Hertfordshire Supported Living Services

Hertfordshire support living is a domiciliary care agency providing personal care. The service provides support to people with a Learning disability and autistic people. At the time of our inspection there were 3 people using the service.

People’s experience of the 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Care

The provider did not operate a safe recruitment procedure. We found gaps in their recruitment systems.

People had risk assessments that detailed their immediate risk, however, in some area’s did not always identify how to mitigate the risks. We recommend risk assessment are reviewed and developed further, highlighting in detail how to mitigate risks where appropriate.

Medicines administration records were not always completed accurately with the prescribers’ instructions, where entries of medicines were written on the records, staff did not always follow best practice by two staff signing off to state the records were accurate.

People said they were encouraged to be as independent as they can with their medicines and staff supported them when required.

Right Culture

The provider had a management structure that monitored the quality of care to drive improvements in the service delivery. In some circumstances they had not identified the areas of improvement, such as staff completing learning disability training, recruitment files and medicine administration records.

The registered manager had a good understanding of people they supported. People described that they had a good life, and they were able to do as they wished, however in some circumstances the care plans could be developed further to capture peoples long term aspirations and what was important to them.

People and staff were involved in the running of the service and fully understood and considered people’s protected characteristics.

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.

Right Support

Staff said they felt there was enough staff to keep people safe. People said they felt safe.

People were safeguarded from abuse and avoidable harm. The provider and registered manager had systems in place to ensure people were supported safely. The registered manager made sure there was a consistent approach to safeguarding matters, which included completing a detailed investigation and sharing the learning with staff, following any incident.

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 (28 June 2016).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement

We found a breach in regulation 19. The provider was unable to produce the recruitment documents for staff to show that staff were recruited safely. 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.

This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information. We visited people in their own homes and phone calls to engage with people using the service as part of this performance review and assessment.

Hertfordshire Supported Living Services provides personal care and support services to adults with a learning disability living in their own homes, within shared premises in the Hertfordshire area. The provider took over the running of the service in January 2016 as the previous provider had failed to provide good quality care to people using the service. At the time of the inspection, the provider was supporting five people with regulated activities.

The service has a Registered Manager in place. 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.

There were risk assessments in place that gave guidance to staff on how risks to people could be minimised and how to safeguard people from the risk of possible harm.

The provider had effective recruitment processes in place and there were sufficient staff to support people safely. Staff understood their roles and responsibilities and would seek people’s consent before they provided any care or support. Staff received supervision and support, and had been trained to meet people’s individual needs.

People were supported by caring and respectful staff who knew them well. Relatives we spoke with said that there had been a positive change in the way people were cared for since the new provider had taken over. People were supported to go into the community and pursue their interests.

People had been assessed, and care plans took account of their individual needs, preferences, and choices. Staff supported people to access health and social care services when required and encouraged them to lead an independent life.

The provider had a formal process for handling complaints and concerns. They encouraged feedback from people and acted on the comments received to continually improve the quality of the service. The provider also had effective quality monitoring processes in place to ensure that they were meeting the required standards of care. However, they had not been effective in ensuring that the housing provider made the necessary repairs and adaptations to people’s homes.

We observed that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that support plans and risk assessments were informative and up to date. Staff we spoke with were aware of their contents, which supported them to deliver appropriate and safe care. Staff recruitment systems were robust.

The provider had a range of quality monitoring systems in place to ensure that care was being delivered appropriately by staff in line with individual care plans, and that people were satisfied with the service they were receiving.

We found the provider had systems in place to ensure people were making informed decisions about their care. We also found that people's care plans and risk assessments were reviewed regularly to ensure people were receiving the care they needed. The provider had policies and procedures in place to protect people from abuse or unsafe care. There were quality assurance systems to assess, monitor and evaluate the quality of service provided. We noted that the provider had done a comprehensive assessment of the number of staff needed to support people who use the service.