Creative Support – Leeds & Wakefield Services

Creative Support (Leeds) provides support for people with a range of disabilities and complex needs. The service aims to enable people to live independent and dignified lives, by the provision of care in a supported living environment. At the time of inspection there were 14 people receiving a personal care service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

The service was not always well-led. The registered manager had oversight of the running of the service, however these had lapsed over the last few months due to loosing key staff in the houses. We found the management of medicines and care planning required improvement and audits in relation to these had not always been picked up. The registered manager had recognised this, and a practice lead had just started supporting the home around identifying and applying quality improvements.

Staff were aware of the safety and wellbeing of people who used the service and kept people safe from avoidable harm, abuse and discrimination. Staff followed good infection control practises.

People received the right support based on their current needs and preferences. Staff had the right skills and knowledge to carry out their roles effectively and were well-supported by the registered manager.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were kind and compassionate and showed a genuine passion for providing good standards of care. We were told by people their privacy and dignity were respected and they were supported to be as independent as possible.

People received care and support based on their individual needs and preferences.

We have made a recommendation in the ‘safe’ section of the full report around improvements around the auditing of medication.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published May 2017).

Why we inspected

This was a planned inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Creative Support provides personal care and support to people living in their own homes in a supported living environment.

At the time of our inspection there was a registered manager in the home. 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.

People told us they felt safe receiving this service. There were effective systems in place to ensure people’s safety who used the service, whilst also encouraging and promoting their independence. Staff could describe the procedures in place to safeguard people from abuse and unnecessary harm. Recruitment practices were robust and thorough.

Staff received supervisions in the service; however these supervisions differed in standard and content throughout. This was dependent on the coordinator who had completed these. We spoke to the registered manager who told us this would be looked into and addressed at the next staff meeting.

People received their prescribed medication when they needed it and appropriate arrangements were in place for the storage and disposal of medicines. Staff were trained in supporting people’s medicines management. We spoke to the registered manager on the importance of ensuring when people were away from their home that the records indicated this.

People were cared for by sufficient numbers of suitably trained staff. We saw staff received the training and support required to meet people’s needs well. Staff spoke positively of their training and said this prepared them well for their role. The registered manager told us they were recruiting staff at the time of inspection to ensure consistency for people.

People’s needs were assessed, and care and support was planned and delivered in line with their individual care needs and preferences. People had detailed, individualised support plans in place which described all aspects of their support needs and aspirations.

Staff were trained in the principles of the Mental Capacity Act (2005), and could describe how people were supported to make decisions.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who treated them with kindness and were respectful of their privacy and dignity.

People participated in a range of activities both in their home and in the community and received the support they needed to help them stay in contact with family and friends. People were able to choose where they spent their time and what they did.

Staff had good relationships with the people living who used this service. Staff were aware of how to support people to raise concerns and complaints and we saw the provider learnt from complaints and suggestions and made improvements to the service.

There were effective systems in place to monitor and improve the quality of the service provided.

We found there were not always effective systems in place to respond appropriately to complaints and comments made by people who used the service or people acting on their behalf. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. During our inspection, we found improvements had been made in the required area.

Creative Support provides personal care and support to people living in their own homes in a supported living environment.

At the time of our inspection there was a registered manager in the service. ‘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.’

During our visit we saw people looked well cared for. We observed staff speaking in a caring and respectful manner to people who lived in the home. Staff demonstrated hey knew people’s individual characteristics, likes and dislikes.

Systems were in place to monitor the quality and safety of service provision; however, the provider did not have structured processes in place to enable people who used the service to give regular feedback on the service received. There were enough staff to meet people’s needs. However relatives of people who used the service told us they felt at times there were not staff on shift to support the service. This was mainly on weekends when agency staff were used.

We found staff had received training during their induction and also saw evidence of annual refresher training in areas such as dementia care, Mental Capacity Act 2005, safeguarding, health and safety, fire safety, challenging behaviour, first aid and infection control. This meant people living in their home could be assured staff caring for them had up to date skills they required for their role. We spoke with staff who told us about the action they would take if they suspected someone was at risk of abuse. We found that this was consistent with the guidance within the provider’s safeguarding policy and procedure.

People participated in a range of activities within the home and also in the community. People were able to choose where they spent their time.

The service responded to complaints and comments made by people who used the service or people acting on their behalf. Relatives of the people felt the new manager listened to them and felt confident any complaints would be dealt with effectively.

Medicines were administered to people by trained staff. People did receive their prescribed medication when they needed it. However, appropriate arrangements were not always in place to check medication on a daily basis.

We looked at four staff files and saw the recruitment process in place ensured staff were suitable and safe to work in the agency. Staff we spoke with told us they received supervision four times a year and had annual appraisals carried out by the registered manager. We saw minutes from staff meetings which showed they had taken place on a regular basis and were well attended by staff.

We saw the provider had a system in place for the purpose of assessing and monitoring the quality of the service. We saw evidence of weekly and monthly audits which demonstrated these systems were effective.

Health, care and support needs were assessed and met by regular contact with health professionals. People were supported by staff who were respectful of their privacy and dignity.

This inspection considered our five key questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, their relatives, and the staff supporting them as well as from looking at records.

Is the service safe?

Safeguarding procedures were robust and staff understood how to safeguard the people they supported. We found incidents that had taken place had been reported to the local safeguarding authority. This meant people were provided with appropriate protection plans where safeguarding incidents had taken place.

Staff were clear about the protocols to follow when people showed behaviour that challenged. De-escalation techniques were used, reducing the need for physical intervention.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

Is the service effective?

People's health and care needs were assessed with them or their relatives. People were supported to access support from a multi-disciplinary team.

Some staff had not had the training they needed to adequately meet people's needs. Where staff did not have the necessary training the new management team had identified gaps and incorporated this into a training plan.

Is the service caring?

People we spoke with told us they were satisfied with their care. One person told us, 'Everything's good. (Staff) are alright; you can have a laugh with them.'

Staff we spoke with were very knowledgeable about the people they supported and told us how they tailored their support. Staff told us, 'We know people really well. It is important that you are bubbly and outgoing around (person A) as if you were stern they would not be compliant. I would not use that approach with (person B).'

People's preferences, interests, aspirations and diverse needs had been recorded their care and support had been provided in accordance with people's wishes. However, there were occasions when the lack of available established staff impacted on the support people received.

Is the service responsive?

People's needs were assessed before they received support. Relatives told us they were involved in care planning.

People were involved in a range of activities; however, this was sometimes limited by available staffing. This included people having to access public transport, increasing the risk of triggering behaviours that challenged, as staff were not available who could drive the person's car.

Records did not always reflect the support staff had provided to people who used the service. Some information staff required to meet people's needs was not always readily accessible.

Where complaints and safeguarding incidents had identified learning these had not always been addressed. However, the new management team had recently incorporated these in to an action plan.

Is the service well-led?

At the time of our visit the registered manager had recently applied to cancel their registration with the Care Quality Commission.

The service had a new management team in post. This covered all levels of the management team from team leader to service director level. The service manager explained they had started the process of applying to CQC to register as manager and they would remain in this post for a minimum of six months until a permanent manager was recruited.

The provider had a 24 hour on call arrangement. This allowed staff to access management support at any time.

The service did not have effective systems for quality assurance. This meant shortfalls had not been identified and addressed prior to the arrival of the new management team. Where actions had been identified these had not always been completed. The new management team had implemented a quality monitoring system two weeks prior to our visit; however they had not had opportunity to check all issues had been identified at the time of our visit.

The provider and staff were aware of their responsibilities regarding protecting people from abuse. Staff told us they knew how to raise concerns.

We found that robust monitoring arrangements were not in place to ensure that staff received appropriate training.

There were effective quality auditing procedures and appropriate systems were in place for gathering, recording and evaluating information about the quality of the service provided.

We found that medicines were not always managed in a safe way.

The provider and staff were aware of their responsibilities regarding protecting people from abuse. Staff told us they knew how to raise concerns.There were enough qualified, skilled and experienced staff to meet people's needs.

The provider had quality assurance systems in place to check that the quality of the service being delivered was meeting people's needs.