The Moorings Supported Living Service

Updated 10 May 2023

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

The inspection was completed by 2 inspectors.

Service and service type

This service provides care and support to people living in their own apartments in one ‘supported living’ setting, 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 12 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.

Inspection activity started on 16 March 2023 and ended on 23 March 2023. We visited the location’s office/service on 16, 22 and 23 March 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. 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 sought feedback from the local authority and professionals who work with the service. We used all this information to plan our inspection.

During the inspection

We spoke with 5 people who used the service and with 4 members of care staff and the registered manager, the regional quality & compliance manager and the divisional director representing the registered provider. We reviewed a range of records. This included 6 people’s care records and medication records. We looked at 6 staff files in relation to recruitment, training and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 10 May 2023

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

The Moorings Supported Living Service is a supported living service providing personal care to people with a physical disability, older people, younger adults, and people who may have learning disability and/or autism. At the time of the inspection 9 people were receiving personal care and lived in their own accommodation at the one location.

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

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. Staff supported people to make decisions following best practice in decision-making. Most people were able to make decisions for themselves and staff were seen to respect people’s choices.

Right Support:

People’s medicines records were not always accurate this meant we were not fully assured their medicines were managed safely. Staff supported some people to manage their own medicines independently. Staff enabled people to access routine and specialist health and social care appointments to ensure their health and wellbeing.

Some staff employed had not had all the required checks completed for working with vulnerable people before they began their employment. There were enough staff available to provide care and support to people as they needed it and in the event of an emergency.

We have made a recommendation the recruitment process used includes all of the required checks of suitability to work with vulnerable people.

People told us they were supported to be independent. People were supported by staff to pursue their hobbies and interests in their homes and in the community. People told us they enjoyed a variety of activities in the local community. One person told us, “I go out most days to do a variety of things. Today I’m going out for lunch with my relative.” Staff supported people to identify and achieve their aspirations and goals.

People had a choice about their living environment. The service gave people care and support in managing their own home, support with cleaning and choosing appropriate furnishings. One person told us they had been supported by staff to choose a new bed more suitable for their physical needs.

Right Care:

Some people's care and support plans were not always reflective of their current health needs and risks associated with their health. This meant those people were put at risk of not receiving the appropriate care, treatment, and support for their health condition. Staff had carefully identified and assessed other health conditions and risks associated with people’s health and lifestyles.

People received kind and compassionate care. One person told us, “The staff I have are so helpful.” Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs.

People were safe and protected from abuse. 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. One person told us, “I definitely feel safe I can call a member of staff at anytime and they always come to check on me.”

People liked the staff who supported them. One person said, "[Staff member] is nice, they have helped me sort out my new bed." People could communicate with staff and understand information given to them because a team of regular staff supported them consistently and understood their individual communication needs.

One person who had individual ways of communicating, using body language, sounds and their own sign language. Staff had worked with them to develop this and to understand and devise their new signs.

Right Culture:

People’s concerns and complaints had not been managed in line with the company’s policies and procedures. We saw some complaints had been informally responded to by the registered manager. However, we did not see how they had been investigated and/or responded to and what if any actions had been taken. This meant we could not be sure people and those important to them had their complaints fully investigated and resolved.

Governance processes in place were not used effectively. This meant there was no meaningful oversight of the safety and quality of care and support. We could not be sure there was a clear understanding of the performance of the service and where improvements were needed to be made had been recognised.

Staff did not always receive regular support in the form of continual supervision, appraisal, and recognition of good practice. Staff could describe how their training related to the people they supported.

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity. Staff knew people well and placed their wishes, needs and rights at the heart of everything they did.

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 good (published 16 November 2018).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about managing specific medical health needs. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the records used to manage specific health needs, so we widened the scope of the inspection to become a comprehensive inspection which included all of the key questions.

The inspection was prompted in part by notification of a medical incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of specific health needs. This inspection examined those risks.

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

Enforcement and Recommendations

We have identified breaches in relation to the records for identifying and managing health risks, the safe management of medicines, dealing with complaints and the oversight of the safety and quality of the service at this inspection.

During and immediately following the inspection the provider ensured any risks identified were addressed.

We have made a recommendation about ensuring all of the required checks of suitability are made during the recruitment of staff.

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 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.