Shrewsbury

Updated 28 July 2022

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 Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

This service provides care and support to people living in 23 ‘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. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 13 May 2022 and ended on 18 May 2022. We visited the office location on 13 May 2022.

What we did before inspection

Prior to the inspection we reviewed the intelligence we held on the service and contacted the local authority to gather their views. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

During the inspection

We visited five supported living settings as well as the office location. We communicated with 11 people who used the service and five relatives about their experience of the care provided. Some people were able to communicate with us verbally and where this was not possible, we used basic Makaton and made observations of the care people received.

We spoke with 18 members of staff including the nominated individual, registered manger, compliance manager, assistant managers, and support staff. We also received and reviewed email responses from six members of staff. All staff were emailed by CQC and given the opportunity to share their views.

The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included four people’s care records and medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We also spoke with the local authority team who oversee the application of the Mental Capacity Act 2005.

Updated 28 July 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Shrewsbury (Perthyn) is a supported living service. They were supporting 30 people with their personal care needs at the time of the inspection. Not everyone who used 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 also consider any wider social care provided.

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

Right Support

The principles of the Mental Capacity Act (MCA)were not always being met. Restrictions in people’s daily lives had not been assessed to be in their best interests. New staff were being recruited following the application of robust recruitment checks. People were supported to develop their independent living skills and participate in daily living activities. People were supported to take their medicine on time and where appropriate self-manage their medicine. People were supported to attend their annual health check and attend health appointments throughout the year.

Right Care

People were supported by staff who had received training to support them in the role. However, not all staff had completed autism training. People had comprehensive care plans and risk assessments in place for staff to follow. Some plans were very detailed, and information was not easily accessible due to the volume of detail. Staff understood how to protect people from poor care and abuse. Staff could explain how to report incidents and any safeguarding concerns. People lived in homes which were clean, and staff completed the necessary checks for COVID -19. Governance checks were in place, but some issues had only recently being identified. For example, missing best interest decisions and the need for medicine temperatures to be monitored. Staff understood how to support people with modified diets and people were offered choice at mealtimes.

Right culture

Staff demonstrated a good understanding of people’s needs. The provider could evidence lessons were learnt when things went wrong, and action was taken when concerns were highlighted. Staff and relatives felt supported by frontline managers and able to approach them with any concerns. Staff worked with other agencies to ensure people’s needs were met and best practice was shared.

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 (report published 24 February 2018).

Why we inspected

This inspection was prompted in parts due to concerns received about staffing. A decision was made for us to inspect and examine those risks. As part of the inspection we also considered whether the service is applying the principles of Right support right care right culture.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to regulation 11 (Need for Consent) and have made recommendations about the need for people's restrictions to be assessed using the principles of the Mental Capacity Act

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.