Archived: Creative Support - Bedfordshire Service

Creative Support – Bedfordshire Service provides personal care and support to people living in ‘extra care housing’. People using the service lived in flats in three buildings across Bedfordshire. At the time of this inspection 33 people were using the service.

Not everyone living at the schemes 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.

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

People had positive experiences of using the service and told us they felt safe. People were supported by teams of regular, consistent staff. There were enough staff to support people and meet their needs.

The provider had robust recruitment procedures in place and completed relevant checks before staff worked at the service.

Staff had been trained and understood the principles of safeguarding people from harm. Risk to people's health, safety and wellbeing had been identified and assessed. Staff knew the actions they needed to take to support people to stay safe.

Medicines were managed safely, and staff followed good infection control practices.

People were involved in planning their care. Care plans in place reflected people’s needs and preferences. Staff knew people well and understood how their identified needs should be met.

The provider had systems in place to obtain people’s feedback about the service and to seek their views.

There were quality assurance systems in place to monitor all aspects of the service. There were processes in place to manage accidents, incidents and complaints and to ensure these were investigated and learned from. Audits were completed to monitor all aspects of the service. Action plans were in place to ensure any issues found were addressed and improvements made when identified as required.

People, relatives and staff spoke highly of the registered manager. All staff felt supported by the registered manager to complete their roles and were provided with the guidance, training and support they needed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 June 2019).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service between 03 June 2019 and 07 June 2019. Breaches of legal requirements were found and recommendations made. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe recruitment, governance and the absence of a registered manager.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements and recommendations.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Creative Support – Bedfordshire Service on our website at www.cqc.org.uk.

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.

People’s experience of using this service: People were not always kept safe from harm. Incidents and accidents did not receive adequate oversight to ensure that lessons were learned to help keep people safe.

People’s risk assessments and care plans were lacking in information, both to keep people safe and to identify peoples likes, dislikes and preferences. Care plans and risk assessments were not being regularly reviewed.

Staff were not receiving supervision and competency checks in line with the provider’s policy. This meant that the management team did not have an oversight as to whether staff had the skills, training and knowledge to be competent in their roles.

Staff recruitment checks were not being robustly completed and areas such as references from previous employers and gaps in employment history were not evidenced in staff files.

Audits and systems in place to monitor the quality of the service were not effective in identifying areas where the service could improve. There had not been oversight of the service at senior management level for an extended period of time.

People and their relatives were positive about the service and the care they receive. One person told us, ‘‘I am well looked after here, and I am very happy. The staff are very good and very helpful.’’

People were supported with kindness respect and compassion. The core staff team were passionate about providing person-centred care to people.

There were enough staff to meet people’s needs. People received their care visits on time and for the correct duration of time. The service was currently using a high percentage of agency staff and were in the middle of recruiting new permanent members of staff.

People were supported safely with their medicines. We have made a recommendation to the service about completing stock checks of medicines.

People had access to healthcare professionals and staff were flexible with their visit times to ensure people could attend health appointments.

People had not been supported to put plans in place for the end of their life. We have made a recommendation to the service about supporting people to do this if they choose to do so.

There was a detailed complaints policy and procedure in place for people to use.

The management and staff teams worked well with outside agencies to provide people with opportunities to take part in different activities.

People and their relatives were positive about the management of the service.

The manager and area manager acknowledged that improvements needed to be made at the service.

Rating at last inspection: At the last inspection the service was rated as Good (report published 02/12/2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection. During this inspection we found evidence which means that the service is now rated as Requires Improvement. Full details are in the report below.

Enforcement: We identified three breaches of the Health and Social care Act (Regulated Activities) Regulations 2014. Details of actions we have asked the provider to take can be found at the end of this report.

Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor information and intelligence we receive about the service to ensure good quality is provided to people. We will return to re-inspect in line with our inspection timescales for Requires Improvement services.

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

This inspection took place on 4, 5 and 6 October 2016, and was announced. At the last inspection in October 2015, we asked the provider to take action to make improvements to the number of staff on duty and the completion of mandatory training for members of care staff. This action had been completed.

The service has a registered manager in post that was present throughout our inspection. 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.

People told us that they felt safe and were supported by consistent, reliable staff. Staff understood their responsibilities with regards to safeguarding people and they had received relevant training. There were systems in place to safeguard people from the risk of possible harm.

Accidents and incidents were reported promptly, analysed by senior staff and action taken to reduce reoccurrence. Personalised risk assessments that gave guidance to staff on how individual risks to people could be minimised were completed and updated regularly.

The service had robust recruitment procedures in place. There were sufficient staff on duty to meet the care and support needs of people and an effective system to manage the rotas and schedule people’s care visits in each of the schemes.

There were effective systems in place for the management of medicines. People were supported to take their medicines as prescribed, where assessed as required.

Staff were skilled and competent in their roles and were supported by way of spot checks, supervisions and appraisals. These were consistently completed for all staff and used to improve and give feedback on performance.

People were complimentary about the catering services provided at the schemes and the support they received at mealtimes. People were supported to maintain their health and well-being and accessed the services of health professionals.

Staff were kind, caring and friendly. They provided care in a respectful manner and maintained people’s dignity. People were involved in making decisions about their care and their consent was sought. Positive relationships existed between people and staff.

People’s needs had been assessed and they had been involved in planning their care and deciding in which way their care was provided. Each person had a detailed care plan which was reflective of their needs and had been reviewed at regular intervals. Staff were knowledgeable about the people that they were supporting and provided personalised care.

People, their relatives and staff knew who to raise concerns to. The provider had an robust process for handling complaints and concerns. These were recorded, investigated, responded to and included actions to prevent recurrence.

There were effective quality assurance processes. Feedback on the service provided was encouraged and action plans had been developed to address any issues raised within audit processes and surveys, with a view to continuously improve the service.

There was positive leadership at the service and people, staff and relatives spoke highly of the registered manager. Staff felt valued, motivated and were committed to providing quality care.

People were very complimentary about the care staff and the standard of service they received. They were aware of their care plans, had discussed them with staff and could make changes if required. One person told us, "They're marvellous." and another said, "They can't do any better. I'm very happy with the service." People told us they felt safe.

There had been issues with regard to some missed calls and medication errors at one of the schemes during the period of October 2012 and January 2013. We found that the provider had taken action to address these, working with service commissioners to identify the issues and put systems in place to reduce the risk of further incidents. This work had led to significant improvements in staff training and auditing arrangements, and people and staff told us the service had improved.

We saw there were systems in place to support staff with performance reviews, supervision and training. Staff told us they felt supported by the company and the local management team.

The provider had a system in place for receiving and resolving any complaints. We saw that where complaints were made these were investigated and systems reviewed to reduce the risk of a reoccurrence.