Creative Support – Bolton Service supports people with Autism Spectrum Condition (ASC) and challenging behaviour, in their own home, providing personal care in line with a supported living model. People who use the service have their own tenancies and receive their support from staff employed by Creative Support.The last inspection of the service took place on 09 and 15 December 2015 and was announced. The service was rated as Requires Improvement.
This inspection took place on 18 May 2017. The provider was given 48 hours’ notice of our intention to visit. This was because the location provides a domiciliary service and we needed to ensure there would be someone present at the office to facilitate the inspection.
We were assisted throughout the inspection by the registered manager and project managers in the houses. 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. The registered manager at Creative Support – Bolton Service had been in post for several years.
We spoke with a number of people throughout the inspection including, relatives, staff and community professionals. People who used the service had limited means of communication and were unable to share their experiences. People who used the service relied on families to act on their behalf in making decisions.
The service had a robust recruitment procedure in place, to help ensure that staff employed were suitable to work with vulnerable adults. There were sufficient staff on duty to ensure the needs of people who used the service were supported appropriately. Staffing numbers were looked at on a daily basis to ensure that appointments and trips and planned activities were covered.
New staff undertook an induction programme, which involved classroom based training and shadowing of experienced staff. Training was on-going, however we noted that some annual training had not been completed.
We looked at the supervision and annual appraisal record and staff spoken with confirmed they received regular supervisions. Supervision meetings enabled managers to assess the development needs of staff and to address training and personal needs in a timely manner.
Staff worked positively with external professionals to help ensure people received safe and effective care.
Procedures were in place to manage people’s medicines safely. However, these had not always been followed, which had resulted in some errors being made with medicines on several occasions. Arrangements for the safe recording and administration of people’s medicines required improvement to ensure people were protected from the risk of unsafe medicines management.
Systems were in place in relation to ordering, storage, administration and disposal of medicines. Health and safety measures were in place and up to date.
Care plans were person-centred and included information about people’s likes and dislikes, interests, family backgrounds and personalities. Care plans included a range of health and personal information to ensure that the needs people who used the service were supported.
Each person had their own bedroom and communal areas were available. Two of the premises seen were clean, tidy and well maintained. One property was clean and tidy but would benefit from a refurbishment.
Staff we spoke with had a good understanding of the basic principles of the Mental Capacity Act (2005) (MCA) and decision making process. However, the service had been unsure of the procedures with regard to notifying CQC of applications to the Court of Protection. We advised them to notify CQC of all Court of Protection applications as per requirements
We observed staff interacting in a kind and friendly manner throughout the day, there was a good relationship observed between staff and people who used the service.
People’s privacy and dignity was respected and we saw that the staff promoted independence as much as possible.
There were a wide range of activities on offer for people to participate in. Some had their own mobility cars.
The service had good links with the local community, which helped people who used the service to mix and integrate with the community.
Systems were in place for dealing with complaints and concerns.
A number of quality audits and checks were carried out by the service; however a recent audit two days before the inspection had failed to pick up on the medication issues found on inspection.