The Supported Living Conundrum

This year more than ever before the team at Swift Management have been requested to assist with Supported Living Registrations related to services providing care for those living with autism or a learning difficulty either from the conceptual stages or from the point of a notice of proposal not to register a service from the regulators.

The previous guidance “Registering the Right Support” has been replaced with Right Support, Right Care, Right Culture which was issued by CQC in October 2020. This document aims to clarify the position of the regulators.

There appears to be much concern from existing providers and confusion from those wishing to enter the sector, about how to structure their services, and it is easy to see why.

For many existing services, care and accommodation has been tied together, not necessarily in one contract, but one contract being tied to another. Many providers have traditionally provided accommodation which ties the occupant to one care provider usually operated by the same group of companies. This can offer a cost and volume savings for all concerned. The location and structure of homes or clusters of homes also no poses issues.

New providers keen to follow in the footsteps and use existing models are equally confused. The guidance issued has come about by bringing together several pieces of research and best practice guidance publish by the National Institute of Clinical Excellence (NICE). This coupled with considerable negative press has caused a ripple of change to come about more rapidly than perhaps anyone could envisage.

When reviewing the operation of existing providers and supporting those who are entering the industry for the first time, the key points about the success will be based on the usual issues of policies, procedures and safeguarding but also about providing real choice for the service users, ensuring that they are in control about where they live, who they live with and how their care and support is provided to them.

In essence, people requiring services should not be required to move a long way from their family and friends, the service should be local to ensure real community inclusion. The service should be near community facilities such as shops, libraries, dentists, and other local amenities.

To this end to successfully register a new service, the provider will need the support in writing from the local authority, confirming the need for a service in the area.

The service should be small and domestic in nature and should not be either institutional or intimidating. The tenancy agreement should pass the REAL tenancy test and should not be linked in anyway to the care and support contract. This is often referred to as “separation”. There is also a need for the accommodation provider to demonstrate that the terms of the tenancy has been discussed and that the person signing the agreement has the legal powers to do so, if the resident is not able to sign the agreement themselves.

The care homes provider, who may provide 24 hour care or time specific care depending on need will need to demonstrate that the care provided meets both the physical and phycological needs of the service user optimising social and community interaction, and demonstrating the service user has choice and involvement within the care plan.

In essence, whist many are perplexed by the guidance as there are extensive documents to read and digest to fully understand the position of the regulators here are some which may assist.

  • Right Support, Right Care, Right Support – Oct 2020
  • Building the right home – Dec 2016
  • How CQC checks services that support autistic people and people with a learning disability – Oct 2020
  • The Real Tenancy Test – tenancy rights in supported living – NDTI – Sept 2010
  • Housing with Care – Oct 2015
  • A practical guide to the REACH standards – Nov 2015
  • The Scope of registration – March 2015
  • NICE guidance NG93
  • NICE guidance NG11
  • NICE clinical guidelines CG142
  • Supplemental information for commissioners – Oct 15
  • Positive and proactive care – Department of Health.

As you will note, many of these papers are not new, but brought together by the regulators, to assist them in making decisions about registration appropriateness.

We have also seen several people move towards the currently unregistered supported living arena, which offers accommodation which is not registered to provide personal care. The support and care needs are then met using a domiciliary care agency. Anyone considering this as an option should consider, how long will it be before all supported living accommodation is regulated and if the local authority who are also bound to take into consideration the guidance above supports the use of non-registered services.

We would suggest to any new entrant to the industry to seek advice before embarking on a regulated service. We are happy to assist in the process and offer guidance and support. We also work with several expert solicitors who can provide the legal structure of contracts to support the registration process.