Archived: South Network

Updated 23 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on the 29 and 30 June 2016 and was unannounced. The inspection team consisted of two adult social care inspectors on the first day of the inspection and one adult social care inspector on the second day. We contacted families of people who used the service after the inspection to gather their views.

Before the inspection we reviewed the information we held about the service, including notifications the service had made to us. We used this information to plan our inspection.

During our inspection we spoke with four people who used the service and nine members of staff. We also spoke with four care co-ordinators, a visiting social worker, the clinical learning disability nurse, a student nurse on placement at the service, the acting registered manager and the Interim Team Manager for Manchester City Council Supported Accommodation Services. Following the inspection we spoke with three relatives of people who used the service.

We looked at the care records, including care plans and risk assessments, of ten people who used the service and observed how people were being supported and their interactions with staff. We also looked at a range of records relating to how the service was managed, including four staff personnel files, staff training records, quality audits, policies and procedures.

Updated 23 July 2016

This was an unannounced inspection which took place on the 29 and 30 June 2016. This was the first inspection of the service since being registered in November 2013.

South Network provides support for 62 people living in their own homes. 37 people live in shared supported accommodation with staff support 24 hours per day. 25 people with physical disabilities live at Alsager Close, 16 of whom live in their own flat with a range of different support hours each day and nine who live in two shared bungalows with staff support 24 hours per day. Each house or set of flats had a designated staff team. The staff teams were managed by a care co-ordinator. There were eight care co-ordinators in total.

Manchester City Council has two other similar services covering the North and Central areas of the city. Following a Care Quality Commission inspection at South Network’s sister service, MLDP North, Manchester City council formed an improvement team covering all three supported accommodation services in the city. An improvement plan covering the three services had been agreed. We were shown minutes from the weekly leadership meetings held to monitor the implementation of the improvement plan.

The service had an acting registered manager in place at the time of our inspection who was in the process of applying to become the registered manager. 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. They were supported by the Interim Team Manager for Manchester City Council Supported Accommodation Services, who had been recruited to develop and oversee the implementation of the improvement plan across the three supported accommodation services in Manchester.

People we spoke with, and their relatives, said that they felt safe being supported by South Network staff. Staff told us that they had completed safeguarding training and could describe the action they would take if they witnessed or suspected abuse. We were shown a new escalation policy to ensure any referrals made to other professionals and agencies with regard to a safeguarding concern were responded to in a timely manner.

We found some risk assessments were in place to identify and mitigate risks people may face. However not all risks had been identified and the risk assessments were not always up to date. Behavioural support plans were in place for people with complex needs. These gave guidance for staff to manage people’s behaviour; however they had not been regularly reviewed and kept up to date.

Incident and accident forms were being monitored by the acting registered manager to ensure all actions required following an incident had been completed and any learning from the incident could be applied across teams.

We saw care plans included people’s likes and dislikes. However care plans had not been reviewed and updated. An audit of all care files had been completed as part of the improvement plan and the service was aware of the need to update the information in the care files.

We found the care plans were not all written in a person centred way. Some staff we spoke with were not able to describe what person centred care was. We have made a recommendation about training and guidance for staff in person centred care.

We found agency staff were employed on temporary contracts to provide more consistent support for people. We saw a recruitment plan was in place as part of the improvement plan to reduce the need to use as many agency staff.

We found a safe system for administering medicines was in place. Staff had received training in the administration of medicines. People we spoke with told us that they received the medicines as prescribed.

A safe system for recruiting staff suitable for working with vulnerable adults was in place.

Staff we spoke with demonstrated a limited understanding of the Mental Capacity Act (MCA) and how this legislation was relevant to their practice. The service had not taken the necessary action to assess people’s capacity to consent to their support and apply for authorisation for any deprivation of liberty; for example locking doors so people could not leave the property without staff support. This had been identified in the improvement plan and the lead for safeguarding was part of the Manchester City Council improvement board.

Staff we spoke with said that they had completed training courses relevant to their role. Training records were being collated onto a tracker spreadsheet so the acting registered manager could more easily see the training courses staff required. We found staff needed refresher training to be completed.

We found that people were supported to maintain their health. Health action plans were being written. However we did not see records of any medical appointments attended. Systems were in place to monitor people’s nutritional intake where required; however not all of these detailed the quantity of food or fluid the person had consumed.

All the people we spoke with, and their relatives, were complimentary about the regular staff supporting them. We observed positive interactions between staff and people who used the service during our inspection. Staff we spoke with had a good understanding of people’s needs.

We saw people were referred to advocacy services if they did not have any family members involved in planning and reviewing their care. We noted that some people had end of life care plans in place and their wishes in the event of their death documented.

Some people at Alsager Close had access to assistive technology in order to maintain their independence.

Staff said they enjoyed working at the service. However we found staff supervisions and team meetings were inconsistent across the service. Vacancies at the care co-ordinator level had recently been filled. The care co-ordinators aimed to visit the properties more frequently and complete staff supervisions, including observations of staff practice, every six weeks.

The acting registered manager had introduced a range of monitoring tools. Regular audits of properties by the care co-ordinators had been re-introduced and action plans written of their findings. The service improvement plan included the contracted agency workers having regular supervisions, a review of all care plans and risk assessments, a timetable for the completion of annual reviews with each person and the application for Deprivation of Liberty Safeguards.

During this inspection we found eight breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.