Living Ambitions - Newcastle

Living Ambitions - Newcastle provides care and support to people living in 16 ‘supported living’ settings. At the time of the inspection 30 people were using the service.

People’s experience of using this service and what we found

People told us they were happy with the service, felt comfortable with staff and were kept safe. Risks were managed safely. The provider learned from previous accidents and incidents to reduce future risks. The manager understood their responsibilities about safeguarding and staff had been appropriately trained. Arrangements were in place for the safe administration of medicines and staff were recruited in a safe way.

Assessments of people’s needs were carried out before they started receiving support. Staff received regular training and supervisions as well as annual appraisals. People were supported with their nutritional needs, where required, and to access a range of health care professionals in order to maintain their health. People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People and relatives felt staff treated them with dignity and respect. Staff promoted and maintained people’s independence by encouraging them to care for themselves, where possible. People were supported to access advocacy services.

Care plans were detailed, person-centred and included people’s preferences. People’s communication needs were detailed within care records and staff knew how to communicate with them effectively. People and relatives knew how to raise any concerns and the provider had an effective complaints procedure in place.

People and relatives were complimentary about the service. Staff felt management were visible and approachable. An effective quality assurance process was in place. People and relatives were regularly consulted about the quality of the service through surveys. Staff were involved in the ongoing development and improvement of the service through regular meetings.

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 requires improvement (published 5 April 2019) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when, to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Living Ambitions provides personal care and social support to people living in their own homes in Newcastle and Northumberland. At the time of our inspection there were 54 people with a learning disability and/or a mental health related condition receiving a regulated activity from the service, mostly on a 24/7 basis. Not everyone using Living Ambitions receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

This inspection took place on 6 and 13 February 2019, with further phone calls with relatives and external professionals on 15 and 18 February 2019. The inspection was unannounced.

The service had 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.

The service was not well managed. The registered manager and supporting leadership staff had not ensured a move to the new office and the implementation of new records had been managed well. There was lack of oversight regarding core processes and information, such as care records and medicines administration.

Medicines were not always managed in line with good practice guidelines and staff competence regarding medicines administration was not consistently assessed.

Service managers and team leaders had not carried out effective spot checks of support workers to assess their competence and the accuracy of care records.

In depth risk assessments were not always complete following an initial general assessment of risk. Staff knowledge of the risks people faced was good but there was evidence of some risks not being assessed appropriately.

Financial management arrangements in place were not always flexible enough to meet people’s changing needs and preferences.

People's goals were not clearly documented or acted on. We have made a recommendation about this.

A range of training had been delivered to staff on joining the service, with regular refresher training provided. There were improvements to be made to the efficiency of the system used to remind staff to complete training and the provider was a aware of this. We found instances where staff required specific training to support people and had not had this training. Staff had however been working with a suitably experienced member of staff, reducing the level of risk.

People spoke highly of the staff who supported them to live at home. They told us they felt safe, respected and comfortable. Policies and procedures were in place to safeguard people from harm and the staff we spoke with understood their responsibilities. Lessons however were not always learned following incidents to ensure the service made improvements on an ongoing basis.

Care plans were not always person-centred and required review. At times, person-specific information was difficult to access. New paperwork had been introduced and it was evident staff were not yet comfortable or confident in new ways of recording people’s needs and goals. People's personal sensitive information was not always kept safe.

Recruitment processes continued to be robust and staff were safely recruited. An induction process was in place and staff training was up to date.

Staff told us they received supervisions and team meetings were held within each household. This however was dependent on the availability of senior staffing.

We found staff understood the principals of the Mental Capacity Act (2005) and their responsibilities. Documentation relating to decisions that were made in people's best interests were at times incomplete or inaccurate.

People told us the staff supported them to maintain a balanced diet. They said their support workers made good meals and always offered them a choice. People told us that their support workers understood their likes and dislikes and staff we spoke with demonstrated this.

Everyone we spoke with and their relatives felt they were treated with dignity and respect.

An annual satisfaction survey was used to formally gather opinions about the service.

The service was not working to principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around consent and governance. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 28 February 2017 and was announced, we concluded the inspection on 1 March 2017, and spoke with relatives and external professionals in the following days. We previously inspected this service in March 2016 where we identified the service required improvement. At that time, the provider was in breach of three of the Health and Social Care regulations relating to safety, staffing and governance.

The service had an established 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 manager had a history of managing this type of care service and the staff we spoke with told us they found her supportive and approachable. She had a clear vision for the service as she had been present at our last inspection and was aware of the improvements required. There was a friendly office culture and we saw support workers regularly called into the office to meet with their team leaders and managers.

We looked at how the service now managed medicines. We found improvements had been made to the recording of information and safe procedures were in place for staff to follow.

Detailed risk assessments had been implemented to protect people from risks they may encounter in their daily lives. Accidents and incidents were now appropriately reported to the office staff and these had been recorded and monitored.

Additional training had been delivered to staff in order to help them support people with specific needs. This included positive behaviour support, epilepsy, autism, diabetes and person-centred working.

People spoke highly of the staff who supported them to live at home. They told us they felt safe and comfortable with the staff and they received a good service. Policies and procedures were in place to safeguard people from harm and the staff we spoke with understood their responsibilities. Records were kept about concerns of a safeguarding nature and timely investigations had taken place. The registered manager reported incidents of a safeguarding nature to the local authority’s safeguarding adults team as necessary.

Person-centred care plans were in place to support staff to provide a personalised service. Records demonstrated that regular reviews were now carried out of people's needs and the service they received.

Records of staff recently employed showed the recruitment process continued to be robust and staff were safely recruited. An induction process was in place and staff training was up to date. Competency checks were routinely carried out.

Staff confirmed they received regular supervision and appraisal and team meetings were held within each household. Staff felt there were enough staff employed to manage the services with a consistent team.

We found staff understood the principals of the Mental Capacity Act (2005) and their responsibilities when they assessed people’s capacity. Decisions that were made in people’s best interests’ had been appropriately taken with other professionals and relatives involved.

People told us the staff supported them to maintain a balanced diet. They said their support workers made good meals and always offered them a choice. People told us that their support workers understood their likes and dislikes.

The staff we spoke with displayed caring attitudes. All of the people we spoke with said they were treated with dignity and respect and that staff were nice and friendly towards them and their families. The relatives we spoke with reiterated this.

The registered manager proactively monitored the quality of the service; she held electronic records which related to all aspects of the service such as safeguarding, complaints, accidents and incidents.

Service managers and team leaders carried out spot checks of support workers and they regularly courtesy called people who used the service and their relatives. An annual satisfaction survey was used to formally gather opinions about the service.

Living Ambitions provides care and support to individuals with learning disabilities, challenging behaviour, physical disabilities as well as dual diagnosis conditions. Dual diagnosis means people who have two health conditions at the same time, for example; learning and physical disabilities. At the time of the inspection there were 35 people receiving a service. The majority of people received 24 hour support within their own homes or in shared facilities, although the provider supported two people in their own homes with staffing hours as required.

At the time of our inspection the service had 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 and associated Regulations about how the service is run.

We considered people were not fully protected against the risks associated with medicines because information was not always in place and safe procedures were not always followed to manage medicines safely.

Risk assessments were not always fully detailed to protect people, were sometimes not in place and were not always reviewed regularly. Accidents were not always reported by staff to the provider from the individual people’s homes. The new quality monitoring system analysed accidents to check for trends forming.

Training records confirmed that staff had received training but the provider needed to help them support people effectively and protect themselves by providing additional training in a timely manner.

Individual care plans were in place for people, but we found that these sometimes lacked detail and had not always been reviewed in suitable timescales.

The people we spoke with told us they felt safe receiving care and support from staff at the service. Their family members confirmed people were safe. Staff received safeguarding training and were able to recognise and respond to signs of abuse. The provider took appropriate action in response to safeguarding concerns we looked at.

Recruitment practices were safe as background checks were carried out to ensure staff were suitable to work with vulnerable adults.

Staff received an induction. Staff were supported with supervision and appraisals being carried out, although a small number of staff did not feel they were supported and we brought this to the attention of senior management.

People were supported to enjoy a balanced diet and they were encouraged to make choices around meals, although we spoke with the registered manager about one person who we thought may have needed additional encouragement. The service worked with a range of health professionals to ensure people received support which met their healthcare needs.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. In this type of service, the court of protection makes decisions and appoints deputies to act on behalf of people who are unable to make decisions about their personal health, finance or welfare. We found the provider was complying with their legal requirements. We saw staff had received training in the Mental Capacity Act (2005) decision making processes. We saw people had information on mental capacity in their care plans and staff had been supported to make best interests decisions with the involvement of others, including healthcare professionals and relatives.

People thought that the staff team were caring individuals and relatives spoke positively about the staff who worked with their family members. Staff spoke to people with kindness and patience and found they knew the people they supported well. Staff knew what action to take to protect people's privacy and dignity.

People were supported to participate in community life through a range of activities.

Relatives knew how to complain and those who had made complaints told us they were satisfied with the response they received. Staff demonstrated how they provided people with choice and encouraged people to make decisions.

People and relatives spoke positively about the management team, although some staff members were less positive. We passed these concerns over to senior management.

Quality management processes were in place. The provider had recently implemented new audit process’s which the service was now following. We found a number of issues during our inspection, which had not always been highlighted by any of the quality monitoring checks in place.

We found three breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, staffing and good governance. You can see the action we have told the provider to take at the end of this report.