Shrewsbury

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.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. There were systems in place to identify and manage risks and to protect people from harm or abuse. People received their medicines when they needed them and medicines were stored and managed in a safe way.

People continued to receive effective care. People were supported by staff that were well trained and competent in their roles. People’s health care needs were monitored and met. 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.

The agency continued to provide a caring service to people. Staff were kind, considerate and patient when they supported people and people responded positively when staff interacted with them.

People received care which was responsive to their needs and preferences. Staff were skilled in recognising what a person wanted or was feeling even though people were unable to communicate their needs. People were supported to maintain contact with their family and friends and to take part in their preferred activities and social events.

The agency continued to be well led. The registered manager knew people well. Staff told us the management within the service were open and approachable. The registered manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

There was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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.

People who used the service, family members and external agencies were very complimentary about the quality of support provided. The registered manager and staff involved families and other agencies to ensure people received the support they needed to express their views and make decisions that were in their best interests.

People were supported to lead fulfilling lives. People were helped to try new activities and make changes in their lives. The registered manager and staff had a good understanding of managing risk and supported people that had previously challenged other services to reach their full potential and to keep them safe.

Staff developed ways to address the fluctuating needs of people ensuring their full inclusion at all times. Over time people were supported to progress and their support plans adapted and developed to promote their independence.

There was a robust recruitment procedure to help ensure the staff recruited were suitable to work with the people who used the service. People were actively involved in the interviewing process for potential employees.

The registered manager ensured that staff had a full understanding of people’s support needs and arranged training to equip them with the skills and knowledge to meet them.

There was a well-established management structure in place which ensured that staff at every level received support when they needed it. Staff were clear about their roles and responsibilities and how to provide the best support for people.

People had assessments of their needs and care was planned and delivered in a person-centred way. People led fulfilling lives and they were supported to make choices and have control of their lives. People and their family members were fully consulted and involved in assessments and reviews.

People’s nutritional needs were met and they had access to a range of professionals in the community for advice, treatment and support. Staff monitored people’s health and wellbeing and responded quickly to any concerns.

Management of people’s behaviours that may challenge the service and others was based on the least restrictive best practice to support people’s safety. This supported staff to provide a consistent approach to situations that may be presented, which protected people’s dignity and rights.

There was a positive culture within the service. The management team provided strong leadership and led by example. The registered manager had clear visions, values and enthusiasm about how they wished the service to be provided and these values were shared with the whole staff team. There was an emphasis on exercising choice and developing independence, supporting people with their right to an ordinary pattern of life within the community.

Systems to continually monitor the quality of the service were effective and there were ongoing plans for improving the service people received. The provider gathered information about the quality of the service from a variety of sources including people who used the service, their family and professionals. The service had developed and maintained links with professionals. This provided a multidisciplinary approach in supporting people using best practice.

Below is a summary of what we found. The summary describes what people using the service and the staff told us and the records we looked at. Perthyn Shrewsbury provides personal care and support to people living in their own homes.

Is the service safe?

One person told us, 'Staff are very nice, I feel safe here'. We saw that risks to people's safety and wellbeing were assessed and measures put in place in order to reduce these. Risk assessments were up-to-date. Health and safety audits were carried out by staff from the health and safety department.

Staff were up-to-date with their training considered to be mandatory by the provider. Topics included manual handling, safeguarding vulnerable adults and health, safety and hygiene. This enabled staff to carry out their role safely.

Staff told us that they had received induction training at the start of their employment so that they would be clear about their roles and responsibilities towards people in their care.

Is the service caring?

People told us that they were well supported by the staff team. They confirmed that staff treated them well and that they were treated with dignity and respect. One person told us, 'Staff treat everyone with respect'. People told us that staff would listen to them if they had a problem.

Is the service responsive?

People who used the service were asked for their views about their care and treatment and they were acted on. People told us that they would feel confident talking to staff if they were unhappy with aspects of their care. This meant that the service was responsive to the needs and views of people.

Is the service effective?

People we spoke with told us they were satisfied with the service provided and that their needs were met. People's needs were assessed and care was planned and delivered in line with each individual care plan. Staff we spoke with understood people's care needs and the support they were to provide.

Staff had developed close and positive working relationships with health and social care professionals such as the district nurse and GP. This ensured they worked in people's best interests and were able to continue to meet people's changing needs.

Is the service well led?

The service had an experienced registered manager in post. Most staff felt well supported. Improvements were noted in the arrangements for staff training and supervision. Some staff however felt that the communication and support from the management team could be improved.

The provider had an effective system to regularly assess and monitor the quality of service that people received. This ensured people received a service which was of high quality and met their needs.

People's needs were assessed and care was planned and delivered in line with their individual care plan. People we spoke with told us they had a care plan in place and had felt involved in putting the plan together.

The recruitment and selection processes were sufficiently robust to assure the safety of people that used the service. Some staff were not up-to-date in training considered to be mandatory by the provider. There were also gaps in some of the staff's supervision. This meant that staff were not always supported to carry out their work.

There was a system in place for assessing and monitoring the quality of the service, which involved people who used the service. This ensured people received a service which was of high quality and met their needs.

Two people told us that they always made their own decisions about how they lived their lives. Staff told us how they supported people to make choices and decisions and how they used other agencies when appropriate.

People said they were happy with the support they received and we saw that people had a good rapport with support staff. Staff were knowledgeable about people's needs, preferences, likes and dislikes. Staff told us that support plans were comprehensive and gave them all the information they needed to meet people's needs effectively.

Staff told us that medication procedures were comprehensive. They said that they were regularly assessed for competency and that they received excellent training and support to administer mediation effectively.

The agency had a complaints policy that was available in different formats. Staff told us how they supported people to make complaints when appropriate. One person told us they had effectively used the procedure. People said they would be confident to share their worries and concerns with staff or managers.

We saw that staff files were well organised and reflected a thorough and robust recruitment process. Newly appointed staff told us that they had been well supported and this enabled them to be confident in their support role.