The Care Quality Commission
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Archived: Choice Support - Sutton & Merton Office

Overall: Good read more about inspection ratings

MSA House, Hackbridge Station, London Road, London, Surrey, SM6 7BJ (020) 8669 9668

Provided and run by:
Choice Support

All Inspections

18/06/2015 and 01/07/2015

During a routine inspection

This was an announced inspection. We gave the registered manager two days’ notice so they, or a suitable person, could be available to support the inspection. The last CQC inspection was carried out in August 2014. At that time we found breaches in relation to care and welfare, medicines and consent.

The service supports people in their own flats which were mainly within supported living schemes with staff available for support at all times. Most people had high support needs as the service specialised in providing care to people with severe to profound learning disabilities, as well as physical disabilities and autism. There were 34 people using the service at the time of our inspection.

There was a registered manager in post. 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.

At this inspection we found the provider had taken the action necessary to become compliant in relation to the three breaches we found at our last inspection. In relation to care and welfare the service had obtained advice from a dysphagia nurse for people at risk of choking when eating and suitable guidance was in place for staff to follow. We observed staff followed this in practice and had a good knowledge of how to support people to keep them safe while eating and drinking. Staff had received training regarding this. The service assessed people’s wheelchairs to ensure they were comfortable and people could be positioned within them in line with the recommendations to keep them safe while eating and drinking.

In relation to medicines we found good systems were in place with records for ordering, receiving, administering and returning medicines to the pharmacy. Our stock checks showed people were receiving their medicines as prescribed. In addition, medicines were now being administered covertly in line with the requirements of the Mental Capacity Act 2005.

The provider was no longer breaching the regulation relating to consent because they had assessed which people may be being deprived of their liberty and had informed the local authority so that they could make the necessary applications to the Court of Protection as required. Staff had a good understanding of their responsibilities under the Mental Capacity Act 2005 when depriving people of their liberty.

Staff understood how to recognise people may be being abused and were encouraged to report concerns. The service liaised appropriately with the local authority safeguarding team to keep people safe when an allegation of abuse was made.

There were sufficient numbers of staff deployed to meet people’s needs. The provider supported staff effectively though appropriate supervision, appraisal and training to provide them with the necessary knowledge.

Staff supported people appropriately to eat and drink and provided them with food according to their preferences. Staff monitored people’s risk of malnutrition and provided them with specialist support, such as dietitians, where necessary and followed their guidelines.

Staff were kind and caring towards people and treated them with respect and staff kept information about people confidential. People were involved in making decisions and planning their own care. The service assessed people’s needs and people had personalised care plans in place for their needs which staff kept up to date so the information in them was accurate and reliable for staff to follow. Staff knew the best ways to communicate with people and individuals had communication guidelines in place for staff to follow. Staff knew the people they were supporting well, including their backgrounds, preferences and daily routines, which allowed them to provide care in the best ways for people. Staff supported people to do activities they were interested in.

People were encouraged to maintain relationships with those who mattered to them, such as relatives, with no restrictions on visiting times and staff making guests feel welcome.

Suitable procedures were in place for people to raise concerns or complaints with a team in place to investigate these appropriately.

The registered manager and staff had a good understanding of their responsibilities. The quality of the service was monitored and reviewed through a range of audits carried out by different teams and individuals. Necessary improvements were made where concerns were identified in audits.

People were involved in developing the service and were supported to carry out inspections of individual schemes in the organisation to highlight areas of good practice and areas which could be improved. Staff were also involved in developing the service through regular staff meetings where they could share their ideas and suggestions for improvement.

Resources for driving up improvement were available. Within the organisation there were robust internal processes to share learning and best practice, including groups which met regularly to discuss safeguarding and other issues.

20/08/2014 and 22/08/2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by the Care Quality Commission (CQC) which looks at the overall quality of the service. This was an announced inspection. We gave the registered manager two days’ notice of our inspection. The last CQC inspection was carried out in February 2014. At that time we found that all areas we reviewed were met.

The service provides care and support to people living in their own flats, most, but not all, within supported living schemes. It specialises in providing care to people who have severe to profound learning disabilities, as well as physical disabilities and autism. There were 36 people using the service at the time of our inspection.

There was a registered manager in post. A registered manager is a person who has registered with CQC to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

People were not always protected from the risks of choking as guidance in place for individuals was not always followed.

Our stock checks showed that some medicines were unaccounted for, and people may not have received their medicines in the way in which records showed.

Staff we spoke with did not have a good understanding of their responsibilities in relation to the Deprivation of Liberty Safeguards (DoLS) and how these apply to people living in their own homes. There was no policy in place in relation this and the service had not carried out assessments to identify people who required applications to be made. People’s rights in relation to this were therefore not properly recognised, respected and promoted.

Systems were not always in place to identify the support people required to make choices and decisions about their care, according to the requirements of the Mental Capacity Act 2005.

There were enough staff employed in the service to meet people’s needs. Staff had a good understanding of how to identify abuse or neglect, and knew how to respond to keep people safe. There were policies and procedures in place to help keep people safe. Recruitment procedures were robust, with procedures in place to ensure that only applicants who were deemed suitable worked within the service. Staff were provided with a range of training and received supervision and appraisals to help them to carry out their roles appropriately.

People had care plans in place which reflected their assessed needs. People were supported effectively with their health needs. The service supported people who were at risk of malnutrition and dehydration, and those with specialist needs related to their diet. Referrals were made promptly to specialists where required.

Staff treated people with kindness and compassion and cared for people in an individual rather than a task-based way. Most staff had worked with people for many years and had a good understanding of their needs and preferences. People were encouraged to be involved in the running of the organisation.

People using the service, relatives and staff were encouraged to give feedback on the service. They knew how to make complaints and there was an effective complaints management system in place.

The service carried out regular audits to monitor the quality of the service and to plan improvements. However, these audits had not  identified the issues we found relating to deprivation of liberties and medicines management. 

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the end of this report.

14 February 2014

During a routine inspection

We spoke to relatives who told us people were treated with dignity and respect by staff. One relative told us the staff have people's, "Best interests at heart." We spoke to three support workers who conveyed a good understanding of the people they cared for and spoke about people in a respectful manner.

We found people's needs were assessed by healthcare professionals, key workers, the services manager and where possible people's families. One relative told us, "I am involved in all aspects of care." Another relative told us, "They know exactly what is needed, they know him so well."

We saw staff had been trained in safeguarding vulnerable people. We spoke to three support workers who told us they were happy with their safeguarding training and were able to discuss the different forms of abuse. We noted staff followed safeguarding procedures when incidents took place and knew who to contact in the event of a safeguarding issue.

We found there were sufficient numbers of staff with the right competencies, training and knowledge to provide safe, effective care. We noted there were systems in place to be able to respond to changing circumstances within the service.

We saw evidence that the provider and registered manager regularly monitored the quality of the service provided. This involved regular audits of quality of support and care and feedback audits. We noted that risk and support plans were updated and reviewed regularly.

27 February 2013

During a routine inspection

We were informed by the manager of the service that the people who use the service had complex needs and were non-verbal in their communication. We looked at the systems that were used by the provider to obtain feedback from people, contacted some social care professionals, spoke with seven staff that provided care and support to people and contacted the close relatives of five people who use the service.

Some relatives said "I can't praise Choice Support highly enough", "the staff are wonderful, they go beyond what they need to." The majority of relatives told us they felt involved in the care of their relative and were kept informed about changes that took place. Feedback from some relatives was that they did not feel staff always followed people's support plans.

Relatives said they felt assured that people were treated with dignity and respect. The staff we spoke with conveyed a good understanding of the people they cared for and respectful attitude towards people. Staff said they would like the opportunity to take people out more, but that this was limited by the hours they were given by the local authority to support people, as they could not provide one-to-one support for all people who use the service. This was confirmed by the relatives and the Operations Manager for the service.

The staff were supported in their role, though some said they would like more opportunities for professional development.