St Anne's Bradford Supported Living Services

St Anne’s supported living service – Bradford provides care and support to people living in a number of '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 we looked at people's personal care and support. The service supports people with physical disabilities, learning disability and mental health support needs. 29 people were being supported by the service at the time of the inspection.

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.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support: The service maximised people’s choice, control, and independence. Staff were mostly safely recruited and received an induction followed by training from the provider. Training was completed by staff. Staffing capacity was enough to meet people’s needs.. The provider followed best practice guidelines to effectively manage people's medicines and risks associated with infection prevention and control (IPC). People and their relatives were positive about the care provided. People told us they liked their home and the staff who supported them.

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. If people lack capacity to make certain decisions appropriate support is sought to support them.

Right care: Care is person-centred and promoted people's dignity, privacy, and human rights. People were encouraged to communicate freely and accessed the community for activities when they wanted to. Staff supported people to learn new skills and maintain important contacts. Staff knew people well and understood their support needs which empowered people to make decisions about their care.

Right culture: People who use services had inclusive, and empowered lives through care staff's ethos, values, attitudes, and behaviours. Regular communication between the service and family members and medical experts helped to foster positive working relationships.

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 good (published 30 October 2018).

Why we inspected.

We inspected due to the length of time since the last inspection.

We undertook a focused inspection. This report only covers our findings in relation to the Key Questions Safe and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed not changed. 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 St Anne’s Community Services – Bradford 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.

St Anne's Bradford Supported Living Services is a domiciliary care service. The service supports adults with learning disabilities to live in their own home. At the time of this inspection 31 people were using the service supported in 15 houses across the Bradford area.

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 last inspection in July 2017 we rated the service as ‘requires improvement’ overall. We found the provider was in breach of Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because people’s medicines were not always managed safety and quality assurance systems were not operated effectively. Following the inspection, the provider put an action plan in place to address these shortfalls. During this inspection we found the required improvements had been made. The provider was not in breach of any regulations.

The service had three registered managers. 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 told us they felt safe and if they were worried they would talk to a support worker or a member of the management team.

Medicines were managed safely.

Risks to people safety and welfare were well managed. There was clear guidance for support workers about how care and support should be delivered.

Support workers knew the needs and wishes of people at the service. Support workers spoke respectfully and kindly about the people they supported and it was evident they cared about them and their wellbeing. We observed person centred and caring interactions between people who received support and staff.

People were supported to have a varied and nutritious diet and encouraged to choose healthy eating options.

People were happy with the care and support they received. They were encouraged to make day to day choices and had control over their lives.

People were supported to get involved on the running of their houses and the service overall. They were supported to share their views though meetings and surveys.

People were supported to take part in range of activities of their choosing at home and in the community.

There were enough support workers deployed to make sure people got the right support. Support workers worked in teams which helped to make sure people were supported by staff they knew and felt comfortable with.

All the required checks were done before new support workers started work. People were given the opportunity to get involved in the recruitment of new staff.

Support workers told us they felt well supported by the management team. They received the training and support they needed to carry out their duties.

People were comfortable talking to support workers and members of the management team and said they would discuss any issues or concerns.

The provider had effective systems in place to monitor the quality and safety of the service.

St Anne's Bradford Supported Living Services is a domiciliary care service. The service supports adults with learning disabilities to live in their own home. At the time of this inspection 30 people were using the service in 16 houses around the Bradford area and surrounding districts.

The service had three registered managers. 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 told us on the whole they felt safe and if they were worried they would talk to a member of staff or a member of the management team. Two people felt unsafe when another person they lived with got angry.

Medicines were not managed consistently and safely and staff did not always receive medicine related training or a competency assessment.

Risk was usually well managed and care and support was planned. Staff had guidance around how care should be delivered. People told us they were happy with the meals and support they received to help make sure they stayed healthy. Meals were not sufficiently monitored so the provider could not be confident people’s nutritional needs were being met. The provider wrote to us after the inspection visit and told us they had taken swift action to address this.

People were happy with the care and support they received. They were encouraged to make day to day choices and had control over their lives. The provider was introducing decision making assessments and support plans. People got involved in the running of the home and enjoyed person centred activities, which often involved engaging in the local and wider community.

Staff felt supported by colleagues and management. However, training and supervision was not always kept up to date. The provider had picked this up through their monitoring systems and action was being taken to make sure staff received appropriate support.

People received support from a consistency workforce and their agreed one to one staffing. Recruitment procedures were robust and ensured suitable workers were employed.

People were comfortable talking to staff and members of the management team and said they would discuss any issues or concerns. The provider encouraged people to share their views through surveys. Promoting regular tenant meetings was an on-going action plan.

The provider had some effective quality management processes however, these were not applied consistently across the service and some of the issues identified at the inspection had not been picked up by the provider. The registered managers took swift action in response to the issues we raised. We received positive feedback about the management team.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. These related to safe care and treatment and person centred care. You can see the action we have told the provider to take at the end of this report.

The last inspection took place in December 2013 and the provider was compliant with all the standards inspected.

St Anne's Bradford Supported Living Services is a domiciliary care service. The service supports adults with learning disabilities to live in their own home. In addition, through a floating outreach service they support adults with learning disabilities, head injuries and /or mental health issues with individual packages of care ranging from a small number of hours per day or per week through to 24/7 depending on the individuals assessed needs.

The service had 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 told us they felt safe and could speak to any of the staff if they were worried about anything. The manager understood their responsibilities for safeguarding people and staff were trained to understand and recognise abuse. They knew who to report concerns about people’s safety and welfare within the organisation and to external agencies if necessary.

Sufficient numbers of staff were deployed to provide people with the care and support they needed. The required checks were done before new staff started work and this helped to keep people safe. Staff were provided with training and support to help them carry out their roles. However, some staff felt the training was somewhat limited.

Where people were supported with their medicines this was done safely. There were safe systems in place to support people with managing their finances.

Risks to people’s safety and welfare were identified and managed. Risk assessments clearly identified the risks to people and what could be done to mitigate the risks and keep them safe whilst promoting independence. Staff were provided with information about how to deal with emergencies and senior managers were on call outside of office hours to provide support.

Meals at the supported living houses were prepared and cooked by staff with the involvement of the people who lived there. We saw people’s nutritional needs and preferences were taken into account.

We found the service was working in accordance with the Mental Capacity Act 2005 and this helped to make sure people’s rights were protected. When there was any doubt about a person’s capacity to understand a particular decision the correct process was followed to make sure any actions taken were in their best interests.

‘Health Action Plans’ were in place to help support people to lead a healthy lifestyle. These included information about health care professionals involved in supporting people and details of how people were able to communicate health care issues and emotions. The service worked with other health and social care professionals to help achieve positive outcomes for people.

To promote person centred care the provider was in the process of training all staff on Positive Behaviour Support (PBS). This is a care model promoted by BILD (British Institute of Learning Disabilities) as the preferred approach when working with people with learning disabilities who exhibit behaviours described as challenging.

People told us staff respected their privacy and dignity and provided them with the support they needed. Staff demonstrated a caring attitude and we saw the interactions between staff and people who used the service were friendly and warm. People were supported to maintain relationships with family and friends and take part in a range of social activities of their choosing.

People were involved in decisions about all aspects of their care and support and where appropriate people were supported to access advocacy services.

The care documentation supported a person centred approach. However, we found this was not always reflected in the way they were completed and we found the records were not always up to date. We also found the records in the office did not always have the same information as the records in people’s houses.

There was a complaints procedure. The people we spoke with said they had no reason to complain but would not hesitate to speak with one of the staff or the manager if they had any concerns.

There were systems in place to monitor and improve the quality and safety of the services provided.

The way the service was organised prevented the registered manager from fulfilling their role and responsibilities. The service was divided into four operational patches and they had limited access to the records about people who used the service and staff in three of the four patches. In addition, they did not have line management responsibility or authority over the other patch managers.

We talked with two relatives, one told us 'Without the service we would not have known what to do, my relative has got really better since they moved into the house They told us they would recommend the service. Another told us their relative was involved in their care and the care was now person centred and the staff planned for any changes to their relatives care needs.

We saw fourteen people had completed a client satisfaction survey in 2012, when asked if they thought the staff listened to them and if they had a choice in how their support was provided all stated 'Yes' to both questions. This showed us that peoples care was individualised to meet their specific care and support needs.

We found staff sought people's agreement and people were provided with the opportunity to make decisions about their care and treatment. People's care and treatment needs were assessed before a service was offered and people had experienced care and support which had met their needs. St Anne's Bradford Supported Living Services also had effective systems in place which identified, assessed and managed the risks to the health, safety and welfare of people who used the service and others such as members of staff.