Sanctuary Supported Living (Bromley Care Services)

Updated 7 October 2022

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 Health and Social Care Act 2008.

Inspection team

An inspector and two Experts by Experience carried out the inspection.

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

This service provides care and support to people living in two ‘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.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

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

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us.

The Inspection activity started on 14 July 2022 and ended on 26 July 2022. We visited one site and the location’s office on 14 and 26 July 2022 and the other site on 20 July 2022.

What we did before the 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 (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We visited the two sites where the regulated activity was provided and spoke with seven people across both sites about the support they received. Some people were not able to express their views fully to us and so we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with five people using the service at one site and two people at the other site.

An expert by experience made phone calls to six relatives of people using the service to gain their views about the support provided.

We spoke with staff including the registered manager and deputy managers of both sites and five care workers across both sites.

We reviewed a range of records. This included five people’s care records and five medication records. We looked at three staff files in relation to recruitment and training. We reviewed a variety of records relating to the management of the service, including audits and meeting minutes.

Updated 7 October 2022

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.

About the service

Sanctuary Supported Living (Bromley Care Services) provides personal care to up to 15 people with a learning disability and/or autism in two supported living settings. Most people using the service also have a physical disability.

People using the service lived in one of two houses with shared communal facilities. 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 our visit, the service supported ten people on one site and five people at the other site.

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

Right Support:

Arrangements to support people to make decisions did not follow best practice in decision-making in relation to their support. The model of care and setting did not always support people's choice, control and independence. Although one site had wheelchair accessible cooking facilities, these were not utilised to foster people’s independence and skills.

The service did not support people consistently to have the maximum choice, control or to be as independent as they could be. Arrangements to support people to make decisions did not follow best practice in decision-making in relation to their support.

There were sufficient numbers of suitably skilled staff to meet people’s assessed needs. Staff knew people well and understood their communication needs.

Right Care:

The service at both sites was run more as a care home with group-based activity and planning, rather than a model of care that was fully person centred.

Some decisions in relation to activities, routines and food choices were made with staff as a group rather than supporting people with person centred planning and choices in these areas, to increase choice and meet their preferences in these areas.

People’s human rights were not always promoted as their diverse needs were not assessed and there was an absence of records to show how these were effectively supported.

People’s care was not planned in line with best practice guidance; people were not supported to identify goals.

Staff knew how to keep people safe but risk assessments records did not always include risk management plans.

We have made a recommendation around the assessment and management of risks.

People and their families told us they thought people were safe and well looked after. Staff understood how to recognise and report any signs of abuse or neglect.

Medicines were safely administered and managed.

Staff enabled people to access health and social care support from health professionals. The service worked with people to plan for when they experienced periods of distress or anxiety. People were provided with information about the service in an accessible format.

Right Culture:

Staff were kind and considerate to people and interacted with warmth. However, the ethos of the service and staff behaviours did not always proactively consider aspects of people’s support needs with a view to increasing their autonomy and empowering them to lead fuller lives in the community.

There was a system for monitoring the quality and safety of the service but this was not always effective and had not identified many of the issues we found.

The provider did not ensure staff training needs were fully monitored or that staff fully understood the training and were able to put it into practice.

The provider had an Equality Diversity and Inclusion Strategy and shared information about some campaigns and developments with staff. However, we found there was an absence of proactive provider leadership in terms of ensuring staff were supported to fully embed best practice in relation to people with learning disabilities.

Following the inspection the provider sent us information to show how they had recently developed resources for staff they were introducing to promote community involvement and person-centred planning.

Overall people and their families were positive about the management and staff at the service. People’s views about the service were sought through tenants’ meetings and key worker sessions.

Staff were positive about the support they received from the management team and the provider. They told us they worked well together as a team.

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 the service was at a different address and the name of the service has changed since the last inspection. It was previously known as Sanctuary Home Care Ltd – Bromley. The last rating for this service was good, (Report published 9 July 2019.)

Why we inspected

This inspection was prompted by a review of the information we held about this service and to check if the service was applying the principles of 'Right support right care right culture.'

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

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

The registered manager has taken action to start to address the issues we found.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sanctuary Home Care Ltd – Bromley on our website at www.cqc.org.uk.

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.