I visited 24 services last week in both England and Wales. I was very impressed when I went to Cwrt-y-Bella in Wales to meet a young man that we support who is currently training to be a football referee. I was also very impressed when I went to Hillview in Surrey to speak to another young man who told me very proudly how he is starting voluntary work as a youth worker. At the moment, as I go around CMG services, I am reminding staff about how essential it is to have good communication with families. This is following a complaint we had from a parent where a member of staff communicated poorly and unintentionally gave the impression that the woman’s son had gone missing, causing a great deal of unnecessary distress. I was very pleased, but not surprised, to be shown the “communication with families” file at Kings Road, one of our two outstanding rated services. Every person we support has a written communication agreement with their family as to how they would like to be kept informed about developments with their next of kin and every single contact that is made with the next of kin is recorded thoroughly. This is an excellent example of good practice and one I would encourage all our services to meet.
I have also been looking at daily diaries as I have been going around services as they are a really good way of seeing what kind of life the people we support are having. Some of them are recorded in a very comprehensive way and you very clearly see people having a great quality of life with a strong emphasis on promoting independence. Others are too brief and don’t fully reflect the lives of the people being supported. Daily diaries are key to evidencing what we do with the people we support and it is essential that they are filled in thoroughly.
I was invited to attend a workshop by a local authority which is actively promoting de-registration of residential care. The presentation they gave clearly indicated a preference for supported living over residential care and implied that residential care is the poor relation of supported living.
In CMG, we run both residential care services and supported living. I think there are some myths about supported living and I would like to take this opportunity to challenge them. Yes, supported living is better than residential care because people we support have greater security of tenure and also have more disposable income. However, when it comes down to quality of life, in my experience it is far more important how competent the manager of the service is than what the label says over the door. We have taken over supported living services when we have won tenders in the past and the quality of some of them have been pretty dreadful; so the assumption that supported living is always better than residential has to be challenged.
There are also downsides to supported living which never seem to get discussed. I would like to highlight two of those:
• Most providers (CMG is an exception) register supported living as domiciliary care. This means that one registered office, that potentially oversees 20 or more services, is registered and inspected by CQC. This is different to residential care where every individual service is registered. The effect of this is that supported living services get far less regulatory scrutiny than residential care homes.
• A lot of supported living services involve service users being tenants of housing associations with a separate care provider. With some exceptions, housing associations generally have a pretty poor track record of maintaining property. In CMG, we have our own maintenance team which maintain properties that we own. They are far more responsive at fixing and repairing things than the majority of housing associations we work with; at the end of the day, we employ the maintenance team and can direct them accordingly. We can’t do the same with an independent housing provider .
As you know, we have two outstanding rated services in CMG; Kings Road in Hampshire, which is a residential home, and The Ridgeway in Essex, which is supported living. They are both fantastic services and in my opinion equally good. One is not better than the other because it is supported living.
I appreciate that there are financial incentives for local authorities to promote supported living, particularly access to housing benefit. However, at the end of the day, the money does still come from the public purse. I do wonder how often the people who set the policy that supported living is somehow far superior to residential care ever actually go into services and see what’s going on.