Archived: FitzRoy Supported Living - Trafford

This service provided care and support to people living in 'supported living' settings. In supported living, people 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; we looked at people's personal care and support. At the time of this inspection the service was providing support to 19 people in four 'supported living' settings for adults over 18 years, people living with learning disabilities, physical disabilities and/or autistic spectrum disorder and people with sensory impairments.

At the last inspection in November 2017, there were three breaches of legal requirements in relation to the Mental Capacity Act 2005 in respect of assessing people's capacity, auditing systems had identified issues with the quality of the service, but these were not always being addressed in an effective way and we found the registered provider had not ensured that there was always enough staff to meet people's needs. At this inspection we found the requirements had been fully met.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a registered manager 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. The registered manager was also supported by a service development and implementation manager and two deputy managers.

Since our last inspection we found noticeable improvements in developing new systems for audit and quality assurance. A new suite of audit tools had been introduced covering key aspects of service delivery.

Prior to our inspection we were notified in June 2018 by the provider they had made a safeguarding referral and contacted the Police due to finding a significant amount of money missing from people’s bank accounts at one of the supported living services. As a result of an internal investigation the provider found significant failures in respect of the registered and deputy managers finance checks of people’s monies. At the time of this inspection the Police were still conducting their inquiries in respect of the allegations of theft against a staff member and the provider made a timely referral to the Disclosure and Barring Service (DBS). The provider also reimbursed all monies that were stolen from people and the auditing of people’s finances was fully reviewed by the provider, which resulted in thorough checks being completed on all financial transactions at the service and the other three supported living services.

At the last inspection we found the provider did not have a clear overview of the staffing hours being provided at Highfield Avenue. At this inspection we found the staffing levels were being appropriately deployed across all of the four supported living services. There were enough staff to support people and the provider carried out checks to make sure new staff were suitable to work in the service.

At the last inspection we found staff had limited understanding of the Mental Capacity Act (MCA) and required mental capacity assessment were not always undertaken. At this inspection the provider understood their responsibilities under MCA and refresher training had been provided to staff. During the inspection we saw that people were not deprived of their liberty unlawfully and the appropriate applications to the court of protections had been made.

People told us staff treated them with dignity and respected their privacy. We found staff knew the people living at the home well and they were able to talk in depth to us about people's needs, preferences and social histories. Staff interacted well with people and were quick to act to make sure people were comfy and received the support they needed.

Medicines were managed safely and people were encouraged to be as involved as possible with their medicines. Room temperatures where medicines were being stored were now being consistently recorded to ensure medicines didn’t spoil and remained below the recommended temperature.

Support staff completed training the provider considered mandatory. The provider also arranged training specific to the needs of the people using the service. Support staff also told us they found the provider's training helpful. Staff had the supervision and support they needed to work effectively with people using the service.

The provider had an easy read complaints procedure that used pictures to make the process easier for some people using the service to understand. The registered manager had a better oversight of received complaints and we saw they investigated all complaints in line with the provider's procedures.

Activities at the service continued to be limited due to budget constraints. People relied on their personal budgets to support with activities. However, we did see attempts when possible where staff would support people to have meals out and access the local community.

It was clear at this inspection the registered manager demonstrated a renewed commitment and willingness to improving the quality and safety of care provided by FitzRoy Supported Living –Trafford. The registered manager also greatly benefited with the support from the providers service development and implementation manager who also supported with audits at the service.

At the time of this inspection the service was providing support to 19 people in four 'supported living' accommodations for adults over 18 years, older people, people living with learning disabilities, physical disabilities and/or autistic spectrum disorder and people with sensory impairments. Supported living describes the arrangement whereby people with learning disabilities are supported to live independently in their own tenancies.

At the last inspection on 04 and 05 April 2016, we rated the service as overall "Good". Four months after that inspection we received concerns relating to the staffing levels and medication errors at one of the supported living services, Orchard Court. As a result we undertook a focused inspection to look into those concerns on 28 September 2016. During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the staffing levels.

The service had a 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.

We found the provider did not have a clear overview of the staffing hours being provided at Highfield Avenue. We noted a number of discrepancies in relation to the evening support of four hours that had not been provided consistently for a number of months.

Staff had limited understanding of the Mental Capacity Act (MCA) and followed the principles on a day to day basis. However, people's ability to make a decision had not been assessed before decisions were made on their behalf. There was a risk decisions could be made for people who were in fact able to decide for themselves.

Staff were knowledgeable about the different types of abuse people might be vulnerable to and knew what action to take to safeguard people from harm. Staff looked after money for people and there were effective systems to protect people from financial abuse.

Medicines were managed safely and people were encouraged to be as involved as possible with their medicines. Protocols around the use of 'as and when needed' medicines were in place for people who required this.

People had good relationships with the staff who supported them. Staff knew people well and treated them with dignity and respect. People had some opportunities to express themselves and have a say about their care on a day to day basis, but we found an inconsistent approach by the provider to evidence people’s involvement when planning and reviewing their care.

New employees were required to go through an induction which included training identified as necessary for the service and familiarisation with the service and the organisation's policies and procedures. There was also a period of working alongside more experienced staff until such a time as the worker felt confident to work alone.

Some people attended local day services, or completed voluntary work. People were supported to be part of their local community and follow their interests or hobbies. However, we found social outings during the weekends did not take place, due to no flexibility in the staffing structure to allow additional staff to work the weekends. The registered manager felt this was the case due to a lack of commissioned hours to use during the weekends.

People had support to eat healthily and planned their own menus. Some people were supported to complete batch cooking for their meals, while others used microwavable foods due to the lack of cooking facilities in their flats. We were informed by the registered manager this had always been the case previously for people.

People's care plans and risk assessments provided staff with all the information they required to keep people safe and meet their needs. Care plans we looked at were person centred and showed the care needed to promote people's health and independence. This included any environmental risks in people's homes and any risks in relation to the care and support needs of the person. For example, each person had a Personal Evacuation Emergency plan (PEEP) which provided information to people what to do in the event of a fire. The PEEP was presented in a visual

and written format. This meant that people received information that was meaningful to them.

At this inspection we found the quality and safety monitoring of the service was ineffective at identifying where the quality and the safety of the service was being compromised. Some quality audits were not effective and were not being checked by the registered and deputy manager as frequently set out by the provider’s policy. There was a lack of systems in place to ensure the service was monitored in a meaningful way. The service did not have clear records to show that people had been given the opportunity to provide feedback about the quality of their care.

The CQC had been informed of any important events that occurred at the service, in line with current legislation. However, we found the provider had failed to notify us of one incident that occurred at Highfield Avenue.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out an announced comprehensive inspection of Fitzroy Supported Living – Trafford on 04 and 05 April 2016 when it was found to be meeting all the regulatory requirements which were inspected at that time. After that inspection we received concerns relating to the staffing levels and medication errors at one of the supported living services, Orchard Court. As a result we undertook a focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for FitzRoy Supported Living – Trafford on our website at www.cqc.org.uk

FitzRoy Supported Living – Trafford provides supported living service for 15 people with a learning disability. Five people were receiving this support at Orchard Court at the time of our inspection.

The service had a 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.

During this inspection we found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to the staffing levels. You can see what action we told the provider to take at the back of the full version of the report.

When we commenced our inspection at 8am we found two people were up and dressed. The other two people were still being supported with their personal care needs. We observed the one care worker on shift rushing between both people to ensure they were ready in time for their daily activities. We received a mixed response from people receiving the service regarding whether or not there were enough staff on duty to meet their needs. People’s representatives and staff told us they didn’t feel there was enough staff on duty, particularly in the mornings to meet people’s needs.

Medicines were ordered, stored, administered and disposed of safely. However we found the registered provider did not record the room temperatures where people’s medicines were stored.

We recommend the registered manager reviews the 'NICE guidance' on ‘Managing medicines for people receiving social care in the community’ as this provides good practice recommendations for the management of medicines.

People's support plans were detailed and person-centred. Support plans contained information about how people liked to communicate and be supported in all aspects of their care. Daily care records evidenced that staff supported people according to their support plans and we observed this during the inspection.

Appropriate plans were in place to guide staff in how to minimise risks to keep people safe. Staff knew what action to take to ensure people were protected if staff suspected they were at risk of harm. They were encouraged to raise and report any concerns they had about people through safeguarding and whistleblowing procedures.

The service at 98 Lorraine Road provides ‘supported living’ accommodation for six people with learning disabilities in four flats. Supported living describes the arrangement whereby people with learning disabilities are supported to live independently in their own tenancies. At this service, two flats provide single accommodation and two are shared. There is an office and staff sleeping room adjoined to the flats.

The service had a 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.

Staff had a working knowledge of the Mental Capacity Act in terms of people’s capacity to consent. However, there was confusion about whether people were being deprived of their liberty and when the service should apply for authorisation if people’s liberty was being deprived so we made a recommendation about training around this.

People told us that they felt safe at 98 Lorraine Road. Relatives we spoke with agreed. Staff had received safeguarding training and understood how to safeguard vulnerable people.

People, their relatives and the staff thought there were sufficient support workers to meet people’s needs. We saw that the service used a robust recruitment process.

The home undertook risk assessments for all aspects of people’s care and support. Facilities and equipment were well maintained and regular health and safety checks of the premises were made. People’s flats were clean and tidy and they told us staff supported them with cleaning tasks.

People’s medicines were well managed by the service. Support staff administering medicines had been trained and assessed for competence and documentation was filled in correctly.

Support workers received the training they needed to support the people safely. They also had regular supervision with the registered manager and an annual appraisal.

People were supported by staff to write their own shopping lists and to shop for and prepare the foods they chose. They were also supported to access a range of healthcare professionals in order to maintain their holistic health.

People and their relatives told us that the staff were caring and that they promoted their dignity and respected their privacy. We saw staff interacting with people in a warm and friendly way and it was clear that staff knew people very well as individuals.

Staff promoted people’s independence by giving them choices and encouraging them to do as much as they could manage for themselves. People were referred to advocates when they needed them and were supported by staff and their families to design end of life care plans.

People’s support plans were detailed and person-centred. Support plans contained information about how people liked to communicate and be supported in all aspects of their care. Daily care records evidenced that staff supported people according to their support plans and we observed this during the inspection.

People and their relatives had an annual meeting with support staff, to which staff from the day centre (if they attended) and the local authority were invited. At this meeting people’s progress and future goals were discussed.

People and their relatives told us that people had enough to do. We saw that people had sufficient opportunities to take part in person-centred activities.

There was an effective system in place for the audit and monitoring of safety and quality at the service.

The service had an open culture. People, their relatives, staff and other healthcare professionals involved with the service were asked for feedback on their experience. The staff understood the vision and values of the service and we saw that it underpinned the support they gave the people.

We looked at three support plans, they all contained detailed profiles of individuals, highlighting likes and dislikes and things important to people. Support plans also documented people's wishes, including what support people would like.

We observed people were comfortable and happy interacting with staff; staff were calm and understood how to meet individual's needs. We observed only positive interactions between staff and the people they supported.

People were supported to be able to eat and drink sufficient amounts to meet their needs.

We found systems were in place for medicines to understand how they are ordered, stored, administered and disposed of.

People who use the service, their representatives and staff were asked for their views about their support and they were acted on.

During our visit we spoke with two people who lived at Lorraine Road. One person said they were 'happy' and 'liked the staff as they helped them'. The second person was looking forward to attending a Christmas party that evening.

We observed staff interacting with people. It was clear staff understood their needs and had a good relationship with them.

We also spoke with staff about working for the service. They told us that there was 'good communication' between the team and felt there were sufficient staff available to support people.

We did find that some information contained within care records and policies and procedures needed reviewing so that the information was accurate and up to date.