EMH Supported Living 3

Updated 17 November 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

Three inspectors carried out this inspection, several supported living settings were visited. An Expert by Experience (EXE) also supported this inspection by speaking with relatives. An EXE is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in several supported living settings, so that they can live as independently as possible. 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 had a manager registered with the Care Quality Commission who left in the summer and a new manager was due to commence during the inspection period. However, the applicant did not commence the post as expected. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection because people are often out, and we wanted to be sure there would be people at home to speak with us.

Inspection activity started on 15 September 2021 and ended on 28 September 2021. We visited the office location on 20 and 21 September.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We visited seven properties and spoke with ten people who used the service and seven relatives about their experience of the care provided. We spoke with 19 members of staff across the wider range of properties, which included the operations manager, quality and compliance manager, care coordinators, care staff and an inclusion and engagement facilitator. We reviewed a range of records. This included parts of nine people’s care records and seven medication records. We looked at two staff files in relation to recruitment and saw records relating to staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We spoke with three external professionals about their experience of working with the service.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 17 November 2021

About the service

EMH Supported Living provides personal care to people with a learning disability or autistic spectrum disorder, who may also be living with physical disability. People received care in their own private single or multi-occupancy living accommodation via individual private tenancy agreements. At the time of our inspection there were 163 people using the service.

Not everyone who uses the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we consider any wider social care provided.

The service is developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People’s experience of using this service and what we found

The provider had all the systems and processes in place to monitor and improve the quality of the service, but these were not always effective or embedded. There was a lack of oversight of practices in some properties, which meant people did not always receive their care as planned.

Medication procedures were in place; however, we identified some administrative errors in three properties. Where audits had identified areas for improvement, action had not always been taken to ensure the issues had been followed up. In other properties there were detailed and comprehensive audit systems which were working well.

There was not always a positive culture within the service. At six of the properties, staff advised of concerns relating to either staffing, management support or both. There was regular use of agency staff in three of the properties where people told us this had impacted on their care. The provider told us recruitment processes were ongoing to increase staffing.

Care plans were person centred, but not all staff had seen or were aware of the contents of plans, or changes to people's current needs. The approach to promoting people's independence was inconsistent across the different properties. Staff we spoke with understood people's needs however, as not all had seen the care plans, we could not be sure they were guided by people’s preferences or requirements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

Based on our review of Safe and Well Led the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support: The model of care used, maximised people’s choice, control and independence over their lives in some properties, other properties were still working on improving care plans.

Right care: Care was person centred and promoted dignity, privacy and human rights in most properties.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensured people using services were able to lead confident, inclusive and empowered lives in most properties.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 17 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the safety and management oversight of people using the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well-Led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-Led sections below. You can see what action we have asked the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for EMH Supported Living on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to oversight and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.