This inspection took place on the 29 August 2017 and was unannounced. 6A Clock Tower Mews is registered to provide personal care to people living in the community. They also provide care to people with a learning disability living within a supported housing environment. At the time of our inspection there were five people using the service. Two people were living within a supported living environment with staff who were providing 24 hour care support and three people were living independently in the community within Suffolk and Cambridgeshire.
It was evident during our inspection that the service was not always being managed on a day to day basis from the registered office, 6A Clock Tower Mews in Newmarket. The supported living service was provided and managed from a house in Littleport where the scheme manager and staff were based. This was the location, which was the point of contact for people who used the service.
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. The registered provider was the director of the company and was the registered manager responsible for the day to day management of the service.
Relationships between staff and people were relaxed and supportive of their needs, wishes and preferences. People were actively involved in making decisions about their daily care and support. Staff sought the consent of people in the planning and delivery of their care. Staff promoted and supported people's independence and enabled them to have access to the local community. Where risks to people had been identified, there were plans in place to manage them effectively.
Staff had completed training in safeguarding adults from the risk of abuse. Staff demonstrated how they would recognise and report safeguarding concerns to the relevant authorities. However, the risk of abuse to people was not always considered because there were ineffective systems in place for the recruitment and selection of staff.
People were generally satisfied with the service apart from occasional shortages of staff, which prevented them from receiving their planned care. We were unable to determine how hours commissioned by the local authority to provide one to one staff support to people both within the supported living service and to those people living in the community had been allocated. This meant we could not be assured people were receiving their care as commissioned.
Systems were in place to ensure that people received their prescribed medicines. Medicines were administered by staff who were trained to do this safely.
The provider did not have a clear overview of what training staff required. Staff had not been provided with all the training they needed to equip them for the roles they were employed to perform. For example, in meeting the needs of people living with dementia and those with complex needs who presented with distressed behaviours towards themselves and others. Staff had also not been provided with training in understanding their roles and responsibilities with regards to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).
Staff and the registered provider did not demonstrate a full understanding of their legal roles and responsibilities with regards to the Mental Capacity Act 2005.
People’s healthcare needs had been identified. However, further work was needed to ensure that planning for future appointments and annual health reviews for people living within the supported living service were clearly documented within their care plans.
Staff promoted a healthy diet and provided people with choice and opportunities to develop skills in the preparation and cooking of meals.
People had a support plan which reflected their personal choices and preferences regarding how they wished to live their daily lives. Support plans reviewed in the supported living service contained comprehensive information but were bulky and difficult to navigate with some out of date information. Care plans were not always recorded in a personalised format that the people who used the service could understand.
The registered provider did not operate an effective, accessible system for identifying receiving, handling and responding to complaints. People did not always have their complaints responded to in accordance with the provider’s policy.
Whilst staff told us that they felt supported in their role and worked well as a team, staff were not always provided with opportunities to contribute to the development of the service. This was because the provision of team meetings was sporadic and there was a lack of regular one to one supervision meetings with no access to annual appraisals.
Quality assurance systems had not been effective in recognising and rectifying issues. Quality assurance audits had not been completed on a regular basis to ensure the service was providing good quality care.
During this inspection, we identified a number of breaches 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 this report.