Background to this inspection
Updated
25 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection site visit took place on 10 and 12 September 2018 and was announced. The provider was given 48 hours’ notice because the location provides a ‘supported living’ service and we needed to be sure someone would be in the office to facilitate the inspection. Telephone calls were made to relatives of people using the service on18 September 2018.
The inspection visit was conducted by one adult social care inspector from the Care Quality Commission (CQC).
Before this inspection, we reviewed notifications that we had received from and about the service. A notification is information about important events which the provider is required to tell us about by law. We reviewed the Provider Information Record (PIR) before the inspection. This is a form that asks the provider to give some key information about the service, and tells us what the service does well and the improvements they plan to make. We also checked with the local safeguarding and commissioning team whether they had any concerns about the service. All this information was used to plan the inspection.
During the inspection, we visited four houses in which 12 people were receiving supported living services. We spoke to five people receiving support, two relatives and discreetly observed staff interactions with people. We did not complete a Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. This was because it was felt to be intrusive in people’s own homes so we spoke with their relatives to ascertain this information.
We spoke with the registered manager, regional manager, two service managers, three team leaders and four support staff. We looked at various documentation to ascertain how care and support was assessed, planned and delivered. We looked at six care files and other associated documentation including medicine administration records (MAR).
We reviewed six staff recruitment files, supervision notes, training, induction process, staff rotas, minutes of meetings, audits, quality performance reports and policies and procedures. We used this information to inform our inspection judgement.
Updated
25 October 2018
The inspection took place on 10 and 12 September 2018 and was announced. We gave the registered manager 48 hours’ notice so they were available to facilitate the inspection. We made phone calls to people's relatives on 18 September 2018.
This service provides care and support to people living in 11 ‘supported living’ settings, so that they can live in their own home as independently as possible. The properties were situated throughout the Swinton area and each house visited supported either three or four people. People had their own bedrooms and shared communal areas such as lounge, kitchen and bathrooms. There was also an additional bedroom for staff which doubled as an office.
In supported living arrangements, people’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service was last inspected on 16 May 2017 when we rated the service as ‘requires improvement’ overall and in the key questions, effective and well-led. We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding meeting people’s nutrition and hydration needs. We also made a recommendation that the provider reviewed its governance and auditing systems in relation to people’s specific dietary requirements.
Following the last inspection, the provider sent us an action plan detailing what they would do and by when to address the breach identified. At this inspection we found the provider had made the necessary improvements and was meeting all the requirements of the regulations.
At the time of the 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.
We found the service had an up to date policy and suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. Recruitment procedures had been followed and employment checks had been completed prior to staff commencing in post.
The management of medicines promoted people’s safety. Appropriate arrangements were in place to ensure that medicines had been ordered, stored and administered appropriately.
People and relatives spoken with told us people were safe because of the care and support received. People were supported by staff that were creative in their ways of communicating with people to ensure they understood and met people’s needs.
There were comprehensive risk assessments and measures identified to reduce risks. Changes in risk were identified and support plans reviewed and updated to meet people’s needs. People and their relatives’ views and decisions about care provided were listened to and acted upon.
Staff demonstrated they provided care in line with people’s preferences and ensured the service was responsive to people’s individual needs.
Staff were working in line with the Mental Capacity Act (2005) and people were supported to make their own decisions. When required we saw evidence of best interest decisions being made and these were clearly documented to demonstrate the process followed.
People and their relatives praised the staff and were complimentary about the care they provided. Relatives were pleased they had some continuity of staff and felt this was imperative when caring for their loved ones.
The houses visited during the inspection were relaxed and people and staff were observably happy in each other’s company. We saw staff responded appropriately to people when upset or distressed and people were comforted and provided reassurance.
People’s privacy and dignity was maintained and opportunities explored to promote people’s independence. Staff spoke about people positively and were motivated to make a difference to people’s quality of life.
Stimulation, outings and activities were provided on an individual basis depending on people’s one to one hours and interests. Staff also supported people with activities of daily living and indoor activities such as movie nights and games to provide regular engagement.
The service had a complaints procedure in place and we saw complaints received had been responded to within required timeframes.
Staff completed ‘My Lifeways’ training which was an online programme that identified training requirements depending upon the staff members role within the service. Regular supervision and annual appraisal provided staff with the opportunity to explore training and development opportunities.
Staff spoke highly of the registered manager and the positive changes to the service under their leadership. There had been significant changes within the management team and delays encountered establishing a full management compliment which had resulted in some inconsistencies in the houses. However, at the time of our inspection this had been addressed and there were service managers and team leaders identified to provide operational oversight and support.
The service had a range of systems and procedures in place to monitor the quality and effectiveness of the service. Audits were completed both internally and at provider level, with action plans and checklists completed to ensure improvements were made.