Archived: Manston

Manston is a service registered to provide personal care to people living in their own homes. People were all living in supported living services, and had their own tenancies. The service supports adults who have learning disabilities, physical disabilities and mental health needs throughout East Kent. At the time of the inspection seven people were receiving a personal care service.

We last inspected this service in August 2016. We found significant shortfalls and the service was rated Inadequate and placed into special measures. The provider had failed to inform CQC of notifiable events. Suitable means of communication were not provided for people on a consistent basis. People’s care plans did not contain ways of maintaining or increasing their independence. People and their relatives were not involved in updating their care plans or making decisions around their care. People did not receive care that reflected their preferences. Staff did not have a clear understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and had made decisions on people’s behalf without seeking their consent or a less restrictive option. Care and support was not provided in a safe way to people. People were not receiving their medicines safely and in line with the prescriber's instructions. Complaints were not investigated and necessary and proportionate action had not been taken as a result. The provider had failed to assess, monitor and improve the safety of the service. The provider had failed to mitigate the risks relating to the health, safety and well-being of people. The provider had failed to keep an accurate, complete and contemporaneous record in respect of each person. The provider had failed to seek and act on feedback from relevant persons. There was a lack of suitably qualified, competent, skilled and experienced staff to meet people’s needs.

This service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us regular information about actions taken to make improvements following our inspection. At this inspection we found that improvements had been made in many areas, however there were still areas where improvements were required.

There was a registered manager in post. They had been employed since our last inspection. 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.

Staffing levels had improved since the last inspection, and some people now received consistent support from the same permanent staff. However, there were a large number of staff vacancies so the provider used temporary staff from another agency to cover the shortfalls. Some people regularly received support from temporary staff from a different agency. Incidents had occurred when people were being supported by these temporary staff and people’s behaviours that challenge had escalated. The incidents had not been managed effectively by staff. Staff had called the police for support during some incidents rather than try to prevent the behaviour occurring using techniques of positive behaviour support. There was guidance in place to assist staff with supporting people with behaviours that challenged. Other risks relating to people’s care and support were now managed effectively.

There was a lack of oversight of the temporary staff being used to support some people. One person received support almost entirely from the temporary staff; they had not been consulted about or supported to change their support provider. The registered manager told us they regularly spoke with this person about the support they received but these conversations were not recorded and no formal quality assurance was carried out.

Some people required emergency medicine to be administered if they had an epileptic seizure. Staff had not all been trained in how to administer this medicine and people were regularly being supported by staff working on their own who had not had this training. There was a risk people would not get their medicine when they needed it to stop their seizures. The registered manager arranged training on the second day of the inspection and subsequently confirmed people were only receiving support from staff trained to administer their medicines.

Relatives and social care professionals told us they had raised concerns about the consistency of staffing and a lack of activities for some people, but there was no record of these complaints or the action taken. The registered manager told us that these complaints had not been recorded as they had not been raised as formal complaints and they would meet with relatives that had concerns.

Checks and audits had been completed but they had not identified the concerns that we highlighted at this inspection.

When people received consistent support there was a positive, person-centred culture and staff were kind and caring. People received the assistance they needed to access the activities of their choosing and staff supported people to use a range of communication methods to help them make their needs known.

Staff had the induction and training needed to carry out their roles. Staff had received training in how to manage people’s behaviours safely, and how to prevent behaviours from occurring. Staff met regularly with their manager to discuss their training and development needs.

Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. People were supported to prepare a variety of different meals.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). In supported living applications for DoLS are made to the Court of Protection. DoLS are a set of checks that are designed to ensure that a person who is deprived of their liberty is protected, and that this course of action is both appropriate and in the person's best interests. The registered manager had made some applications to the Court of Protection but these had not yet been authorised. Staff had up to date knowledge on the Mental Capacity Act 2005 (MCA) and DoLS. They supported people to make their own choices.

Both people and staff told us they thought the service was well led. The registered manager was experienced in working with people with learning disabilities and providing person centred care. The Care Quality Commission (CQC) had been informed of any important events that occurred at the service, in line with current legislation. Staff were recruited safely. The registered manager had reported any safeguarding concerns to the local authority and these had been investigated fully.

Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of regulations .The service will therefore remain in special measures. We will continue to monitor Manston to check that improvements continue and are sustained. You can see what action we told the provider to take at the back of the full version of the report.

Manston is a service registered to provide personal care to people living in their own homes. People were all living in supported living services, and had their own tenancies. The service supports adults who have learning disabilities, physical disabilities and mental health needs throughout East Kent. At the time of the inspection nine people were receiving a personal care service.

The service did not have a registered manager in post. A registered manager is a person who is registered with the Care Quality Commission (CQC) 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 agency had an acting manager who was also the registered manager at another service.

There was a number of staff vacancies so people often received support from temporary agency staff. People, their relatives and external professionals all raised concerns about the lack of consistent staff and the fact that people did not always know who would be supporting them. Some people had been given a written rota but they did not know all of the staff on it, other people had no information about the staff supporting them.

People, and others, were at risk of harm as staff did not support them to manage their behaviours safely. Some people had no behavioural support plan or risk assessments in place, although they displayed behaviours that challenged. Staff did not engage or interact with other people in a meaningful way, even though an identified trigger for their behaviours was ‘boredom.’ Risks to people’s health and well-being had not always been identified, assessed and mitigated. Accidents and incidents were not analysed to look for trends or ways of reducing them.

People’s medicines were not managed safely. People did not always receive their medicines when they needed them. Staff regularly did not sign medicine administration records, so they could not be certain when medicine had been given. Staff were not trained to administer emergency medicine, and one person had been hospitalised when this medicine had not been given.

Senior staff had reported a large number of safeguarding alerts relating to missed medicine, the conduct of temporary agency staff and the management of people’s behaviours. Some of these investigations were ongoing. Not all staff were trained in safeguarding and there was a lack of information for people about how to report any issues.

Staff had not received the training they needed to support people effectively. Staff told us they did not always understand their role in a supported living service. Some people had mental health needs and staff had not received any specific training about this. Staff had not had the opportunity to meet regularly with their manager to reflect on their practice or discuss any areas for improvement.

Some staff lacked understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards. Decisions had been made on people’s behalf without considering the least restrictive option and there was no record of any best interest meetings regarding these decisions.

Staff did not have information or guidance about some people’s health care needs. We saw people attending healthcare appointments on the day of the inspection. Some people were supported to plan and prepare their meals. Other people were restricted as they were not allowed to access their kitchen or help with cooking. There was no information for people about what they were going to eat that day.

Some people could not communicate verbally. One person had a picture book in place to help them communicate with staff, but other people had nothing. Staff were polite to people but had not received the appropriate guidance or induction to engage with people in a meaningful way.

People and their relatives told us they wanted to learn how to do new things and increase their independence yet there were no plans in place to help them to do this. Staff based at the office of the agency were re-writing people’s care plans without involving people or their relatives. Some of these re-written care plans contained inaccurate information, and we were told a meeting would be held with staff to discuss the errors. There were no further plans to involve people in writing their care plans.

Reviews had not been held to see how people were settling into the service or if they required any changes to their support. Assessments of people’s needs were usually carried out but arrangements were not made to ensure staff had the skills to support people before they were offered a service. People had no agreements with the agency so they, and staff, were not clear about what was provided and what was not. This inconsistency had led to some incidents.

External professionals had raised concerns about the lack of activities for people so activity plans had been recently introduced. Some people were not able to do the activities they wanted, such as cycling, as they were not always supported by staff able to do the activity. Staff did not always have the skills or knowledge to engage people with complex needs in activities they enjoyed.

People told us they had complained about the service. Staff confirmed that they were aware of a complaint, but there was no record of it or of any actions taken. We found a record of one other complaint that had not been investigated and responded to.

Staff were unclear about their role within supported living services. People did not receive the support they needed as a result. There was no registered manager in place. Incidents had occurred which, by law the Care Quality Commission (CQC) should be notified about but we had not been informed.. The provider had not requested health declarations during the recruitment process so had not established if any reasonable adjustments were needed.

People and their relatives had not had the opportunity to formally feedback their views about the service. An independent consultant had carried out audits of the service. 54 issues had been identified in October 2015 and 71 in February 2016 with no action plan to say how and when the issues would be addressed. We found the same issues were still occurring. There was a lack of oversight and scrutiny of the service being provided by agency.

The provider sent us an action plan and has kept us informed of the action they are taking to rectify the concerns identified.

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

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.