Bolton Supported Living

Updated 18 March 2023

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.

Inspection team

The inspection was carried out by two inspectors, an expert by experience and a medicines inspector. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of service.

Service and service type

This service provides care and support to people living in 32 ‘supported living’ settings, so 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were two registered managers in post.

Notice of inspection

This inspection was unannounced.

Inspection activity started on 11 January 2023 and ended on 14 February 2023. We visited the location’s head office on 11 and 26 January 2023. We visited several supported settings on 17, 18, 21, 22, 25 and 26 January 2023. We reviewed further evidence remotely between 1 and 14 February 2023.

What we did before the inspection

We reviewed the information we had received about the service since the last inspection. 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. We used information gathered as part of monitoring activity which took place on 2 November 2022 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with 21 people and 6 relatives to understand their experience of care and support from the service. We also spoke with 22 staff including the nominated individual, 2 registered managers, assistant operating managers, senior support workers and support workers. 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 7 peoples support plans and risk assessments, records relating to the daily care and support of multiple people across 9 supported settings. We reviewed medication records across 4 supported settings and reviewed 5 staff files in relation to recruitment and supervision. A variety of records relating to the management of the service including policies and audits were also reviewed.

Updated 18 March 2023

About the service

Bolton Supported Living Service is a supported living service providing personal care to people living in the Bolton area. The service provides support to people with a learning disability and autistic people as well as people with mental health needs. At the time of our inspection there were 218 people using the service.

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.

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.

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

Right Support: People’s independence was promoted where possible by the provider and some staff; however, due to to staff shortages across the health and social care sector the provider was not fully staffed with Bolton Cares staff. This had led to a higher than ideal use of agency across the service at various times. In some services this limited the number of staff working with people who knew them well. In some services people’s choices were limited, particularly in relation to activities.

The provider acknowledged the service was in the process of transition following a restructure within the management team and had identified areas for improvement before we started our inspection. However, at the time of our inspection systems being implemented had not become standard practice across the service. The level of quality varied across each supported living service particularly in relation to paperwork. In some instances we found support plans to be person centred and contained sufficient detail to enable staff to understand who people were and how to support them; in others we found further information was required to amend language used and some support plans needed linking to relevant risk assessments.

Where permanent contracted staffing levels allowed, we found examples of people being supported to achieve positive outcomes following innovative and creative support. However, in other areas of the service we found people’s goals and aspirations had not been met and some people were only able to access the community in the form of ‘going for a drive out’. The provider shared how they had promoted recruitment; this included promotional videos, continuous recruitment drives and analysis of staff’s feedback on why people were leaving their roles.

People were not always supported to have maximum choice and control of their lives. However, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: People received kind and compassionate care. Staff protected people’s privacy and dignity. Regular staff understood and responded to individuals needs in a way they were comfortable with. People had access to healthcare professionals when they needed them. Medicines were not always managed safely; we found evidence medication errors had occurred; this included an incident where untrained staff had administered medication in error and other incidents where medical advice was not sought following missed medicines. Following our inspection, the provider immediately arranged to review audits which generally showed medication practice to be scored at ‘100%’ while at the same time identifying that medicines had not always been administered safely.

Right Culture: Staff feedback on working in partnership with the provider and senior leadership team was mixed. On the whole staff reported they felt Bolton Cares was a supportive company to work for, particularly in relation to career progression and practical development. However, the same staff also felt a disconnect had developed between the provider and staff working within the supported settings resulting in a lack of understanding of the challenges staff were facing. The provider evidenced attempts to engage with staff; however, these hadn’t had the desired impact. For example, the provider setup sessions where staff could meet with the Nominated Individual and Managing Director; attendance at these sessions was poor. We discussed this with the provider who demonstrated a commitment to finding new ways to engage with staff.

The service had two registered managers (registered manager 1 and registered manager 2) for Bolton Supported Living Service. Both had been working for Bolton Cares in other areas but became the services registered managers within the 12 months prior to the start of our inspection. We found they had identified similar issues to those we found during this inspection and they shared these openly along with the work they had already done to start addressing some of the issues. One example of this was staff’s compliance with training which had been impacted by a frequent turnover of staff and a new team of assistant operating managers (AOMs) had been recruited. Part of their role was to manage and improve training compliance locally within the supported settings. The registered managers felt the AOMs in post at the time of our inspection would continue to improve compliance and showed evidence this had already started.

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 (published 20 October 2017)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.