Archived: Manston

Updated 3 June 2017

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 took place on 6 April 2017 when we visited people in their homes, and on 7 April 2017 at the registered office of the domiciliary care agency (DCA). The provider was given 48 hours’ notice of our visit to the DCA office so that someone would be available to help us access the records required.

The provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we had received from the local authority and notifications received by the Care Quality Commission. A notification is information about important events, which the provider is required to tell us about by law.

At the office of the DCA we spoke with the registered manager, one senior member of staff and the human resources manager. We also spoke with one team leader, six members of staff, three people and one relative.

We looked at six people’s care plans and the associated risk assessments and guidance. We looked at a range of other records including four staff recruitment files, the staff induction records, training and supervision schedules, staff rotas, medicines records and quality assurance audits. We observed how people were supported and the activities they were engaged in. Some people were unable to tell us about their experience of the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us

After the inspection we spoke with the local authority safeguarding and commissioning teams. We spoke with one additional social care professional and three relatives about the service.

We last inspected this service in August 2016. Breaches in the regulations were identified at this inspection.

Updated 3 June 2017

This inspection was carried out on the 6 and 7 April 2017 and was announced.

Manston is a service registered to provide personal care to people living in their own homes. People were all living in supported living services, and had their own tenancies. The service supports adults who have learning disabilities, physical disabilities and mental health needs throughout East Kent. At the time of the inspection seven people were receiving a personal care service.

We last inspected this service in August 2016. We found significant shortfalls and the service was rated Inadequate and placed into special measures. The provider had failed to inform CQC of notifiable events. Suitable means of communication were not provided for people on a consistent basis. People’s care plans did not contain ways of maintaining or increasing their independence. People and their relatives were not involved in updating their care plans or making decisions around their care. People did not receive care that reflected their preferences. Staff did not have a clear understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards and had made decisions on people’s behalf without seeking their consent or a less restrictive option. Care and support was not provided in a safe way to people. People were not receiving their medicines safely and in line with the prescriber's instructions. Complaints were not investigated and necessary and proportionate action had not been taken as a result. The provider had failed to assess, monitor and improve the safety of the service. The provider had failed to mitigate the risks relating to the health, safety and well-being of people. The provider had failed to keep an accurate, complete and contemporaneous record in respect of each person. The provider had failed to seek and act on feedback from relevant persons. There was a lack of suitably qualified, competent, skilled and experienced staff to meet people’s needs.

This service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us regular information about actions taken to make improvements following our inspection. At this inspection we found that improvements had been made in many areas, however there were still areas where improvements were required.

There was a registered manager in post. They had been employed since our last inspection. 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.

Staffing levels had improved since the last inspection, and some people now received consistent support from the same permanent staff. However, there were a large number of staff vacancies so the provider used temporary staff from another agency to cover the shortfalls. Some people regularly received support from temporary staff from a different agency. Incidents had occurred when people were being supported by these temporary staff and people’s behaviours that challenge had escalated. The incidents had not been managed effectively by staff. Staff had called the police for support during some incidents rather than try to prevent the behaviour occurring using techniques of positive behaviour support. There was guidance in place to assist staff with supporting people with behaviours that challenged. Other risks relating to people’s care and support were now managed effectively.

There was a lack of oversight of the temporary staff being used to support some people. One person received support almost entirely from the temporary staff; they had not been consulted about or supported to change their support provider. The registered manager told us they regularly spoke with this person about the support they received but these conversations were not recorded and no formal quality assurance was carried out.

Some people required emergency medicine to be administered if they had an epileptic seizure. Staff had not all been trained in how to administer this medicine and people were regularly being supported by staff working on their own who had not had this training. There was a risk people would not get their medicine when they needed it to stop their seizures. The registered manager arranged training on the second day of the inspection and subsequently confirmed people were only receiving support from staff trained to administer their medicines.

Relatives and social care professionals told us they had raised concerns about the consistency of staffing and a lack of activities for some people, but there was no record of these complaints or the action taken. The registered manager told us that these complaints had not been recorded as they had not been raised as formal complaints and they would meet with relatives that had concerns.

Checks and audits had been completed but they had not identified the concerns that we highlighted at this inspection.

When people received consistent support there was a positive, person-centred culture and staff were kind and caring. People received the assistance they needed to access the activities of their choosing and staff supported people to use a range of communication methods to help them make their needs known.

Staff had the induction and training needed to carry out their roles. Staff had received training in how to manage people’s behaviours safely, and how to prevent behaviours from occurring. Staff met regularly with their manager to discuss their training and development needs.

Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. People were supported to prepare a variety of different meals.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). In supported living applications for DoLS are made to the Court of Protection. DoLS are a set of checks that are designed to ensure that a person who is deprived of their liberty is protected, and that this course of action is both appropriate and in the person's best interests. The registered manager had made some applications to the Court of Protection but these had not yet been authorised. Staff had up to date knowledge on the Mental Capacity Act 2005 (MCA) and DoLS. They supported people to make their own choices.

Both people and staff told us they thought the service was well led. The registered manager was experienced in working with people with learning disabilities and providing person centred care. The Care Quality Commission (CQC) had been informed of any important events that occurred at the service, in line with current legislation. Staff were recruited safely. The registered manager had reported any safeguarding concerns to the local authority and these had been investigated fully.

Although we acknowledge that this is an improving service, there are still areas which need to be addressed to ensure people's health, safety and well-being is protected. We identified a number of continued breaches of regulations .The service will therefore remain in special measures. We will continue to monitor Manston to check that improvements continue and are sustained. You can see what action we told the provider to take at the back of the full version of the report.