PSS Merseyside

Updated 19 October 2019

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 Care Act 2014.

Inspection team

The inspection was carried by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

A part of this service provides domiciliary care. It provides personal care to people living in their own houses and flats.

PSS Merseyside also provides care and support to people living in ‘supported living’ settings, so that 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.

The service also operates shared lives schemes across Merseyside and Wirral, they recruit, train and support self-employed shared lives carers (SLC) who offer accommodation and support arrangements for vulnerable adults within their own family homes in the community.

The service had two managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We gave the service 72 hours’ notice of our inspection so that the service could check with people or their representatives whether they were happy to visit people in their own homes. We also wrote to people using their service to let them know we may be calling them on the telephone.

Inspection activity started on 7 October and ended on 10 October 2019. We visited the office location on 10 October 2019.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with 11 people who used the service and four relatives about their experience of the care provided. We spoke with 10 shared lives carers, as well 10 members of the provider’s staff. These included the registered managers as well as other managers and senior managers, team leaders, support workers and a development worker. We also spoke with the provider’s nominated individual. 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 people’s care records and medication records. We looked at files in relation to staff and carer recruitment, as well as training and supervision records. A variety of records and information relating to the management, leadership, culture and development of the service, including checks and procedures were reviewed.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As pa

Updated 19 October 2019

About the service

PSS Merseyside provides personal care to people in their own homes, ‘supported living’ services and ‘shared lives’ schemes. The different parts of the service supported people of all ages with a large variety of health and care needs. People using the service included those with a learning disability and/or autism.

PSS Merseyside is a large and complex service covering Merseyside and the Wirral and had just before our inspection extended into St Helens and Knowsley. However, 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. At the time of inspection the service supported 64 people with personal care.

The majority of people receiving personal care lived in ‘supported living’ settings or ‘shared lives’ schemes. Supported living sites were small houses or bungalows in residential neighbourhoods, shared by up to three people. These were people’s own tenancies and included their individual bedrooms and some shared facilities, such as adapted bathrooms.

Some supported living services had been developed out of the provider’s former ‘care home’ sites. There were deliberately no outside signs to give a care home feel. We discussed some considerations to promote working with people in equal partnerships within their own, real tenancies. The registered manager explained their plans to improve this.

Shared lives schemes provided people with long-term placements, short breaks and respite care, within shared lives carers (SLC) own homes. Community support staff visited people in their own flats or houses.

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

To arrive at a fair and proportionate judgement for this complex service, we took into account an overall balance of our findings in the different parts of PSS Merseyside. We considered excellent examples of the service making a real difference to people’s lives, together with the improvement needs we found. On balance, people’s experience of using the service was very good.

People, relatives and shared lives carers told us they were overall very happy with the service. People’s comments included, “They are alright, the staff. They do everything they can really” and “We have lots of fun here, we are always laughing”. A relative told us, “I think we are quite lucky to have such good place for [relative] to live.”

However, we received some mixed feedback from people about how the service listened to them and involved them in some decisions. We found some improvements were needed to the consistency of staffing and staff supervision, as well as aspects of medication support. We made recommendations regarding these matters, which managers were addressing. People’s support plans gave detailed information about their life stories and needs, written in partnership with people, families, shared lives carers and staff. We highlighted a few areas for review, to ensure effective guidance for all staff.

The service was developing with respect to the principles of Registering the Right Support and other best practice guidance. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives. They ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. A more outcome-focused way of working had been introduced, which was still being embedded. We made a recommendation regarding the use of best practice guidance, to review how people were supported in partnership within their own tenancies.

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 overall supported this practice. We highlighted some development needs, which the provider was addressing.

We heard many examples of how the service had made a real difference to people’s quality of life. The provider shared with us stories of some fantastic outcomes for people using the service. Although not all of the examples related to people receiving personal care, we considered them as part of the service’s wider aspirations and successes to change people’s lives.

People using the service were supported in at times remarkably caring ways by staff and shared lives carers that had been robustly recruited. Staff and shared lives carers felt very well supported. The provider was continuously developing and looking to innovate the very positive culture, described by everyone we spoke with. A well-respected management team was seeking new ways to involve everyone in service design and delivery, to create an increasingly person-led service. The service worked in partnership with a large variety of professionals to promote people’s health, wellbeing and quality of life, which had been complimented upon by stakeholders.

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

Rating at last inspection

This service was registered with us on 30 October 2018 and this is the first inspection. The last rating for this service was good (published 30 May 2018). Since this rating was awarded the service has moved premises. We have used the previous rating to inform our planning and decisions about the rating at this inspection.

Why we inspected

This was a planned inspection.

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.