Archived: Salford Regional Office

Updated 8 April 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008, as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23 February 2016 and was announced. We provided 48 hours’ notice of the inspection to ensure management were available at their Salford office to facilitate our inspection. We also contacted relatives of people who used the service via the phone on the 24 and 25 February 2016 to obtain their views of the services provided. The inspection was carried out by two adult social care inspectors from the Care Quality Commission.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we held about the service in the form of statutory notifications received from the service and any safeguarding or whistleblowing incidents which may have occurred. We also spoke to local commissioning and safeguarding teams.

At the time of our inspection, the service was made up of 13 homes, providing support for 38 tenants who lived in the Salford area. We spent time visiting five homes, which provided accommodation for 10 people who used the service, to see how services were provided and to review care files. Due to the complexity of needs of people, we were only able to speak with six people who used the service. However, we spoke with 15 relatives and a friend of one person who used the service via subsequent telephone interviews. During the inspection, we spent time at the office and looked at various documentation including care files and staff personnel files.

At the time of our inspection the service employed a total of 74 members of staff. During our inspection, we spoke with the regional manager, three service managers, the office administrator and 12 members of support staff.

Updated 8 April 2016

This was an announced inspection carried out on the 23 February 2016.

The service provides services to people with learning disabilities and complex physical health needs so that they can live as independently as possible in their own homes. People who use the service are tenants in their own right and live with support in various types of accommodation provided by a variety of different landlords. The service is currently made up of 13 homes, providing support for 38 tenants who live in the Salford area.

There was no registered manager in place during our visit, however a regional manager was present throughout the inspection. 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. We were told that Community integrated Care were currently in the process of restructuring services they provided and that a registered manager would be appointed once this programme had been completed.

This service had not been previously inspected by Care Quality Commission (CQC).

Immediately following our inspection on the 23 February 2016, we were informed that the service had moved office from its location at the time of our inspection visit to a new address. We found that the service had moved location without submission of an appropriate application request to CQC and before the application had been approved. We are currently considering our enforcement options at this time.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

While most staff acknowledged receiving supervision and confirmed that support was always available, a number of staff stated they had not received supervision consistently and could not remember whether they had received annual appraisals.

When we reviewed staff personnel files, whilst we saw evidence that some supervision had been undertaken, we saw no evidence of any consistent annual or regular appraisal of staff performance. Service manager’s acknowledged that supervision and appraisal had not been consistent as it could have been, but were currently addressing the issues.

This is a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because the provider could not demonstrate the appropriate support and professional development of staff.

We found the service had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. We looked at the service Adults Safeguarding Policy and guidelines together with the Local Authority Safeguarding Procedures, which provided guidance on managing safeguarding concerns.

As part of the inspection we looked at a sample of six care files and found that a range of risk assessments had been undertaken by the service. These provided guidance to staff on people’s individual needs and included risk assessments to ensure people were safe.

We looked at how the service managed people’s medicines and found that suitable arrangements were in place to ensure the service was safe. We found that records supporting and evidencing the safe administration were complete and accurate in people’s homes. People’s medication was stored in a secure cabinet within each person’s bedroom.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. On the whole, relatives told us they felt that there were generally sufficient staff numbers on duty to meet people’s needs.

We found all new members of staff underwent an induction programme. New staff attended a six day office based training session followed by a period of shadowing based on their individual requirements and confidence.

Staff had received training in the Mental Capacity Act (MCA) area were able to provide good examples about when people may be deprived of their liberty, or may not be able to make choices for themselves.

We looked at how people were supported to maintain good nutrition and hydration. We found where this had been identified as a support need, people had appropriate care plans and risk assessment in place.

People who used the service told us they were happy and felt well looked after by staff.

Staff we spoke with were able to provide good examples to demonstrate how they respected people’s dignity and privacy. One member of staff explained how they always ensured when providing personal care that doors and curtains were closed and emphasised how they respected people’s privacy and dignity at all times.

Both people and relatives told us the care staff helped to promote their independence or the independence of their relative. Staff told us how people become confident after being encouraged to be more independent.

On the whole, most relatives we spoke with said the service was responsive to their and their loved one’s needs.

People we spoke with confirmed they were involved in determining the care needs of their relative and were invited to annual reviews, where they felt listened to.

Each person had care plans in place which provided guidance for staff about how best to meet each person’s needs. These provided staff with information on medication, personal care, dietary requirements, communication, mental capacity, mobility and behavioural issues. The care plans were located at each house we visited so staff could access them easily, with duplicates held at the office.

We found the service had systems in place to routinely listen to people’s experience, concerns and complaints. The service had a complaints and compliments policy and procedure in place. This provided information about how people could inform staff if they were unhappy about any aspects of the service they received.

Most staff we spoke with told us they felt well-led and supported and that the service promoted an open and transparent culture.

We found the service undertook a comprehensive range of checks to monitor the quality service delivery. These included a health and safety check list, accident and incident reports and medication audits. The provider used a service quarterly audit tool, completed by service managers to review the quality of service delivery.

The service had policies and procedures in place, which covered all aspects of the service delivery. The policies and procedures included safeguarding, medication, whistleblowing, infection control and Mental Capacity Act.