Archived: 19a Rock Street

At this inspection we found the service to be Good overall. However, the well-led question remained Requires Improvement. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

We found some improvements were needed to people’s records to ensure they contained all the information about people and fully reflected people’s risks and support needs. We made a recommendation about this.

Staff had a good understanding of the risks associated with the people they supported. Risk assessments provided further information for staff. People were protected from the risks of harm, abuse or discrimination because staff knew what actions to take if they identified concerns.

People were supported to receive their medicines when they needed them. There were enough staff working to provide the support people needed, at times of their choice. Recruitment procedures ensured only suitable staff worked at the service.

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. People's health and well-being needs were met. They were supported to have access to healthcare services when they needed them. Staff received training that enabled them to deliver the support that people needed. Staff received support from the manager and their colleagues.

People were supported by staff who knew them well. Staff understood people’s needs, choices and histories and knew what was important to each person. People were treated with kindness, respect and understanding. They were enabled to make their own decisions and choices about what they did each day.

People received support that was person-centred and met their individual needs, choices and preferences. People’s hobbies and interests were included in their support to ensure their well-being needs were met. Complaints had been recorded, investigated and responded to appropriately.

The manager was well thought of and supportive to people and staff. They had a good overview of the service. There were systems in place to assure quality and identify if improvements to the service were needed.

Rating at last inspection: Requires improvement. (Report published 22 February 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At our previous inspection in March 2016 the service received an overall rating of ‘Good’. However, we asked the provider to make improvements to ensure people always received their support hours.

We had received concerns about the running of the service. We were told that people’s support needs were not being met because there were not enough staff. We brought forward this comprehensive inspection to look at all aspects of the service and to ensure people were safe and receiving the appropriate support. We found improvements were required for staff training and supervision. Systems for monitoring the quality of the service were not effective.

19A Rock Street is a Domiciliary Care Agency (DCA). It provides personal care to people living in their own homes in the community. It provides a service to people who are living with complex mental health needs, learning disability and those on the autistic spectrum. Some people were also living with physical disabilities. The provider is Brighton and Sussex Care Limited and it is part of the Lifeways group.

At the time of this inspection 28 people were using the service. However, at this inspection only one person received the regulated activity. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

There was no registered manager at the service. They had left the organisation before this inspection. They had contacted the Care Quality Commission to cancel their registration. 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. At the time of the inspection the service was being managed by an interim manager who had knowledge of the service, and an area manager.

Before the inspection anonymous concerns had been raised about staffing numbers. At the inspection we found there were enough staff working. However, the area manager had identified possible concerns with the deployment of staff. Steps were being taken to address this.

There was a quality assurance system in place. However, this had not identified shortfalls in a timely way. The provider had not identified that concerns raised were not always addressed and staff, at times, felt unsupported by the management team. Improvements were needed to ensure staff received the induction, training and support they needed to enable them to fully meet people’s needs. The staff team were committed to improving and developing the service.

Risk assessments and guidance were in place and staff had a good understanding of the risks associated with the people they supported. Medicines were well managed and staff ensured people received the medicines they had been prescribed.

Staff understood the procedures in place to safeguard people from the risk of abuse or discrimination. Staff had a good understanding of the Mental Capacity Act 2005 (MCA). They told us how they supported people to make their own choices and decisions.

People’s health and well-being needs were met. They were supported to have access to healthcare services when they needed them and maintain good mental and physical health. There was a complaints process in place and complaints were responded to appropriately.

Staff were kind, caring and compassionate. They treated people with respect and helped them maintain their dignity. People were involved in the planning of their care and supported to make their own choices. They received support that met their individual needs and preferences. Staff knew people really well had understood the importance of providing good person-centred care.

19a Rock Street is a domiciliary care service that supports thirty people, with enduring mental health needs, learning difficulties or those on the autistic spectrum, with their daily living tasks.

The service had a registered manager. 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.

The provider had recently merged with another provider. People provided mixed feedback in relation to this. People felt that the management of the transition had been dealt with well. However, due to changes in staffing levels felt that their support hours had been affected. People and relatives told us that this made them feel less safe. One relative told us “Now that the service is under new management it is often short staffed and they are quite often not able to support my loved one. As a result my loved one doesn’t feel safe and secure now as there does not appear to be a plan if certain members of staff are off.”

This is an area in need of improvement.

People were involved in the recruitment of staff. Those that had been recruited were safe to work within the health and social care sector and were aware of their responsibilities in regards to safeguarding people from harm. Risk assessments enabled people to live their lives in the way that they chose, whilst minimising risks to ensure people’s safety.

People were supported by skilled and experienced staff who were regularly supported and encouraged to develop within their roles. One member of staff told us “Staff are encouraged on their pathway, this is then cascaded to the people we support as we try to promote the best in them too.”

People were encouraged to make decisions and consent was gained before support was offered. The provider had taken appropriate measures to ensure that people’s freedom and independence was not restricted. Relevant professionals were involved in people’s care to ensure that they were supported effectively.

Staff had a kind and caring approach. Observations showed warm, positive and genuine relationships that enabled people to feel at ease. One person told us “They are very caring, they’re like friends.” People were involved in their care and were supported to live their lives in the way that they chose to. People’s privacy and dignity was maintained and their rights respected.

People received person-centred and individualised care. Staff adapted their approach to meet people’s needs. They ensured that support was tailored to people’s preferences. The provider was aware of the impact of social isolation and had taken measures to minimise risk. This included implementing clubs, in partnership with people, in response to their interests and hobbies, enabling them to socialise and interact with other people. People told us that they valued this and enjoyed participating in the clubs.

There were various mechanisms in place to monitor the quality of the service being delivered. The provider had identified areas to develop or lessons learned to ensure that changes were made to practice to drive improvement.

People, relatives and staff felt that the service was well-led. They found the management team approachable and responsive to their suggestions. One relative told us “There has been no change in the delivery since the takeover. It has all been very seamless. As far as I can tell it is well-led and well-managed, I am very impressed with them.”

People told us that they received the care and support they required to meet their needs. They said that they were aware of what care was to be provided and were in agreement to it being provided. People told us that their care and support needs had been discussed with them and the care they received reflected this.

They also told us that the care they received was consistent and met their individual needs. One person said, "I'm very happy with the care and support I get. I get on well with all the support workers, they like me and I like them.' A relative of one of the people who use the service told us, 'My first impressions were wow - this is going to be good!'

Another relative told us "The care and support is absolutely fantastic. They are the most honest, enthusiastic and proactive people and it has been so refreshing. They treat my son like an adult. They value his comments and opinions and show him respect ' and he really appreciates that and responds to it."

We looked at the systems and processes the service had in place to protect people from abuse. Staff knew what constituted abuse and what to do if it was suspected.

We reviewed the recruitment procedures that were in place and found that processes were thorough and well documented. Staff received regular training and supervision and felt valued and supported.

The service had effective systems in place to deal with people's comments and complaints.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs. Equality and diversity had been considered in the service by looking at each individual's needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training on safeguarding adults. People told us if they had any concerns they would report them to the manager of senior person on duty.

Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

There were processes in place to monitor the quality of service being provided and we saw that people were involved through questionnaires and regular keywork meetings. The provider had an effective electronic database for recording, storing and auditing information related to delivering the support service.