Background to this inspection
Updated
2 February 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked 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 8 January 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because we wanted to meet with people using the service and they are often out during the day.
The inspection was conducted by an adult social care inspector and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Before the inspection we checked the information that we held about the service and the service provider. This included statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send to us by law. We also contacted the local authority for information.
A Provider Information Return (PIR) was available for this service. This is a form that asks the provider to give some key information about the service, what the service does well and any improvements they plan to make. We used all of this information to plan how the inspection should be conducted.
We observed care and support and spoke with one of the two people using the service, relatives and staff. We also spent time looking at records, including two care records, four staff files, medication administration record (MAR) sheets and other records relating to the management of the service.
On the day of the inspection we spoke with two relatives over the telephone. We also spoke with the registered manager, a service manager, a team leader and four support workers.
Updated
2 February 2018
This announced comprehensive inspection took place on 8 January 2018.
At the previous inspection we found breaches of regulation in relation to; the need for consent and good governance. As part of this inspection we checked to see if the necessary improvements had been made and sustained.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions; Effective, Responsive and Well-led to at least good. We found that improvements had been made in accordance with the action plan in each of the key questions. The service was now meeting regulatory requirements.
This service provides care and support to people living in two ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
A registered manager was in post. 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.
At the last inspection in November 2016 we identified a breach of regulation 11 (Need for consent) because there were no suitable arrangements in place for obtaining consent and acting in accordance with the Mental Capacity Act (2005). As part of this inspection we checked records to ensure that improvements had been made and sustained in accordance with the provider’s action plan.
The records that we saw indicated that the service operated in accordance with the principles of the MCA. It was clear from care records and discussions with people that consent was sought and recorded in relation to care and treatment. People’s capacity to consent to care was assessed and recorded.
The provider was no longer in breach of regulation 11 regarding the need for consent.
At the last inspection in November 2016 we identified a breach or regulation 17 (Good governance) because the provider had failed to maintain an accurate and contemporaneous record in respect of each person receiving a service. As part of this inspection we checked records to ensure that improvements had been made and sustained in accordance with the provider’s action plan.
The care records that were held within the person’s own home contained the same information as those in the registered office and were supplemented with daily notes. The daily notes were respectfully worded and provided staff with important information about; health, activities, sleep-patterns etc.
It was clear from the records that we saw that improvements had been made and sustained in accordance with the provider’s action plan.
The provider was no longer in breach of regulation 17 regarding good governance.
People spoke positively about the safety of the service provided. We saw that the service had well-developed and extensive systems for protecting people from the risk of abuse or neglect. The staff that we spoke with were clear about their responsibilities in relation to safeguarding and said that they would not hesitate to report any concerns to their managers or externally (whistleblowing) if necessary.
The care records that we saw clearly demonstrated that risk was assessed and reviewed to keep people safe. It was equally clear that positive risk taking was encouraged to help people to develop their skills and independence.
The records that we saw provided evidence that staff were safely recruited and deployed in sufficient numbers to keep people safe. Each of the records contained a recent Disclosure and Barring Service (DBS) check, photographic identification and two references.
The service adhered to best-practice guidance for supported living services in relation to the administration of medicines. People had individual arrangements in place for the storage and administration of their medicines. Staff received training and had their competency to administer medicines assessed regularly.
We saw from records that staff were regularly trained in a range of health and social care topics including; administration of medicines, health and safety, infection control, adult safeguarding and the MCA. We also saw that additional, specialist training was provided to ensure that staff had the skills, competencies and knowledge to support people in accordance with best-practice.
People were supported to access a range of community-based healthcare services in accordance with their needs. This included; GP’s, chiropodists, dentists and services to meet specific healthcare needs.
People receiving support and relatives spoke positively about the quality of care and relationships with staff. It was clear from our observations and discussions that staff knew people well and treated them with kindness and respect.
People were encouraged to express their views regarding the service and were involved in decision-making at every level. One of the people who received a service did not use speech. Staff were able to communicate with them by use of Makaton (simplified sign language) signs and through monitoring body language, facial expression and behaviours.
People’s right to privacy and dignity were maintained in all aspects of care and support. Staff understood how people’s behaviours sometimes compromised their dignity in community settings and were vigilant in monitoring people and intervening as early as possible.
Staff promoted regular contact with families through visits and telephone conversations. Relatives told us that they were always made to feel welcome by staff when visiting.
Needs relating to disability, culture and religion were clearly defined in care records. Where required, support plans provided clear instruction for staff in relation to; the need for routine, preparation of food and the provision of personal care.
People were supported to access a range of activities within their own communities in accordance with their wishes. Examples of activities included; attending church, ten-pin bowling, bingo and meals out.
We saw from care records and promotional materials that the service recognised the need to adapt communications to meet the needs of individuals. In adapting its approaches in this way, the provider was meeting the Accessible Information Standard.
Relatives and staff spoke positively about the management of the service and the quality of communication. People using the service, their relatives and staff were engaged through regular meetings. Examples included; service user focus groups, management meetings and staff awards. The service also made use of social media to communicate and invite comment.
The registered manager was aware of their role and responsibilities both within the service and with regards to their registration. Notifications to the Commission had been submitted as required and the action plan arising from the last inspection had been completed in accordance with the agreed schedule.
The service had a robust approach to the management of safety and quality. Regular audits were completed by staff and managers at all levels. A specialist quality team provided oversight of the processes and monitored completion.