Archived: Sefton New Directions Limited - Home Service

This was an announced inspection which took place over three days on 28, 29 April and 6 May 2016. The inspection was carried out by an adult social care inspector.

The service had 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.

We saw that some of the medication administration records were not always clear in the supported living service so it was not clear whether people had received their medicines. There was a need to develop audits for checking medication standards to help ensure consistent safe standards were developed and maintained.

We told the provider to take action.

We were able to speak with people at the two supported living locations we visited. They looked relaxed and had an obvious positive rapport with the staff members providing support. Those able to express an opinion said they felt safe with the support they received.

We saw that people requiring support when out in the community to ensure they were safe, had fully developed plans in place. Staff were arranged to support this depending on each person’s needs. People’s support plans evidenced this.

We found staffing of the service was under regular review and there were sufficient staff available to support each of the three designated services within the Home Service.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We looked at two staff files and found that appropriate applications, references and security [police] checks had been carried out. These checks had been made so that staff employed were ‘fit’ to work with people who might be vulnerable.

The staff we spoke with clearly described how they recognised abuse and the action they took to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report through any concerns they had. There had been a number of safeguarding referrals and investigations since our last inspection of the service. Agreed protocols had been followed in terms of investigating and ensuring any lessons had been learnt and effective action had been taken. This rigour helped ensure people were kept safe and their rights upheld.

Arrangements were in place for checking the care environment to ensure it was safe. There were protocols in place so that staff in all three services monitored the living environments and reported through any issues.

We observed staff provide support and the interactions we saw showed how staff communicated and supported people as individuals. Relatives told us that staff seemed well trained and competent. Communication between relatives, people being supported, staff and senior management was effective.

Staff were supported by on-going training, supervision, appraisal and staff meetings. Formal qualifications in care were offered to staff as part of their development. We saw there were plans to further develop training particularly with respect to the share lives service.

Local health care professionals, such as the person’s GP, and Community Mental Health Team were regularly involved with people. The feedback we received from people using the services, professionals and relatives evidenced good liaison and appropriate working to ensure people received good health care support.

Staff sought consent from people before providing support. When people were unable to consent, the principles of the Mental Capacity Act 2005 were followed in that an assessment of the person’s mental capacity was made and decisions made in the person’s best interest.

We discussed with staff and the people living in supported living how meals were organised. We saw that these were organised individually and people were encouraged to choose and plan their own meals.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

We saw that staff respected people’s right to privacy and to be treated with dignity. For example staff were aware of how one person’s behaviour might impinge on the right of others sharing the accommodation and had made arrangements to minimise this.

All family members and people spoken with felt confident to express concerns and complaints. Most people told us that issues were dealt with at reviews and the service was generally very responsive to any concerns raised.

All of the managers we spoke with were able to talk positively about the importance of a ‘person centred approach’ to care. Meaning care was centred on the needs of each individual rather than the person having to fit into a set model within the service. People using the service and relatives told us they felt the culture of the organisation was fair and open.

We enquired about the quality assurance systems in place to monitor performance and to drive continuous improvement. The manager was able to evidence a series of quality assurance processes both internally and external to the service. There was a clear management hierarchy and we saw that new ideas and service improvements were effectively developed and communicated.

Internally there were other key audits carried out to monitor standards.

You can see what action we told the provider to take at the back of the full version of this report

We saw that staff knew the needs of people using the service. They worked with service users to create and review specific goals which were documented in each service users' care plan. A service user told us that the carers had helped them to regain their confidence and that they were, 'friendly and all lovely.'

We saw that staffing levels were always appropriate to meet the needs of the service users. We reviewed the training records for all staff and found that all staff received appropriate training to care for people using the service, and that it was updated regularly.

We saw that the service had a complaints policy. Details of how to complain were included in the care file for each service user. No written complaints had been made in the last two years. Issues or complaints raised verbally were documented and responded to appropriately.