22 February 2023
During a routine inspection
About the service
Diverse Abilities Plus – Supported Living is a domiciliary care and supported living service. It provided personal care to 33 people at the time of the inspection.
People’s experience of using this service and what we found
Right Support:
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. We have made a recommendation about the recording and review of mental capacity assessments and best interests decisions.
People and relatives said they felt consulted in decisions about care, and that their views were taken seriously.
There were enough staff with the use of agency staff to meet people’s needs. Regular staff supported people in a way that fostered their independence. However, people living in houses with staff vacancies had regularly experienced care from agency staff who did not know them as well. Relatives said because agency staff did not know people as well, they were not as attentive to their individual needs and preferences. We have made a recommendation about which staff support people.
Risks to people and to the staff supporting them were assessed. People’s support plans set out how staff should support people to manage these risks in the least restrictive way. Staff followed support plans with clear instructions about people’s preferences and support needs in relation to preparing food and eating and drinking.
People each had a health passport, which summarised succinctly what care staff and professionals in other settings needed to know about the person.
Staff understood people’s communication needs and provided the support required, as set out in their support plans. Where people had communication passports devised in consultation with a speech and language therapist, support plans referenced these.
Right Care:
People and relatives said they and their loved ones felt safe and comfortable with staff. There were pre-employment checks for new staff. Staff had training about their role in safeguarding people from abuse. The registered managers recognised there had been an issue with staff identifying the need to report incidents and had already started to address this. We have made recommendations about the incident monitoring process, and about the provider’s safeguarding adults policy.
The service had not always notified CQC of reportable incidents. The registered managers took steps to address this immediately we drew it to their attention.
People and relatives said they were happy with their or their family member’s care and support from regular staff, and they felt staff cared about them. People’s needs were assessed holistically, which formed the basis of their highly personalised support plans. Staff confirmed they had access to people’s clear, current support plans that enabled them to provide effective care and support.
People were supported with their medicines in the way prescribed for them. There had been some medicines errors and incidents recently and improvements had been put in place to reduce these.
Staff were supported through initial and update training, training specific to the needs of people they supported, regular individual supervision meetings and team meetings. They also had informal contact with the senior staff and managers connected with the house they worked in, and with on call staff.
Right Culture:
The registered managers were swift to address any issues we identified, or which they themselves had found. However, quality control processes and audits had not identified some issues reported by relatives nor the issues we found with missed notifications to CQC and with the recording of mental capacity assessments and best interests decisions.
The provider had a culture of inclusivity, person-centredness and openness. This was reflected in people, relatives and staff feeling comfortable to raise concerns with managers, and in efforts to ensure people and staff were not disadvantaged because of disability. We have made a recommendation regarding the service’s complaints policy.
The registered managers were open and honest with people and their families in the event of something going wrong or a near miss.
The registered managers recognised consistent staffing was important for people and, recognising the reliance on agency staff in some houses, were actively recruiting new staff. They also ensured that when a person was admitted to hospital, they continued to receive support from Diverse Abilities staff regardless of the hospital being able to fund this.
People were supported to keep in contact with their families and to pursue friendships. Staff also supported them to pursue hobbies and interests, at home and out.
People accessed health services as they needed, including annual health checks, age-related health screening, dental care, sight tests and check-ups with primary care or hospital specialists in relation to health conditions.
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 January 2022, and this is the first inspection.
The last rating for the service at the previous premises was good, published on 10 November 2018.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Enforcement and Recommendations
We have identified breaches in relation to notifying CQC of reportable incidents, and monitoring and improving the quality and safety of the service, at this inspection.
We have made recommendations in relation to accident and incident monitoring, the safeguarding adults policy, mental capacity assessments and best interests decisions, and the complaints policy.
Please see the action we have told the provider to take at the end of this report.
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 continue to monitor information we receive about the service, which will help inform when we next inspect.