Living Ambitions Essex provides a supported living service and personal care for people who are unable to provide it for themselves because of old age, illness or disability. Where people live in their own home they receive care and support in order to promote their independence. As there is a separation between the care and accommodation, the care they receive is regulated by the CQC but the accommodation is not. On the day of our inspection, 113 people were using the service across 28 locations, but not everyone was receiving a regulated activity. Some of the people using the service had complex needs and the frequency of the care and support depended on people's individual requirements.
Supported living
People receiving supported living services rented accommodation separately from the care that was provided by the service. These were small shared houses and bungalows. Where care staff were required to remain at the service overnight, they were provided with appropriate sleeping arrangements.
People’s experience of using this service and what we found
The registered manager had not always identified incidents and accidents that were safeguarding concerns and had not always followed safeguarding policies and procedures.
Incidents had not always been investigated thoroughly and we found little evidence that there had been lessons learnt from them.
The service had experienced a high use of agency staff at some of the supported living sites and staff told us this had made providing consistent care difficult. Whilst we did not review all 28 locations, for those staff we spoke to they told us that people had missed out on opportunities due to shortages of staff. However, the provider had implemented processes to reduce agency staff and recruit regular staff. At the time of inspection this area was improving.
Medicines were managed safely and staff were trained and observed to ensure that they remained competent.
People with high risk needs, such as risk of choking had robust risk assessments in place and staff followed these. However, not all risk assessments were up to date and some were no longer relevant to people’s current needs. The service was in the process of driving improvement in these areas.
Managers were working on improving people’s involvement in how the service was run in line with best practice guidance.
Staff supported people to access a range of health and social care appointments to ensure that they remained healthy. They sought advice from other health professionals if they had any concerns over people’s health and wellbeing.
People who needed support with fluid and nutritional needs were supported well.
Staff understood the importance of capacity and consent and people being able to make decisions about how they lived their lives.
Staff were caring and supported people to maintain their independence. Where staff had been found to be uncaring, managers had taken the appropriate action.
People were supported to maintain important relationships. However, it was not always clear how people had been involved in planning their care.
People did not always receive care that was person centred due to a period of high agency use. However, in areas where there had been regular sustained staff group people did receive care that supported them to live well every day. This was an area that was improving.
The provider had processes in place for people to raise complaints. This was in easy read format. The registered manager investigated complaints in line with the providers policy and procedures.
The service provided end of life care. At the time of inspection one person was receiving end of life care.
Staff told us they did not always feel supported or listened to by senior managers.
Governance systems did identify some areas of improvement needed, but improvements were slow and there was a lack of identifying lessons learnt. Governance systems did not identify all the concerns we found at this inspection.
The registered manager had not always notified the Commission of notifiable incidents.
However, the service had open and transparent relationships with commissioners, the local authority quality improvement and safe guarding teams.
People were supported in the least restrictive way possible and inline their best interests. The policies. and systems in the service supported this practice.
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 6 May 2016)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to the provider notifying the Commission of notifiable incidents, safeguarding people from harm and ensuring that risks to people’s health and wellbeing were identified and mitigated. Governance process in place failed to identify these shortfalls over a twelve-month period.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.