Background to this inspection
Updated
5 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 checked 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.
This inspection commenced on 4 September 2018 and was announced. We gave the service one days’ notice of the visit to the office to ensure we could meet staff who worked in the service. We then made arrangements with the provider to visit two houses on 10 September 2018, after gaining permission [where possible] from the people who lived in these properties.
Before the inspection, we reviewed the information we held about the service, including notifications and previous inspection reports. A notification is information about important events which the service is required to send us by law. The provider sent us a Provider Information Return (PIR). This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. This was done with suitable detail. We used all this information to inform our planning for inspection. We also contacted a social worker and professionals who support people at day services. We planned the inspection using this information.
The inspection was conducted by two adult social care inspectors. The lead inspector visited the office and met managers, nurses and staff and later made phone calls to relatives. The second inspector visited two houses and met staff and people who lived in the properties.
We met with two people who were supported by the service when we were in the office as they had come to visit the main office. We spoke with four relatives by telephone after our inspection. When we visited people's homes we met six more people, spoke with them and observed them in their own environments.
We met the manager of the service and her line manager. We spoke with three nurses, three senior support workers and two support workers on 4 September 2018. On 10 September 2018 we met two more learning disability nurses and four support workers. We also met a visiting reflexologist in one of the properties.
We read six care files which included health care information and person centred plans. We read in depth specialised plans for managing behavioural issues. We checked on medicines managed on the behalf of people who were supported by the service. We also looked daily and weekly planners and daily notes. We also looked at quality monitoring records, records related to fire and food safety and records of individual financial transactions.
We checked four recruitment files and a further six files related to induction, supervision, appraisal and staff development. We saw records showing that staff competence was monitored appropriately.
We were sent details of quality audits and related reports after we had visited the office.
Updated
5 October 2018
At our last inspection in April 2015 the location was rated 'Good' overall. We found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
When we completed our previous inspection on 28 April 2015 we found concerns relating to the management of medicines. We made a requirement under Regulation 12 (2) (g) of the Health and Social care Act 2008. We received a suitable action plan shortly after this inspection in 2015. We saw that steps had been taken to improve matters. A pharmacist from the Lancashire Care NHS Foundation Trust (hereafter referred to as the Trust] had supported and trained staff. Suitable audits and improvement plans were in place. We judged that this breach had been met very soon after the requirement had been made in 2015.
This service provides care and support to people living in fifteen 'supported living' settings, so that they can live in their own home as independently as possible. Some people lived alone with support and others shared their home with up to three other people. 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. Everyone in the service received personal care 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. We saw that this service supported people in line with these guidelines.
This service did not require a named registered manager at this location as the service is part of a National Health Service provider. Lancashire Care NHS Foundation Trust have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. The Trust employed a nurse manager who runs this service and one other 'supported living' service in the area.
Staff had received training on ensuring people were kept free from harm and abuse. They were confident in management dealing with any issues appropriately. The Trust had a confidential phone line and other means of contact for staff to report any concerns.
Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and analysed by the Trust and action taken to reduce risks. Fire risk assessments and fire safety measures were in place. Suitable action was taken in relation to fire risk to ensure staff followed the risk management plans. We noted a possible issue around fire safety in one property but this was dealt with quickly after our visit.
We saw that staffing levels met the assessed needs of people in the service. There were some nurse vacancies in the service but this was being addressed by senior management. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people. The organisation had suitable disciplinary procedures in place.
Staff were trained in infection control and supported people in their own environment. Specialists in the Trust could be called on for advice, when necessary.
This staff team had been supported to develop appropriately. Staff were keen to learn and we saw that induction, training and supervision had helped them to give good levels of care and support. Nurses were given opportunities to keep their clinical practice up to date. Staff received good levels of training around principles of care in relation to people living with a learning disability and/ or autism. They were trained in specific techniques to support each person. They also had general training on supporting people with behaviours that challenge. Restraint had not been used in this service.
Consent was sought, where possible. The Trust and the local authority worked together to ensure the service operated within the Mental Capacity Act 2005. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
People were supported to access health care support from their own GP, the nurses in the location and specialist nurses and consultants. Staff worked with people to support and encourage them to visit dentists and other health care providers, like chiropodists and opticians.
Staff supported people to shop, budget and cook, where necessary. People were helped to take good nutrition and were encouraged to eat healthily. Some people had support to take nutrition by different means and staff were confident in how to manage this. We saw a very good nutritional plan for a person with a specific disorder.
Staff we spoke to displayed a caring attitude. People in the service responded warmly to staff on duty. Staff understood how to support people to maintain their dignity and privacy. Staff showed both empathy and respect for people living with the symptoms of autism and learning disability. People in the service had access to advocacy.
Everyone supported by the service had been appropriately assessed. People had positive behavioural support plans in place as well as person centred plans that staff followed closely. These had been regularly reviewed by nurses (and by other health and social care professionals) to ensure that people had the best care possible.
People were encouraged to go out and to engage, where possible, with sport, learning and social events. Staff were aware of how difficult this was for some people and planning for activities was done at an appropriate pace. We saw some good outcomes for people who had become more involved with activities in the community.
Complaint procedures were in place. There had been no complaints received about the service.
The service had a suitably trained, qualified and experienced manager. Each supported living service was managed by a nurse and a senior support worker. Staff told us they were easy to approach and aware of the needs of the service. The manager had created a culture of openness and we judged that staff worked in a non-discriminatory way. The atmosphere was one of enthusiasm and eagerness to give people the best care possible.
The Trust had a suitable quality monitoring system used in all their services. This service used the quality assurance system. This was evident in internal audits and records of visits by senior officers of the provider. Good monitoring and analysis of the service was in place.
We had positive comments from other professionals about how the service worked with them.
Staff and other people involved with the service were satisfied that the management arrangements were appropriate and that matters of governance were being followed to give good levels of care and support.