The inspection took place on 23 February 2015 and 3 March 2015 and was announced. We last inspected this service on 9 July 2013. We found the service was meeting the regulations we inspected.
Stirling Supported Living Scheme is a domiciliary support agency for people with learning disabilities. The people using the service all live in independent supported living houses with 24 hour support provided.
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 provider had breached Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This was because staff had not completed updated training relating to moving and handling and safer handling of medicines.
You can see what action we told the provider to take at the back of the full version of the report.
People using the service and family members told us the service was safe. People said, “I’ve lived here for several years and feel safe living here, the staff stay overnight and they will help me if I need them during the night”, “I like living here and have everything I need. I feel safe as we lock all the doors and windows at night”, “Lovely, I like it here”, and, “Safe, yes I do [feel safe].”
People also gave positive feedback about the support staff and the support they received. Their comments included. “[Staff were] very good and help me to do things”, “[Staff] help me with anything”, and, “The staff are good and they never rush me, they know I like to take my time.” Family members said, “Can’t praise it enough”, “Absolutely brilliant”, “Really happy”, “[My relative] is very happy with the care”, “Well looked after” “Couldn’t be happier”, “That home is good”, “Very well cared for”, and, “All quite happy there.”
The service had a positive approach to managing risk to promote people’s independence. One family member said staff, “Do a risk assessment and keep an eye on [my relative].” Risk assessments had been reviewed regularly involving people using the service.
People received their medicines in a timely manner. Medicines records we viewed were up to date. Records did not confirm the time some medicines were administered. This was to confirm they had been given in line with the prescriber’s directions. Medicines were stored appropriately.
Staff had a good understanding of safeguarding and had completed recent training. Some staff we spoke with were not clear about the process for escalating concerns. Safeguarding log concerns had been referred to the local authority as required. We have made a recommendation about the reporting of safeguarding concerns. Staff also knew how to report whistle blowing concerns.
People told us they were supported by a consistent staff team. One person said, “The staff don’t change much.” One family member told us they, “Tend to see the same staff, continuity.” Staff told us they had “no concerns” regarding staffing levels. The service had effective recruitment and selection processes to make sure new staff were suitable to work with vulnerable people.
Incidents and accidents were recorded and investigated. Action had been following an incident or accident to keep people safe. We observed the houses and gardens were well looked after. People showed us their rooms which had been decorated according to their personal preferences. We saw a range of regular checks were undertaken within each house to maintain people’s safety. Emergency procedures were in place.
Staff told us they felt well supported and the provider was supportive of them attending training. One staff member said, “I have attended lots of training and have to update my mandatory training on a regular basis, to keep up to date with any changes.” Records showed staff received regular supervision and an annual Personal Development Plan (PDP). The most recent PDP for three out of five staff was not stored in their staff file and not available for us to view during this inspection.
Staff we spoke with had a good understanding of the Mental Capacity Act 2005 (MCA). The registered manager and all staff we spoke with confirmed they had recently completed MCA training. Staff confirmed they always asked people for permission before delivering care.
People were supported to make their own decisions and staff respected people’s choices. One person said, “I decide when to go out and when I want my meals”. They told us the staff knew them very well. Another person said, “I picked bacon and egg for my breakfast.”
Staff said some people sometimes displayed behaviours that challenged others. Staff were clear about the agreed strategies to support these people consistently.
People were independent with eating and drinking. Staff supported them with compiling weekly menus, making healthy choices and offering dietary advice. Staff sought the advice of external professionals to help them support one person who had specific eating and drinking needs.
Various health professionals were involved in people’s care including GPs, community nurses, psychiatrists, speech and language therapists (SALT), podiatrists and dentists. Family members said staff kept them updated about their relative’s support. One family member said, “[Staff] let me know if anything happens.”
We observed staff were kind and considerate towards people. They regularly checked people were alright or needed anything. Staff had a good understanding of the importance of treating people with dignity and respect. They gave us practical examples of how they supported people to achieve this aim. Staff knew about the importance of maintaining confidentiality within the service.
People told us they had a key worker who went out with them and helped them to sort “paperwork and things.” Staff had access to information about each person, to help them better understand the needs of the people they supported. This included information about the person’s ‘life story.’ We found people had their needs assessed and personalised ‘Lifestyle Support Plans’ had been developed. People had goals identified to work towards. Lifestyle support plans had been reviewed consistently but review records did not always provide an update on the person’s current situation.
Some people were accessing their local community independently. People told us they were able to choose how they spent their time. One person said, “Yes, I choose.” Another person said they liked knitting, colouring in and going to the day centre. Some people had details of a named advocate in their care records. Information about how to access advocacy was displayed on the notice board for people and visitors to view.
People and family members told us they knew how complain if they were unhappy. Complaints were fully investigated and resolved. People had opportunities to give their views about the support they received including questionnaires, one to one discussions and monthly update meetings. Family members said their views were listened to. One family member said staff, “Take on board what you have to say.”
The home had a registered manager. We found the provider had not made some of the required statutory notifications to the Care Quality Commission. Family members said the registered manager was approachable. One family member said, Kay is lovely, really nice.”
There were systems to keep staff informed about changes to the service. All staff told us they felt able to speak with the manager anytime. Staff also told us sometimes house meetings were held when, “Something in the house needed to be changed.” One staff member said they had a good professional relationship with the registered manager and felt “very valued.”
We observed there was a positive atmosphere within the home with lots of laughter and banter (friendly chat) between people and their staff. One family member said the service had, “A very homely support attitude, home from home.”
The registered manager carried out quality checks and audits including checks of policies and procedures, medicines, health and safety, fire safety, staffing, people’s finances and support plans. These had been successful in identifying areas for improvement.