This inspection was carried out on 23 and 28 January 2019. This was an announced inspection, which meant we gave the provider 48 hours' notice of our visit. This was because the service supports people living in the community and we wanted to ensure that staff were available in the office, as well as giving notice to people that we would like to visit them.At the last inspection on 7 July 2016, the service was rated good. At this inspection the service had not maintained this rating and required improvement. This is the first time it had been rated requires improvement. We also found three breaches of the regulations relating to staff training and supervision, compliance with The Mental Capacity Act 2005 (MCA) and good governance. You can see what action we told the provider to take at the back of the full version of the report.
Knutsford Supported Living Network is run by Cheshire East Council and provides care and support to people living in a 'supported living' setting, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support. There were 23 people being supported by the service at the time of the inspection.
The care service had not originally 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, so that people with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found that people were given choice, their independence was promoted and the service had an inclusive culture.
There was 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.
Overall people and relatives were very complimentary and positive about the support they received.
The provider could not demonstrate that all staff had undertaken required training and refresher training. Training was provided by a training department; however we were advised training was not always available or there were limited spaces. Staff had not received consistent and frequent one to one supervisions or appraisals with their line manager. The management team expressed that staffing shortages in the senior team had impacted on this.
Staff understood the need to seek consent and the principles of the MCA. However, records were insufficient to demonstrate where decisions had been made for people, they had been made in accordance with the MCA.
The provider’s audits to monitor the service were not fully effective as they had not identified all the issues highlighted in this inspection. Further improvements to the quality monitoring processes are required to ensure there is a clear overview of practice within the service.
Staff understood the importance of reporting any signs of abuse, knew how to report concerns and felt confident that the registered manager would act on any concerns they raised. We saw one incident which had not been reported to the local authority but had been dealt with by the provider. All other concerns had been dealt with appropriately.
There were sufficient staff to meet the needs of the people they supported. There were some vacancies and staff covered extra shifts to meet people’s needs. The senior team had found this had impacted on their management time.
Policies and procedures were in place to support the proper and safe use of medicines, records demonstrated that people had received their medicines safely. However, we found that the provider had not ensured staff training or competency checks around medicines were kept under review.
Risks were assessed and people were supported to stay safe. Staff understood their responsibility to report any accidents or incidents.
People were involved in decisions about what they wanted to eat or drink. Where necessary risk assessments had been completed in consultation with appropriate professionals such as speech and language therapists (SALT). We were concerned in one case that staff had occasionally not followed SALT guidance, which was addressed with the registered manager.
The service supported people to live healthier lives and people had access to health care as needed.
Staff had developed positive and caring relationships with the people they supported. They had time to spend with people and opportunities to listen and talk to people in a way they understood. People were treated with dignity and respect.
People received care that was personalised and responsive to their needs. Staff were knowledgeable about people's needs and understood the importance of supporting people as individuals. The service promoted inclusion and supported people to take part in activities which reflected their interest.
People and their relatives told us it was easy to raise a concern or complaint. The management team were in regular contact and people felt comfortable in raising any issues with staff.
Staff were motivated and those spoken with demonstrated a passion and commitment to the role.
There was a person-centred culture shared by managers and staff which aimed to support people to achieve positive outcomes. People and relatives were satisfied with the care provided and were happy with the support they received from the management team.