This inspection took place on 3 and 4 May, 2018. The inspection was announced. Wilmslow Supported Living Network is managed by Cheshire East Council and is registered to provide personal care to people living in supported living accommodation. The registered provider supports adults with learning disabilities or autistic spectrum disorders and supports them to live as independently as possible as tenants in their own homes.
This service provides care and support to people living in ‘supported living’ settings. 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 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.
At the time of the inspection 19 people were being supported. There were five adjoining bungalows where 18 people lived and one house in the local area where one person lived. The people who lived in the bungalows had support available 24 hours a day; the one person who lived in the local area received scheduled support visits on a daily basis.
At the time of the inspection there was a registered manager in post. A registered manager is a person who has 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.
At the last inspection which took place in July 2016, we found a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (staffing). There was a lack of training and developmental opportunities for staff. The registered provider was awarded an overall rating of 'Requires Improvement'. Following the inspection the registered provider submitted an action plan which outlined how they were improving the standards of care and quality of service. During this inspection, we looked to see if the registered provider had made the necessary improvements.
During this inspection we found a number of improvements had been made however the registered provider was found to be in breach of ‘good governance'. We are taking a number of appropriate actions to protect the people who are being supported by Wilmslow Supported Living Network.
At the last inspection we found that staff were not provided with the necessary training opportunities to support their learning and development. During this inspection we found that training opportunities had improved and staff were being supported with a variety of different training courses.
Although the registered provider was no longer in breach of regulation in relation to ‘staffing’ we recommend that the registered provider consults best practice guidance in relation to training opportunities and 'Care Certificate' requirements.
Individual care plans and risk assessments were in place for each person who was being supported. However the records we reviewed did not always contain the most up to date information. We found inconsistent information and records did not always reflect the most relevant support needs or risks. Quality assurance systems were not always identifying areas of improvement which were required in relation to the quality and standard of care being provided.
You can see what action we told the provider to take at the back of the full version of the report.
We reviewed medication management processes. Medication was administered safely by staff who had received the appropriate medication training. Medication audits were being completed on a monthly basis and areas of improvement were being identified.
We have recommended that the registered provider reviews the PRN protocols in respect of ‘as and when needed’ medication which need to be in place.
The registered provider was operating in line with the principles of the Mental Capacity Act 2005 (MCA). However ‘consent’ records were not always completed by the people being supported. Records indicated that people were involved in the decisions being made about the day-to-day care but a further review of ‘consent’ documentation was needed.
Policies and procedures were available and accessible to all staff and staff were able to explain the importance of having policies and procedures in place. However, we identified that some were out of date and did not always contain the most relevant information
Staff were knowledgeable around the area of safeguarding procedures. Staff knew how to report their concerns and who they would report their concerns to. Staff had completed the necessary safeguarding training and there was an up to date safeguarding policy in place.
‘Accidents and incidents’ were being reported, recorded and monitored accordingly. Safeguarding incidents were routinely recorded by all staff and trends were monitored and analysed.
We received mixed feedback about staffing levels during the inspection. We were informed that the staffing levels and the use agency staff had improved but on occasion staffing levels needed to be better managed. We were informed by the registered manager that recruitment was an on-going issue but staffing levels had improved over recent months.
Staff personnel files demonstrated that safe recruitment practices were in place. This meant that all staff who were working for the registered provider had sufficient references and Disclosure and Barring System checks (DBS) in place.
The registered provider worked in conjunction with the local housing association to ensure the environment was well-maintained and the health and safety provisions were safely managed. Health and Safety audit tools were in place to monitor, assess and improve the quality and standards of the environments people lived in.
The bungalows we visited during the inspection were clean, odour free and well-maintained. There was a daily cleaning rota in place and there was evidence to suggest that infection control policies were being adhered to. This meant that people were living in safe and hygienic environments.
People and relatives we spoke with during the inspection expressed that the care which was provided was safe. People expressed that staff were approachable, responsive and would listen to their views and opinions.
People felt they were treated with respect and staff provided dignified and compassionate care. Relatives we spoke with told us they felt the staff were kind, caring and provided good quality care. Staff supported people to make decisions around their own nutrition and hydration.
People’s choices, preferences, likes and dislikes were taken into account and people told us that staff provided advice and guidance in relation to balanced diets.
There was a complaints policy and procedure in place and people and relatives knew how to make a complaint. The complaints procedure was evident in all care records and was visible in each of the bungalows we visited.
There was a range of different activities taking place for each person who was being supported. Activities were individually tailored and people expressed that they were supported to take part in activities and hobbies they enjoyed.
Processes were in place to gather feedback regarding the provision of care being provided. Processes ranged from ‘tenant’ meetings, care reviews and staff meetings.
Staff and managers promoted a culture of warmth, kindness and compassion towards the people they were supporting. Staff expressed that they felt supported by both the registered manager and senior members of staff. Staff explained that the team worked collaboratively for the benefit of the people they were providing care for.
The registered manager was aware of their regulatory responsibilities and was aware that CQC needed to be notified of events and incidents that occurred in accordance with the CQC’s statutory notifications procedures.