Longley Hall Limited

Longley Hall Limited is a supported living and domiciliary care service which provide personal care to people with a learning disability or autistic people. The supported living service comprises of 2 blocks of flats and can cater for up to 17 people. People live in studio flats with an ensuite shower room and have access to a shared lounge, kitchen, bathroom and garden. There is one small self-contained flat and a manager office co-located on the premises. By supported living we mean schemes that provide personal care to people as part of the support that they need to live in their own homes. The personal care is provided under separate contractual arrangements to those for the person’s housing. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. At the time of our inspection there were 10 people using the service who received personal care.

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

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.

Right Support:

Risks to people’s health and safety were not always effectively managed safely by the service. People’s risk assessment on how to support them safely often contained inaccurate or out of date information, which placed them at an increased risk of harm. Despite issues with people’s care records, most staff appeared to know people well and understood their support needs to effectively manage risk. The provider submitted an action plan to CQC to address the quality and safety issues in people’s care records.

The training and support staff received from managers needed to improve. Staff received the provider’s minimum training requirements to support people. However, not all staff completed training individualised to the needs of the people in the service to support their quality of life. For example, the service supported people with a learning disability and/ or autism, yet only half of the staff were trained in this area. The provider told us physical restraint was not taught or practiced at the service as they promoted less restrictive interventions, such as de-escalation and breakaway strategies with staff. We found approximately half of all staff were trained on how to manage challenging behaviour.

The provider used the Positive behaviour support (PBS) model, which is a person-centred framework for providing long-term support to people with a learning disability, and/or autism, including those with mental health conditions, who have, or may be at risk of developing behaviours that challenge. Where people had been assessed for PBS, plans provided detailed proactive and reactive strategies for staff to follow to prevent behaviour that challenges. However, we found people’s PBS plans were not consistently followed by staff.

Processes to manage incidents and safeguarding concerns had been historically poor, which placed people at increased risk of harm. The provider had recently taken action to re-establish processes to monitor and review incidents and concerns at the service for opportunities to address future risk.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. We saw people were supported to access the community as and when they wished.

Right Care:

People's needs were assessed and developed into a support plan. Further work was underway to ensure support plans and risk assessments contained accurate information to enable people to receive appropriate care and support that was responsive to their needs. The manager and staff understood their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards although records needed to be improved.

There were sufficient staff deployed to meet people's needs and wishes. Staffing levels were determined by people’s assessed needs and the commissioning bodies. The provider told us staffing had recently increased at the service, which they felt was safer. The provider told us there was also a business case under review to increase night-time staffing arrangements.

Right Culture:

Governance arrangements were not as effective or as reliable as they should be. Inconsistencies in leadership led to serious shortfalls in the provider’s quality assurance processes, which meant processes to identify risk and ensure the service was operating within the scope of regulations had not been effective. Relatives, staff and professionals linked to the service told us the recent change in leadership had been positive and the standard of care provided by the service was improving.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 19 May 2018).

Why we inspected

The inspection was prompted in part due to concerns received about people’s care, closed cultures and management of risk. A decision was made for us to inspect and examine those risks.

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

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Longley Hall Limited on our website at www.cqc.org.uk.

Enforcement

We have identified 3 breaches in relation to safe care and treatment, staff training/ support and the systems of 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.

At the last inspection, we found the registered provider had a new quality assurance system in place, but this required further embedding into practice to ensure any potential areas requiring improvement were identified. We also made a recommendation about staff completing training in 'challenging behaviour' and 'conflict management'. At this inspection, we found the quality assurance system had been embedded into practice and was being used to improve the quality of the service and improvements had been made to staff training.

At the last inspection, we found that Mental Capacity Act (2005) guidelines were difficult for the registered provider to follow, as local authority court of protection orders were not always forthcoming. At this inspection, we found the registered manager continued to work with the local authority to ensure people's rights were maintained and protected, and their liberty was not being restricted illegally.

Longley Hall Limited is registered to provide personal care and comprises of one self-contained flat and four flats, which share a communal area. The service provides 24 hour support to people using the service. The service office is located in an annex between the flats. At the time of the inspection, the service supported 13 people and employed 21 support workers. The property has accessible gardens with seating and is in close proximity of Longley Park and public transport.

This service provides care and support to people living in ‘supported living’ settings, so that they can live in their own home 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection there was a registered manager in post. 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.’

People receiving support at Longley Hall told us they felt safe and they liked the staff. Some people who we spoke with did not use verbal communication. They expressed their happiness and satisfaction with the care they received by facial expression (smile), body languages and gestures. When we asked them if they felt safe, they expressed a positive response by holding their thumbs up. The reading of their body language was that they were happy, content and felt safe.

Staff were provided with training and information about safeguarding people. They knew what was meant by abuse and their responsibilities for reporting any concerns they had about people's safety. Risks people faced, including in the event of an emergency had been identified and plans were in place detailing how to minimise the likelihood of harm occurring.

Safe recruitment procedures were followed. Applicants were required to provide information about their previous work history, skills and qualifications and they were subject to a range of pre-employment checks. This information was used to assess their suitably and fitness to work with vulnerable people.

There were sufficient numbers of suitably qualified and skilled staff to safely meet people's needs and keep them safe. Staff were provided with training relevant for their roles and they received a good level of support.

People's views, choices and preferences about their care and support and how they wanted it provided was captured in assessments and incorporated into care plans. Care plans were kept under review with the involvement of people and relevant others so that people continued to receive the care and support they needed and wanted.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. The registered manager and staff had good knowledge and understanding of the Mental Capacity Act (2005) and their roles and responsibilities linked to this. People gave consent to the care and support they received and their ability to make informed choices and decisions was reviewed regularly. Care plans included details of those who had legal authority to make decisions on behalf of people.

People were treated with dignity, respect, and their privacy and independence was promoted. Staff showed people compassion in the way they supported them emotionally. People had formed positive relationships with staff and staff knew people very well including their backgrounds and things of importance.

People were provided with information about how to complain and they were confident about complaining should they need to.

The registered provider held regular coffee mornings and consultations to obtain people’s views. People’s feedback was used to help bring about improvements and changes to the service.

People knew who the registered manager was and where they could find her in the building. People and staff described the registered manager as being supportive and approachable and they told us she managed the service well. Staff told us they were recognised for their hard work and felt valued. They described an open door policy whereby they could speak with the registered manager at any time for advice and support.

There were effective systems in place for checking on the quality and safety of the service and for making improvements. This included checks carried out on care records, medication, staff performance and health and safety. Prompt action was taken to address any areas which were identified as requiring improvement.

Longley Hall Limited provides supported accommodation for people with learning disabilities and people on the autistic spectrum or people with a dual-diagnosis aged 18-65 years. It includes one self-contained flat and four flats with shared space and provides 24 hour support. At the time of the inspection the service supported 16 people. The property has accessible gardens with seating and is in close proximity to Longley park and public transport

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 registered provider had a new quality assurance system in place, but this required further embedding so that audits were able to identify potential areas for improvement.

The registered manager was able to demonstrate they had an understanding of Deprivation of Liberty Safeguards (DoLS) and the Court of Protection. However, we found that Mental Capacity Act (2005) guidelines were difficult for the registered provider to follow, as local authority court of protection orders were not always forthcoming.

We saw that staff completed an induction process and they had received a wide range of training, which covered courses the service deemed essential, such as safeguarding, medication and MCA. However, only three staff had completed training in ‘challenging behaviour’ and ‘conflict management’. We made a recommendation about this is in the report.

We found that staff had a good knowledge of how to keep people safe from harm and we found that the recording and administration of medicines was being managed appropriately in the service. Staff had been employed following appropriate recruitment and selection processes.

Assessments of risk had been completed for each person and plans had been put in place to minimise risk. The service was clean, tidy and free from odour and effective cleaning schedules were in place.

People's nutritional needs were met. We saw people enjoyed a good choice of food and drink and were provided with snacks and refreshments throughout the day. People told us they were well cared for and we found people were supported to maintain good health and had access to services from healthcare professionals.

People had their health and social care needs assessed and care and support was planned and delivered in line with their individual care needs. Care plans were individualised to include preferences, likes and dislikes and contained detailed information about how each person should be supported.

People were offered a variety of different activities to be involved in. People were also supported to go out of the home to access facilities in the local community.

The registered provider had a complaints policy and procedure in place and there were systems in place to seek feedback from people and their relatives about the service provided.

Each person we spoke with who used the service told us the staff were friendly and polite. One person said, "I like it here, staff are nice."

The provider had suitable arrangements in place to ensure that people who used the service were safeguarded against the risk of abuse. People we spoke with said that they felt safe and supported by the staff.

The provider had a satisfactory recruitment and selection procedure in place to ensure that staff were appropriately employed.

The provider had a system in place to deal with comments and complaints. People who used the service could be confident that their comments and complaints were listened to.