At the time of this inspection nine people were receiving a service from the provider, however they ceased to provide a service to six of these people shortly afterwards when the supported living service contract was awarded to a different provider.One inspector visited the offices of the provider on the afternoon of the 13th March 2012. On the same evening we visited a supported living project that was managed and staffed by the provider where six people with learning difficulties were living.
Whilst most of the people receiving support from the agency were unable to tell us about their experiences we were able to observe some interactions with staff at the supported living project and seek the views of their relatives. We also spoke to other families whose relatives were being supported in community placements. In addition we spoke with staff and looked at a range of records including the personal files of people who use the service and personnel records of staff.
Family members we spoke to told us that the privacy and dignity of the person receiving a service was respected whilst being supported with personal care. However we found that some staff were not able to describe the practical steps taken to promote privacy and dignity whilst providing personal care and this meant that we could not be confident that this care was being provided in a sensitive and appropriate manner.
There was little information in the record's of people using the service about their capacity to make decisions for themselves and this meant that important decisions about their care might not be taking place in an appropriate manner. We found that people living at the supported living service were supported to access healthcare appointments.
Relatives we spoke to told us that their family members received regular carers who were only changed when necessary, for example holiday cover.
We found that people referred to the service were not comprehensively assessed and that there was no clear process to refer back to commissioner's when there were issues about the provider's ability to meet the needs of people using the service. This meant that people were potentially being supported where the provider could not meet safely meet their needs.
Each person using the service had an individualised care plan. Some care plans were not regularly reviewed or updated, and not all areas of need were addressed in them. This meant that carers could potentially be unclear about what care was to be provided. Some potential risks had not been assessed, and records detailing the contact between care workers and people using the service were not available in some cases. We were concerned that this could affect the safety, quality and continuity of service provided.
We saw training records that showed that safeguarding training was provided to staff. The staff we spoke with demonstrated an understanding of safeguarding issues and their responsibilities should they have any safeguarding concerns. However, we noted that recent safeguarding concerns had been raised by family members and we were concerned that staff had failed to identify and report potential safeguarding issues. The provider did not inform the Care Quality Commission of safeguarding concerns, and could not readily identify people who use the service who had been subject to safeguarding proceedings.
The provider did not have clear records relating to care workers who held keys for people using the service and this posed a potential safety risk.
There was no manager identified for community based users of the service which could impact upon the quality and continuity of service provided. The provider carried out appropriate pre employment checks on staff and had developed a core training programme. We noted that training on supporting people with a learning difficulty was not included in programme and that some staff had failed to attend training with no indication of how this was being followed up. Whilst staff received regular supervision this did not include direct observation of how they actually delivered care to people who used the service.
The provider had developed quality assurance measures for people using supported living services, however there was no process for reviewing the quality of services provided for people using the service who lived in the community. We found that quality assurance measures did not seek the views of relatives or other professionals.
Where we have concerns we have a range of enforcement powers we can use to protect the safety and welfare of people who use this service. When we propose to take enforcement action, our decision is open to challenge by a registered person through a variety of internal and external appeal processes. We will publish a further report on any action we have taken.