carried out by a team of people from Skills for People, Susie Fothergill, Gail Wright and Donna Johnston.   (www.skillsforpeople.org.uk). 

About Driving up quality

Driving up quality uses standards that are set out in the ‘Driving up Quality Code’.  These are the standards used by PSFU to carry out an assessment of the service they are providing to people.   

Standards are an agreed way of doing things.  Quality Checkers always use standards to make sure things are going well or are done well.  These standards were used when carrying out our independent visit of the service provided to the people living in Creswell, Northumberland.

The ‘driving up quality’ standards are:

1.      Support is focussed on the person.                                                                             

2.      The person is supported to have an ordinary and meaningful life.

3.      Care and support focuses on people being happy and having a good quality of life.

4.      A good culture is important to the organisation.

5.      Managers and board members lead and run the organisation well.

We have written what PSFU are doing well under the five standards from the information we gathered on the day of our visit, our observations and conversations with people supported and their families.  We have also made some suggestions for PSFU to consider to make things better for those living at Cresswell.

Quality Check visit to Cresswell

Positive Support For You provides personal care to four people who are living in their own separate bungalows in a 'supported living' setting.  The bungalows are located at Cresswell, Northumberland.  The four individuals all have very complex histories and do not use words or use very few words to communicate.  The Managers and Staff Team at Cresswell use Positive Behavioural Support (PBS) as an approach to supporting the individuals.  PBS is a person centred framework for providing long-term support to people with a learning disability, and/or autism, including those with mental health conditions, who have, or may be at risk of developing, behaviours that challenge.

Using this approach ensures people are given the right support at the right time, enabling people to reach to their full potential.  PBS is a very structured and person centred way to support people and ensures the person always comes first.  The person takes the lead on how they are supported - they are in control.  PBS believes that all behaviour is important as this is how a person communicates what they need and how they need to be supported. All the staff at Cresswell are trained in Positive Behavioural Support (PBS). 

Skills for People Quality Checkers first visited Cresswell in 2021.  During this time the people living there were not ready to meet with us.  The individuals had not long settled in their new bungalows, having come from living in long stay hospitals for many years.  They needed time to settle in a new environment and get to know their support staff.  This was also a difficult time for everyone, as the country had been through one of the worst pandemics in years.

Although we did not meet the individuals in 2021, we spent considerable time speaking to Managers of the service to find out about the support people were receiving.   We also spoke to some parents and sent questionnaires to the staff teams. 

Our second visit to Cresswell took place on the  4 September 2023.  We initially met with Managers Sue Payton and Cheryl Carpenter as we were aware that any visits would need to be carefully organised and planned.  As we had not met the individuals supported on our previous visit we were keen to work with Sue and Cheryl to make this visit happen.  More importantly, we wanted to find out if people’s support and lives had improved and changed since moving into their own homes.

Quality Checkers really appreciated the help from Sue and Cheryl, who organised and planned the visits very carefully ensuring the needs of the people they support came first at all times and to ensure the visits could go ahead.  This was a huge change, as last time Quality Checkers did not get to meet anyone as they would not have coped with a visit from strangers.  We were also aware that some people may still not be ready to meet with us as they need lots of time to build up trusting relationships and get used to new faces.    Routine and structure are also important to the four individuals, and we did not want our visit to impact on any of their everyday activities.

Quality Checkers also understood from staff that when a person might want us to stop our visit, they might say things like: “no, no, no”, or ignore us; another person may say something like “mushy peas” and another person might say “I don’t know” and get a bit restless. Some people were able to answer simple questions and some people did not like to be asked questions. Quality checkers knew from this information that we would need to stop our visit.

As well as visiting the people supported by PSFU, Quality Checkers also sent out 38 questionnaires to the staff team, thirteen questionnaires were returned.  We forwarded a questionnaire to the two Care Managers from Northumberland County Council who are involved in supporting the people who live at Cresswell.  Unfortunately, neither of the Care Managers returned the survey or provided any comments.

We also spoke to two parents on the telephone about the support provided to their family members by PSFU. Other parents chose not to take part.

Not all people supported or families gave their consent to use photos.  Where consent was given we have used the photos in the easy read version of this report.

Standard 1: Support is focussed on the person.

What is PSFU doing well?

Having good support is very important for the people living at Cresswell. Good support means they can have the same opportunities, choice and control in their lives as everyone else.

·       People take the lead in how they are supported and what they do: Managers really helped Quality Checkers to make these visits happen and they spoke to each person on the day, to make sure they were happy to meet with the Quality Checkers.

·       Quality Checkers were able to visit all 4 people. We saw 3 people in their homes and 1 person outside at the coast.

·       Most people managed to meet us for 5- 10 minutes. One person met us for at least 45 minutes. The individual offered us a cup of tea and a cake and we observed how he was supported by his staff to make cups of tea for us all.

·       One person has now started to use some words. They also use a sign language, called Makaton. When Quality Checkers visited we noticed they were watching a signing music channel.

·       When Quality Checkers visited, everyone looked happy and relaxed, enjoying whatever they were doing.  People were lounging on the sofa or in a chair, out at their favourite place or relaxing in the garden. People were also able to have their own space away from staff.

·       One person who showed us their room had a photo wall with photos of them enjoying all the different things they enjoy and the places they enjoy visiting. This wall of photos encouraged communication with the person.  They were able to point to the places or activities that they wanted to do on the day.

·       One person invited a Quality Checker to look at the wallpaper in their bedroom. The person told their staff to shut the door when it was time for the Quality Checker to come out.

·       One person invited us into their garden where they chatted about “only fools and horses” and sang to us. They enjoyed when we clapped.       

·       One person came up to one of the Quality Checker’s and took their hand. Quality Checkers felt that this showed how far the individual had come in trusting new people. Quality Checkers also saw that this person had a good relationship with the staff member and felt comfortable to hug them.

·       Another person, who also loves their garden, has had it filled with everyday objects to make it into a sensory space for them. They enjoy spending time there.

·       All staff who returned questionnaires said they felt family members are kept involved in the person’s life. This includes visits, updates by emails, having contact with managers and team leaders.

·       Quality Checkers found out that people are very close to their families and see them regularly.

·       One person has just got back in touch with some of their family they hadn’t seen for some time and had met with them.

·       Some people’s homes were more personalised than others. We understand that some people cannot have a lot of objects or pictures lying around their home.

·       Most staff have known the person they support for a number of years and feel the person is happy living where they are.

·       All staff said easy read information and care plans are used with the people they support.

·       Most staff felt the person they supported has a say in their support plans.

·       All staff have felt the person they support has made progress over the last 2 years: Staff said people’s quality of life had improved, behaviours have improved, as well as people’s mental health, well-being, communication, activities and relationships with family.

·       One family member said that their son “has a good quality of life and is much more settled than anywhere they have been”. They said it’s the right place for them. “They are doing more now and they are always out”.

·       Another family member said things have really improved for their loved one, “they are now settled and are a completely different person”.

·       Families feel staff support people well. One person accepts most staff now compared to in the past.                                                          

Standard 2: The person is supported to have an ordinary and meaningful life.

What is PSFU doing well?

·       Each person has their own car which means they can get out to do the things they enjoy and go to the places they enjoy.

·       Quality Checkers met with one person when they were out on a walk and picnic. The individual was very relaxed and happy to let us join them on their outing.  We could see they were enjoying themselves as they were smiling and laughing.

·       We found out how some people have been trying new things for the first time. For example, we were told that one person has been planning a trip to the Metro Centre. This is a very noisy and busy environment and can cause distress. Staff worked very slowly and carefully with the person. After our visit Sue got in touch to tell us that the person had a really successful trip and even went into shops to buy new clothes.

·       We found out that people now have passes for places like Beamish, as previous visits had gone so well and people supported wanted to be able to go back for other visits.

·       Staff receive training and have a good understanding of positive risk taking, which is enabling people supported to develop new skills.

·       Quality Checkers were invited to a Macmillan coffee morning but unfortunately we could not attend on the day.  Sue and Cheryl told us that the people supported were making cakes and one person was hoping to work on the stall.   Sue stated “This is another positive step as we move to slightly busier environments slowly. We hope that all residents will pop in at some point even if it is for a short period”.

·       One person went on a ferry for the first time, Quality Checkers were shown many photos of things they have achieved. Their speech has improved greatly and they are now more involved in making decisions about how they want to live their life.  They have also rekindled a relationships with some family members who they lost touch with many years ago.  They have even participated in activities where they received a reward for being part of a football competition.

Standard 3. Care and support focuses on people being happy and having a good quality of life.

What is PSFU doing well?

·       Staff supporting people have good relationships with them and are making a difference in their lives.

·       Staff are mostly consistent and are not moved around, this enables continuity of support, strong relationships to be built and better person centred support to be delivered.

·       Using PBS as a way to support people is working well for the people supported at Cresswell.  This way of supporting people is very different to how they were supported in hospital and evidence shows that it is working well for the people living in Cresswell.

·       All staff are well trained in using PBS and training is updated regularly.

·       By using PBS as a way to support people, physical restraint is never used.

·       People no longer need medication to calm them down when they feel overwhelmed.

·       Behaviour changes and incidents have reduced significantly for all four individuals since being supported by PSFU.

·       Support plans are written to reflect the individuals likes and needs and to ensure consistency and continuity in how they are supported.

·       Staff know what to do if someone is feeling anxious and their behaviour changes. Staff may give them space, turn the lights down low or close the blinds.

·       Everyone we met had two staff to support them during the day and at night.

·       Everyone has good plans which include all the important things about them: What they like and don’t like; how best to support them and talk to them and what is important for them to live a good life.

·       Each person also has a plan to tell people what they need when they have visits to the GP, Dentist or Hospital.  These are called “reasonable adjustment plans”.

·       They also have hospital passports to make visits more comfortable for them and to make sure hospital staff know what they need.

·       The service has worked hard to ensure enough staff are always rostered to provide support.  Quality checkers observed enough staff supporting people during their visit.  This means they can live well in their own homes and get out to do the things they enjoy.

·       We noticed that staff were respectful, thoughtful and listened well to people. For example we saw one person getting out of his car and into their wheelchair to go for a walk. The person changed their mind and wanted to be back in their car. The person then changed their mind again and decided they did want to get out.  Quality Checkers saw how well staff knew this person, listened and knew to give them time. They were patient so the person could decide what they wanted to do.

·       Staff always told us when it was time to leave. They could tell us when someone had had enough. 

Standard 4: A good culture is important to the organisation.

What is PSFU doing well?

·       One family member said, “the organisation have good values and really make an effort”.

·       All family we spoke to said they can see changes for the better in their loved ones and feel PSFY are doing a really good job. They can see their family member is living a good life. One family member told us “the management here is well organized and actually care about their wellbeing”.

·       All staff said they had worked closely with other staff to learn on the job.

·       All staff said they had good training to do their job and most staff know they can ask to do other training.

·       Most staff said there were opportunities to progress in the organisation.

·       Most staff felt they can have a say in people’s support plans. They felt managers respected and valued their input and suggestions.

·       All staff said they have regular meetings about the person they support.

·       Most staff feel confident about complaining or giving good feedback on behalf of the person they work with.

·       Most felt they received their rota in plenty of time to manage their work-life balance.

·       Nearly all staff said they felt valued by managers and work colleagues.

·       Most staff said managers and team leaders lead by example.

·       Most staff like working for PSFU.

·       Staff commented that they felt: supported, valued, they like their team and management and they were well organised and caring. They commented on their work shifts and that they were able to change shifts if needed.

·       All staff said they have training in whistle blowing and safeguarding, they talk about it in team meetings.

·       Staff commented about the difference in pay between the organisation and that their colleagues in another area were being more than them for doing the same job. We asked CEO Dave Barrass about staff pay.  

Dave explained the history behind this and what they have tried to do to remedy the situation. “The pay is not in my control. We have two contracts, the one in the other area pays significant more an hour and specifies that the enhanced rate is paid to front line workers on that work.  The Northumberland contract does not.  We are a social enterprise and not for profit. We always pass all available funds for pay to staff but cannot cross subsidise from one contract to another.  While I understand that this is regrettable and has caused upset to Northumberland colleagues it is simply unavoidable.  We have lobbied Northumberland County Council to seek additional funding and continue to push for this but the Council tells us it is struggling with austerity pressures.  All our staff including in Northumberland, are recipients of the Real Living Wage and we have worked hard in difficult Financial Times to achieve and maintain this and will strive to continue to do so”.

Quality checkers fully understand the situation with LA contracts and the differences in contracts/funding across different areas of the country and know this is a situation affecting many Social Care Providers. Quality checkers would like PSFU and Dave to continue to update the staff at Cresswell whenever they meet with Northumberland to ensure they always know that PSFU will continue to raise this matter.

Standard 5: Managers and board members lead and run the organisation     well.

What are PSFU doing well?

·       Some staff have met directors and board members and some have not.

·       Some staff felt there were no changes or improvements they would make to support people better.

·       The two parents we spoke to said they were “very happy” with Positive Support for You, their managers and board members and the support they give to their loved ones.

What could Positive Support For You do better?

Friendships and relationships

·       PSFU should look to see if people supported are starting to tolerate more new people and places and explore how they can be supported to develop real friendships.

·       One family member would like to try again to have their loved one visit them at their home.  Quality Checkers think this is important and understand it would take a lot of planning and organising for the individual and may need to be done in small steps.  We appreciate the person may not want to do this but feel this should be explored again.  If a person does not want to do this ensure family members are always informed.

·       Improvements or changes staff would want for the person they support include for the person to be more independent; to have more choice in activities; more hobbies and interests; to go on holiday. Quality checkers are aware that these areas of someone’s life are very important and would like to see these areas being explored further with the staff and management team at Cresswell.

·       One family member would like their loved one to try different things, meet new people and make new friends.  They would also like to see them going out in the evenings. They wonder if more drivers are needed as they felt there were never any drivers supporting people to go out in the evenings. Management at Cresswell should ensure drivers are covered on the rotas at all times and opportunities are being offered to people supported who may wish to go out in the evenings.  Where people supported do not want to go out in the evenings, this should be clearly recorded in support plans and parents informed of their family members decision.

Including family/carers in training

·       One family member said they’d like to understand more about PBS. The service should consider sending out information/resources to families about PBS if not already done so. Understanding PBS and this approach to supporting people is very different to how individuals with complex histories who have been living in long stay hospitals were supported before.  It is important family members fully understand this approach to be able to fully comprehend why support is carried out in this way.

Staffing

·       Not all staff had “induction” training when they first started. PSFU should ensure all staff have induction training from the first day they start.

·       A couple of staff would have liked longer to shadow more experienced staff. Ensure all staff are given the time they need to feel confident and competent to support individuals.

·       One staff member felt that an issue with another staff member was not dealt with appropriately as the person they had the issue with was related to management.  The staff member felt this was the reason this was not dealt with and made them feel uncomfortable and reluctant to speak up again.

·       A couple of staff were not happy about when they have complained and felt nothing changed and said they would feel uncomfortable about complaining again.  PSFU should ensure all staff complaints are dealt with immediately and ensure the person who makes the complaint is given a written explanation of the outcome. 

·       Staff also told us about having to use an outside portaloo when supporting  

People. Staff commented that this was unhygienic and not acceptable.  Quality checkers agreed with the comments from staff and spoke to managers at Cresswell and the Chief Executive Officer (CEO) Dave Barrass about this.

Dave told us “The portaloo continues to be deeply frustrating. When the site was built, it was built as separate bungalows and each is a separate tenancy.  The toilets are en-suite and accessed via bedrooms. This is the heart of the issue. This means that staff cannot access and use toilets throughout the day and this is very problematic as no other toilets were built on the site. 

We also have some people we support who through their behavioural presentation find it difficult to allow staff to use their toilets or offer specific threat as a consequence which makes the issue more difficult. 

PS for You CIC had no say or influence on this aspect of design and it was a fait acompli when the service started.  We have lobbied for solutions with Northumberland County Council and the Housing Association who manage the site and act as landlords. We achieved the portaloo as a consequence but we like the staff remain dissatisfied with this.  The issues staff have raised in the past with cleanliness have been raised again and we are looking at additional servicing in response to this. I have asked to meet the Landlord to explore whether a more sustainable solution with a more permanent facility can be sourced”.

Quality checkers would like Dave and the managers at Cresswell to continue to keep the staff updated on this issue to ensure they are fully aware that this situation is continuously being raised by them.

Recruitment

·       PSFU should Develop a procedure on how they can include families and people supported at Cresswell to become involved in recruitment processes.  One parent said they would like to know more about this. 

·       Another family member we spoke to said they are not involved in choosing staff but would like to be involved in some way.

·       Retaining staff - One family member said they know it can be difficult to keep staff but felt that when they visited they often noticed new staff supporting their family member.  Quality Checkers appreciate the difficulties experienced in recruiting and retaining staff for all Social Care Providers at this time.  PSFU should ensure that families are always made aware of recruitment issues in the service and how the organisation is managing this.

·       Using external agency staff; one staff member told us that “there is a lot of agency staff being used at Cresswell, these workers are more often lazy and on their phones needing woken up because they nod off a lot, communication is also difficult which upsets service users. 

Quality checkers feel these comments are very serious and believe that management should investigate these comments with all team members in supervisions and team meetings.  Staff should be reminded about raising any concerns or issues regarding agency workers immediately with their manager.

·      A staff member believes management to be prejudice towards staff who speak up with issues or any concerns. They want PSFU to employ staff who want to do the job and not employ staff because they are related to management.  They told us they have applied and been offered another job because they feel they are not listened to by PS4U, and this makes them sad as they thoroughly enjoy working with the people supported. Quality checkers were concerned about this comment and feel that management at Cresswell must ensure all staff feel safe to raise concerns about colleagues and that this does not create the potential for personal conflicts to enter the workplace. This can have a negative impact on an individuals' ability to focus on and complete their job duties.  Other team members may believe there is favouritism involved.  PSFU should ensure that policies cover employee relationships, promotions and hiring are clear, and that you have a way to show employees the policies that led to any promotion or hiring decisions involving relatives are open and transparent.

Communication

·       One family member felt they were not kept up to date with how their person spends their time. They were told about important issues and but not about the activities there relative was involved in. PSFU should ensure all families are kept fully up to date with their family members activities on a regular basis.

·       One family member said that the bungalow is more like a home now, but there are still some things they’d like to see changed. They felt the toilet was a problem for their relative and although they acknowledged that some changes had been made they felt more needed to be done.  Management at Cresswell should ensure they are taking on board the comments of family members regarding any improvements or updates to the persons bungalow and reasons why things have or have not progressed.

And finally….

It was clear from our visit that things have improved greatly for people over the last few years. The fact we were able to meet all four people is a huge difference from last time when people would not have tolerated visits from strangers. The country had also gone through Covid and lockdown and quality checkers are well aware that this was an extremely difficult time for many vulnerable people and the staff teams providing support.

Quality Checkers could see from their visit that people liked their staff and were very comfortable and relaxed in their presence.  Quality checkers observed staff members treating people they supported with care and respect, staff listened and responded well to the people they work with. They understand how to support people well and people now have more choice and opportunities in their lives.  

Quality checkers feel that by using Positive behaviour support (PBS), which is a very person-centred approach to supporting autistic people and people with learning disabilities to improve their quality of life and reduce behaviours of distress. Research and long experience tell us that most behaviours described as challenging result from a failure to understand a person’s distress.

Quality checkers observed how the staff and management at Cresswell are using PBS to help the four individuals to improve their quality of life, reduce distressed behaviour, and eliminate restraint as a management strategy.  This approach is clearly working, most people living in Cresswell have reduced the use of medication, there are fewer incidents and restraint is not used.

We observed individuals taking control in their own homes and making their own decisions.  We observed individuals being appropriately supported by staff to maintain their independence for example, making their own drink.

The two parents we spoke with were clearly very happy with the support their family member was receiving from PSFU.  Both parents acknowledged how different their family members lives are now.  They both saw how much their families members had changed with one parent even commenting that “They are a different person now”.

Quality checkers feel the staff and management at Cresswell are doing an excellent job.  We observed the people supported going about their daily lives and how their lives had improved greatly since coming out of long stay hospital.  We observed staff speaking and acting appropriately with people supported and treated them with respect at all times.  Our team was really happy to have been able to meet and spend time with all four individuals who live at Cresswell.  We felt this showed just how much hard work the staff team and managers have been doing over the last few years in helping people to achieve a good quality of life.

Quality checkers appreciate that some staff are unhappy with the situation regarding pay and having to use a portaloo.  We know from our discussions with Sue, Cheryl and Dave that these issues are being taken seriously by them and they are constantly being addressed with the Local Authority and the landlord.  It is important to point out that these issues are not in PSFU’s control.   In saying this, Sue, Cheryl and Dave are, and will continue to address these issues on behalf of the staff team at Cresswell.

Quality checkers would like to thank the people supported at Cresswell for allowing us to visit them at home and to accompany them out on their activities. 

We really appreciate the amount of time spent planning and organising the visits by Sue and Cheryl and the staff team to ensure we were able to meet all four individuals who live there.  We believe the people supported at Cresswell have an excellent quality of life due to the strong leadership and good care and support from their staff.