Background to this inspection
Updated
13 August 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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 was undertaken to check that the provider had made improvements to meet legal requirements after our last inspection, as well as to inspect other aspects of the service as part of this comprehensive inspection.
This inspection took place on 18 June and 1 July 2015 and was announced. This was so that a suitable person could be available to support the inspection. It was undertaken by an inspector and a pharmacy inspector.
Before our inspection we reviewed information we held about the service and the provider, including the action they submitted to tell us how they would improve the service. We also contacted a local authority reviewing officer to ask them about their views of the service provided to people.
We met with eight people who lived at two supported living schemes and they were unable to give us feedback on their care verbally. Because of this we spent time observing how care and support was provided to them. We spoke with one relative, the area manager, two scheme managers and five members of the staff team. We looked at five people’s care records and records relating to the management of the service including quality audits.
Updated
13 August 2015
This was an announced inspection. We gave the registered manager two days’ notice so they, or a suitable person, could be available to support the inspection. The last CQC inspection was carried out in August 2014. At that time we found breaches in relation to care and welfare, medicines and consent.
The service supports people in their own flats which were mainly within supported living schemes with staff available for support at all times. Most people had high support needs as the service specialised in providing care to people with severe to profound learning disabilities, as well as physical disabilities and autism. There were 34 people using the service at the time of our inspection.
There was 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.
At this inspection we found the provider had taken the action necessary to become compliant in relation to the three breaches we found at our last inspection. In relation to care and welfare the service had obtained advice from a dysphagia nurse for people at risk of choking when eating and suitable guidance was in place for staff to follow. We observed staff followed this in practice and had a good knowledge of how to support people to keep them safe while eating and drinking. Staff had received training regarding this. The service assessed people’s wheelchairs to ensure they were comfortable and people could be positioned within them in line with the recommendations to keep them safe while eating and drinking.
In relation to medicines we found good systems were in place with records for ordering, receiving, administering and returning medicines to the pharmacy. Our stock checks showed people were receiving their medicines as prescribed. In addition, medicines were now being administered covertly in line with the requirements of the Mental Capacity Act 2005.
The provider was no longer breaching the regulation relating to consent because they had assessed which people may be being deprived of their liberty and had informed the local authority so that they could make the necessary applications to the Court of Protection as required. Staff had a good understanding of their responsibilities under the Mental Capacity Act 2005 when depriving people of their liberty.
Staff understood how to recognise people may be being abused and were encouraged to report concerns. The service liaised appropriately with the local authority safeguarding team to keep people safe when an allegation of abuse was made.
There were sufficient numbers of staff deployed to meet people’s needs. The provider supported staff effectively though appropriate supervision, appraisal and training to provide them with the necessary knowledge.
Staff supported people appropriately to eat and drink and provided them with food according to their preferences. Staff monitored people’s risk of malnutrition and provided them with specialist support, such as dietitians, where necessary and followed their guidelines.
Staff were kind and caring towards people and treated them with respect and staff kept information about people confidential. People were involved in making decisions and planning their own care. The service assessed people’s needs and people had personalised care plans in place for their needs which staff kept up to date so the information in them was accurate and reliable for staff to follow. Staff knew the best ways to communicate with people and individuals had communication guidelines in place for staff to follow. Staff knew the people they were supporting well, including their backgrounds, preferences and daily routines, which allowed them to provide care in the best ways for people. Staff supported people to do activities they were interested in.
People were encouraged to maintain relationships with those who mattered to them, such as relatives, with no restrictions on visiting times and staff making guests feel welcome.
Suitable procedures were in place for people to raise concerns or complaints with a team in place to investigate these appropriately.
The registered manager and staff had a good understanding of their responsibilities. The quality of the service was monitored and reviewed through a range of audits carried out by different teams and individuals. Necessary improvements were made where concerns were identified in audits.
People were involved in developing the service and were supported to carry out inspections of individual schemes in the organisation to highlight areas of good practice and areas which could be improved. Staff were also involved in developing the service through regular staff meetings where they could share their ideas and suggestions for improvement.
Resources for driving up improvement were available. Within the organisation there were robust internal processes to share learning and best practice, including groups which met regularly to discuss safeguarding and other issues.