Shift planning, CQC and supported living versus residential

06 February 2017

I visited 18 services last week and was particularly impressed by Kings Road’s ‘fun fruit Friday’.  Every Friday they think of a fun activity to encourage the people they support to make and eat healthy snacks and desserts involving fresh fruit.  What a great idea!

Composition of various exotic fruits isolated on white background

At another service I got engaged in a discussion with staff about shift planning. It’s always seemed fairly obvious to me that shift planning, by definition, means planning at the start of the shift what’s going to happen as people go through their shift.  In this service, some of the staff thought shift planning involved recording afterwards what’s taken place.  Shift planning is a really important tool as it makes sure that the right staff are allocated to the right people we support and that they participate in meaningful activities.  I would be grateful if our managers could remind and re-enforce this point with our staff.

With a degree of trepidation, I am going to put my foot into the very controversial waters surrounding ‘registering the right support.’ This is a new initiative by CQC to try and make sure no new services are opened for people with learning disabilities which are large and institutionalised. Having spent a large part of my career closing dreadful old long stay hospitals, I feel very passionately that I don’t want to see any new institutions develop for people with learning disabilities. However, I am not sure I agree with CQC’s view that services should generally be for no more than 6 people. I have certainly seen larger services that can work very well for people.  For example, our Avenue Road supported living service, that was recently rating ‘outstanding’ by CQC supports 9 people each in their own studio flat. Sometimes, when we take over tenders from other providers supporting people in 3 person and smaller supported living services, they can feel quite lonely compared to some larger services which have a more buzzing atmosphere.  As non-disabled people, we all choose to live in a wide variety of different living situations and I don’t see why it should be different for people with learning disabilities.  In my experience, what matters most is the calibre of the registered manager and the values of the staff team.  However,  I do draw the line at larger services for people with very challenging behaviour.  Firstly services of that nature can easily become controlling and abusive with a punitive approach to responding to peoples’ behaviours. Secondly, people with very complex and challenging behaviour do require highly skilled and personalised interventions.

I am going to finish by reverting to a topic I’ve mentioned before; the downside of supported living which nobody apart from me seems to mention.  I am not anti supported living; in my time at CMG we have opened more than 30 supported living services. However I do feel frustrated by the simplistic attitude prevalent across our sector that residential care is bad and supported living is good. The quality of the manager and the staff team is far more important than the label over the door in determining the quality of life that people will experience. One of my concerns about supported living is the lack of inspection and oversight compared to residential care. For example, last week I visited a provider who has around 30 supported living services, all under one registered domiciliary care office. At their last inspection, the CQC inspector visited the registered office and only two of the services.  How can this be right?

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