Trusted Hands Supported Living - Dudley

About the service

Grazebrook Homecare Ltd provides personal care and support to 11 people in four supported living settings.

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

Right Support

The service (or staff) supported people to have the maximum possible choice, control and independence be independent and they had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

People were supported by staff to pursue their interests. Staff supported people to achieve their aspirations and goals. People had a choice about their living environment and were able to personalise their rooms. The service made reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go. Staff supported people to take part in activities and pursue their interests in their local area. Staff enabled people to access specialist health and social care support in the community. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

Right Care

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols and could interact comfortably with staff and others involved in their treatment/care and support because staff had the necessary skills to understand them. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life. Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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

Rating at last inspection The last rating for this service was requires improvement (published 19 October 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This inspection was prompted by a review of the information we held about this service.

You can read the report from our last inspection by selecting the ‘all reports’ link for Grazebrook Homecare Ltd on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Grazebrook Homecare is a supported living service providing personal care to eight people with learning disabilities, and physical disabilities and adults aged 65 years and over. The service supported people living either alone or in small groups in four separate houses.

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

Since the last inspection in January 2019 we found improvements had been made to address the areas we identified as requiring improvement. However, there remained some areas for further development whilst embedding and sustaining the improvements made so far.

People were supported by a group of staff who knew them well. Staff were aware of the types of abuse people may be at risk of and their responsibility to raise concerns to the appropriate authorities. Risks to people were identified and care records reflected people’s current needs. A dependency tool was in place to assist the registered manager in ensuring people were supported by sufficient numbers of skilled staff. Improvements had been made in the administration of people’s medication. Accidents and incidents were report and acted on appropriately and analysed for any trends.

Staff felt supported and well trained. Additional training was sourced to provide staff with the skills to meet people’s individual needs. People were supported to access a variety of healthcare services in order to maintain good health.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These 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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People were treated with dignity and respect by a group of staff who knew them well. Staff respected people’s decisions on how they wished to spend their time and encouraged people to maintain their independence, where possible.

People were involved in the development of their care plans. Care plans held details regarding people’s likes and dislikes, their preferences as to how they wished to b supported and what was important to them. People were supported to maintain relationships with friends and family and take part in activities they enjoyed.

Staff and relatives were complimentary of the service and the registered manager and deputy. They recognised the improvements that had been made to the service since the last inspection and the positive impact these had on service delivery, particularly the increase in staffing levels. The variety of audits introduced provided the registered manager with oversight of the service.

People’s opinions were sought through meetings and surveys. Relatives had no complaints but were confident if they raised concerns they would be responded to appropriately.

The registered manager had a plan for action to continually improve the service and staff were on board with the improvements made to date.

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

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 part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service used some restrictive intervention practices as a last resort, in a person-centred way, in line with positive behaviour support principles.

Rating at last inspection (and update) The last rating for this service was inadequate (published 28 February 2019) and there were multiple breaches of regulation. We returned to the service in February 2019 to follow up on the concerns (published 20 March 2019) and the provider remained inadequate. 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.

This service has been in Special Measures since 28 February 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Grazebrook Homecare 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.

About the service: Grazebrook Homecare is a supported living service providing personal care to seven people with learning disabilities, and physical disabilities and adults aged 65 years and over.

People’s experience of using this service:

People told us they felt safe using the service but we found care and treatment was not always provided in a safe way. The provider had failed to update care plans and risk assessments for peoples changing needs.

The provider failed to ensure people’s care plans and risk assessments contained accurate and up to date guidance. Risk to people was not identified therefore no plans were put in place, exposing people to harm.

No action was taken to reduce re-occurring risks. Analysis of incidents and accidents did not take place. There was a lack of good governance and oversight therefore audits and checks were ineffective.

Systems and processes were not effective in assessing, monitoring and mitigating the risks relating to environmental health, safety and welfare of people. Audits did not take place on a regular basis.

The provider had not undertaken capacity assessments, it was unclear whether people had agreed or consented to care and treatment or had contributed to the development of their care plans. The local authority had not been notified of people who may be deprived of their liberty.

People were supported to access health care services when they needed. People and their relatives told us staff were good at monitoring their health needs. Staff had completed mandatory training.

Staff treated people with kindness and respect. People said they liked the staff and relatives said they could talk to staff. People and relatives were confident if they raised a complaint, it would be dealt with appropriately.

Rating at last inspection: Rated good (report published 29/03/2016)

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

inspection took place in 15 January 2019

Enforcement

Full information about The Care Quality Commission’s (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Follow up

As we have rated the service as inadequate, the service will be placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspect again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

About the service: Grazebrook Homecare is a supported living service providing personal care to seven people with learning disabilities, and physical disabilities and adults aged 65 years and over.

People’s experience of using this service:

People told us they felt safe using the service but we found care and treatment was not always provided in a safe way. The provider had continued to fail to update care plans and risk assessments for peoples changing needs.

The provider continues to fail to ensure people’s care plans and risk assessments contained accurate and up to date guidance. Risk to people was not identified therefore no plans were put in place, exposing people to harm.

No action had been taken to reduce re-occurring risks. Analysis of incidents and accidents was not kept. There was a lack of good governance and oversight therefore, audits had not been completed since the last inspection.

Systems and processes were not effective in assessing, monitoring and mitigating the risks relating to environmental health, safety and welfare of people. Environmental Audits had not taken place since the last inspection.

The provider had not undertaken capacity assessments since the last inspection, it was unclear whether people had agreed or consented to care and treatment or had contributed to the development of their care plans. The local authority had not been notified of people who were deprived of their liberty. The provider did this on the day of inspection

Rating at last inspection: Rated inadequate (report published 22/02/19)

Why we inspected: In the previous inspection we found a breach of regulations. The provider

informed us what they would do to meet the requirements. The information shared with CQC about

the management of risks indicated potential concerns about the safe care and treatment of people

and a lack of governance and oversite. This was a focused inspection that examined those risks.

The inspection took place on 14 February 2019

Enforcement

Full information about The Care Quality Commission’s (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Follow up

As we have rated the service as inadequate, the service will be placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspect again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not, enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The service is registered to provide personal care and support to people in their own homes and at a supported living service. People who use the service may need support or care due to old age, learning disability or physical disability. At the time of the inspection the service was providing support and personal care to seven people in four separate supported living services. Supported living enables people who need personal or social support to live in their own home supported by care staff instead of living in a care home or with family. The levels of support people received from the service varied, according to their assessed needs and levels of independence. This was the first inspection of this service.

There was 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.

People were supported by staff who had received training in how to recognise possible signs of abuse and how to report any concerns. Staff were aware of their responsibilities in this area and what actions they should take. All staff spoken with were confident that if they did raise any concerns, that they would be listened to and acted upon.

Staff were recruited appropriately and there were sufficient number of staff to meet people’s needs. Staff received induction training which included shadowing senior colleagues before starting work. Ongoing training was in place in order to develop staff skills and systems were in place for management to assess the effectiveness of the training provided.

People were supported to live their lives in the least restrictive way possible, staff understood the requirements of the Mental Capacity Act [MCA] and Deprivation of Liberty Safeguards [DoLS], and what it meant for the people they supported.

People were supported with their nutrition and health care needs.

People told us that the staff who supported them were kind and caring and helped them maintain their independence.

People were involved in developing how they wanted to be supported and were encouraged to be as independent as possible and achieve their aspirations.

People were confident that if they had any concerns, they would be dealt with appropriately.

The registered manager and staff group were described as supportive and approachable. Staff performance was monitored and efforts were made to ensure staff were well supported in their roles.

A number of audits were in place to assess the quality of the service provided but had failed to identify a number of issues highlighted by the inspection.. The registered manager and staff regularly sought feedback from the people they supported.