Archived: Natural Ability

Updated 1 September 2018

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, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We gave the service 48 hours’ notice of the inspection visit because it is small service that supports people in their own homes and we needed to be sure someone would be in. The inspection was carried out by one adult social care inspector.

Inspection site visit activity started on 11 July 2018 and ended on 23 July 2018. It included visits to people who use the service, discussions with office and support staff, email surveys of all support staff and contact with external health care professionals. We visited the office location on 11 July 2018 to see the management staff and to review care records and policies and procedures.

We did not request a provider information return (PIR) due to the responsive scheduling of the inspection. A PIR is a form which asks the provider to give some key information about their service; how it is addressing the five questions and what improvements they plan to make.

Before the inspection we checked all the information we had received about the service including notifications which the provider had sent us. Statutory notifications are notifications of deaths and other incidents that occur within the service. We also spoke with the local authority safeguarding team.

During the inspection we visited five people who used the service. Where people could not express themselves, we observed the interactions between them and the staff who supported them. We spoke with the chief executive officer, an education manager (acting as the interim manager for the supported living service), a business development manager, two house co-ordinators and four support workers. We contacted two health care professionals, including learning disability nurses.

We viewed a range of records about people’s care and how the service was managed. These included the care records of three people, medication records of five people, the recruitment records of four staff members, training records and records relating to the governance of the service.

Updated 1 September 2018

This inspection was carried out between 11 and 23 July 2018. The inspection was announced as the provider was given short notice of the visit to make sure someone would be available.

This service provides care and support to nine people living in six small ‘supported living’ settings, so they can live in their own home 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.

This inspection had been brought forward due to concerns. This was because staff had raised concerns about safeguarding incidents that had occurred. These had not been reported to the local authority or to the Care Quality Commission, and had not been investigated by the provider. This meant vulnerable people had not been protected and safeguarding adults’ protocols had not been followed. Also, the provider’s quality monitoring processes were not effective in identifying gaps and shortfalls in the quality and safety of the service.

People were supported with their medicines in a safe way but there was no guidance for staff about when to support people with over the counter or ‘when required’ medicines. We have made a recommendation about this.

Staff told us they had not always felt well supported and had not received some of the training they needed. We have made a recommendation about this. Individual supervisions with staff had not been held in a confidential way. On-call management arrangements had not always been supportive to staff who worked with people who used the service. The provider showed us how these issues were being addressed.

There had been a registered manager at the service but they retired in November 2017. A new manager had applied for registration but left the organisation during this inspection. Another manager (from the organisation’s education department) was acting as manager in the interim until a new manager could be appointed. 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.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People were fully included in their local community and lived ordinary, fulfilled lives as local citizens. They took part in meaningful occupations, such as farming and gardening. They also enjoyed a number of individual leisure activities that they were interested in.

People were treated with dignity and respect. They were encouraged to make their own decisions and to lead as independent lives as possible.

People who could express a view felt the staff were caring and kind. People said they “liked” the support workers and described them as “nice”.

Staff were extremely knowledgeable about individual people and were aware of their individual preferences. People were supported to do their own shopping and make their own meals, with support only where needed.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA 2005). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; they understood the need to obtain consent when providing care. Staff had completed training in relation to the MCA 2005.

Senior manager had recently identified a number of areas for improvement and development. The organisation was committed to implementing those improvements and was considering better ways of monitoring the service in future.

We found two breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. These related to safeguarding people and good governance. You can see what action we told the provider to take at the back of the full version of the report.