North of Tyne Supported Living

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

This is the first inspection for this newly registered service. The key question has been rated good. This meant overall people were safe and protected from avoidable harm. There had been an instability in management, and this had led to some supported living houses experiencing a deterioration in practice. Of the 12 supported living houses, external professionals had raised concerns about the practices in 1 house. At another house we found that there were issues with the safe administration of medicine. The registered manager recognised these difficulties and was ensuring these were being addressed. Relatives felt people were safe but some had mixed views about overall practices at the houses. The differences were not global but specific to individual houses. Some people raised issues around the management of their relative’s finances, staff deployment and the cleanliness in homes. The provider and registered manager were taking action to address these concerns. Risks were assessed and action taken to mitigate any risks. At times these needed to be reviewed to ensure they were up to date, accurate and clear. People were supported to do the things that were important to them and manage any associated risks. Staff followed appropriate infection control measures. Staff understood safeguarding procedures and referrals were made as needed. The provider employed a person who was responsible for overseeing these, looking for themes, lessons that could be learnt and checking appropriate action was taken, each month. Recruitment practices were meeting requirements. There were enough staff to deliver the care and the provider ensured any vacancies were quickly filled.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People appeared satisfied with their care and support. Overall relatives found the care packages met people’s needs. Relatives did not specifically discuss whether there was a learning culture but did tell us they felt involved in the design of the care package and how it was delivered.

Staff found the provider reviewed the operation of the service and checked practices were safe. They felt encouraged to be open and transparent with people. They discussed where the service had been and how they prioritised their work to ensure people were safe and well-cared for first. A service leader said, " I try to create an atmosphere where mistakes are learnt from and we will grow from them together."

Partners told us that in 1 house when standards of care had fallen below expectations, the provider took action to make improvements as a result of this feedback.

Systems were in place to identify any lessons learnt and take appropriate action. The provider ensured lessons learnt were shared with staff and when appropriate this also related to ones learnt from their other services. Recently there had been an instability in management but with the new registered manager in post this was being addressed. The provider had a quality team and people team who worked with locations to ensure staff could raise matters and areas for improvement could be readily identified and acted upon.

Overall relatives felt the service provided safe care and there was a smooth transition when the service started working with people.

Staff understood when people required support to reduce the risk of avoidable harm, and risk assessments were in place. A staff member said, “When I first arrived the risks were not clearly detailed, but I feel the support plans are more person-centred and the risks are set out clearly since changing format.” The staff also understood the importance of ensuring continuity of care when people moved to and from the service. Staff ensured they and new workers spent time with people to learn how best to work with them as they transitioned to services.

The service worked in partnership with other agencies to improve people's opportunities and wellbeing.

The provider had protocols in place for managing transitions to the service in ways which supported people to feel at ease moving in.

On the whole relatives found the service ensured people were safe. A relative said, "I spoke to him last week, he’s happy and safe. It’s a lot better than his last place." Another relative said, "Staff take his needs into consideration for his level of safety. He has a good balance of freedom and lives with other people.” A relative raised concerns about staff practice in 1 house, which the registered manager was aware of and action was being taken to resolve them. 4 relatives felt closer oversight of how people's monies were managed was need. They were concerned people were spending money on meals out most days of the week and bought items they did not need. A relative said, “Most of his money is used up by eating out through the week on junk food. He has gained weight. They should encourage him to eat healthier and cook with him. It’s a basic skill.” We raised this with the provider, who took appropriate action to investigate these concerns and provided assurances they would be resolved.

The directors and registered manager discussed how measures were in place to ensure staff understood when to make safeguarding referrals and how they worked as a team to ensure people were protected from harm. Staff had a good understanding of what to do to make sure people were safe and made safeguarding referrals when needed. A staff member said, " Safety is on the front burner here and adequate steps are taken to prevent risk or possible hazards. Effective communication and interpersonal relationships bring to fore the needs and management strategies to adopt."

People appeared happy with the service.

The provider had safeguarding systems in place. Staff said they had training and a good understanding of what to do to make sure people were protected from harm or abuse.

Overall relatives told us that risks to people were managed. A relative said, “It’s very safe. They couldn’t have better facilities. Night staff are on and there if [person’s name] needs them. There is an alarm on her door if they open it. They are there straight away.” People were involved in the design of the care package and how it was delivered and felt their suggestions acted upon.

The registered manager was new into post and was working with the teams across the houses to identify where gaps existed and address them. Staff discussed where improvements had been made and how they prioritised their work to ensure people were safe and well-cared for first. Staff reported there were enough care workers to meet people's needs and they work together effectively to provide safe care that meets people’s individual needs. A staff member said, “We make sure we understand risks for people and how these can be managed.”

Our observations raised no concerns about how the service managed risks to people.

Risk assessments about care are person-centred, proportionate, but were not always regularly reviewed with the person, where possible.

Relatives found the houses were well-maintained.

Staff had received training around adopting safe working practices and following best practices guidance. They felt safe working at the service and had access to all the appropriate equipment they needed. However, staff discussed the difficulties they faced getting the housing association to complete required works.

People’s houses were decorated in line with what their choices and appeared to be well-maintained.

The provider had protocols in place for managing transitions to the service in ways which supported people to feel at ease moving in.

People found the care package met their needs and there were always enough staff to deliver it. A person said, "I have no complaints as the staff always turn up on time and do everything I ask."

Staff reported on the whole there were enough care workers to meet people's needs and they work together effectively to provide safe care that meets people’s individual needs. A staff member said, “There is more than enough time for staff to complete their work and I have enough time to undertake my role. I have more than enough support to undertake my role.”

People appeared happy with the service.

Robust and safe recruitment practices were in place and these made sure all staff, including agency staff and volunteers, were suitably experienced, competent and able to carry out their role. Recruitment, disciplinary and capability processes were fair and were reviewed to ensure there was no disadvantage based on any specific protected equality characteristic. We saw evidence confirming when there had been changes to individual’s packages of care the provider had worked closely with partners to ensure these changes were delivered safely. The staffing levels and skill mix ensured people received consistently safe, good quality care that meets their needs. Staff receive the support they needed to deliver safe care. This included supervision, appraisal and support to develop, improve services and where needed, professional revalidation.

People found staff followed expected infection control practices. Most people felt the houses were kept clean but some felt improvements could be made. A relative said, " Sometimes when they are not keeping it clean and tidy. The bathroom and kitchen can be in a state. There’s no excuse, [person’s name] got everything there. ‘We are not cleaners’ is what the staff say." We discussed these concerns with this with the registered manager who undertook to review cleanliness in the houses.

Staff confirmed they received training on infection control procedures. They had all the equipment they needed to reduce the risk of spreading infections.

During our site visits we saw that people’s houses were clean and tidy.

The provider had systems in place to mitigate the risks of people and staff from catching and spreading infections.

On the whole relatives found medicines were managed in a safe manner. A relative said, “Medicines are always given on time and there have been no errors.”

Staff were trained in medicines management and processes were in place to assess whether staff were competent to administer people’s medicines. In most houses staff were given clear guidance on when to administer medicines. In 1 house staff confirmed a person could not self-administer their medication but this was not reflected in their care records. Immediate action was taken to rectify this issue.

We found in 10 of the 12 supported living houses medicines were managed well.

Overall staff followed best practice when administering medicines and followed STOMP guidance, which meant people’s behaviour was not inappropriately controlled by medicines. We found in 1 house the provider had found improvements were needed and these had been made. In another there had been issues which had not been picked up by the service lead. For example, ‘as required’ medicine protocols were not in place, changes to the pharmacy had not been noted, for 1 person staff had not been checking the right number of tablets were in medipak and 2 people’s care plans contained conflicting information. We highlighted this to the registered manager who took action to improve practices at the service.