16 March 2023
During an inspection looking at part of the service
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.