Archived: Douglas Arter Centre

This inspection took place on 6 July 2017 and was unannounced. We returned on 17 July 2017 to complete the inspection and follow up some questions that had been raised following feedback from relatives and health and social care professionals.

This was the first inspection since the service was registered in January 2016. Prior to Scope being registered to provide personal care at this location, they supported the same five people in a care home service. Scope has said they intend to stop providing care for people in the supported living service in the near future. There was a process underway to find a new provider to support people.

There was a registered manager in post at the service. 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.

Safeguarding cases following incidents in 2016 and 2017 had identified work was needed to ensure people received consistent safe support, risks were well managed, people were supported to take the medicines they had been prescribed and the risk of cross infection was effectively managed. The service had worked with the safeguarding team, commissioners and health professionals to address the issues.

During the inspection we saw that there was clear information about the specific risks for people and the actions staff needed to follow the meet those needs.

There had been past incidents in which people did not receive support to take the medicines they were prescribed. The medicine management systems had been amended, but a further incident in March 2017 in which medicines were not ordered resulted in a person not receiving a dose of their prescribed medication. The registered manager had completed further work to review the medicines management systems and ensure all staff were aware of their responsibilities. During the inspection we found that medicines were securely stored and there were clear procedures in place for staff to follow when supporting people.

Concerns had been raised with Wiltshire Council about infection control procedures in the service not being followed at all times. As a result of the concerns, a review was completed by a public health nurse specialist in March 2017 and the service was given feedback about areas where improvements were needed. A further visit by the public health nurse specialist was completed in May 2017, which identified areas of good practice, where improvements had been made. However, the report also identified that staff did not always follow good practice in relation to the use of gloves, aprons and wearing suitable clothing to provide personal care support to people. The registered manager had addressed specific issues with staff concerned and completed observations of all staff to ensure the infection control procedures were being followed. During the inspection we observed staff following good practice and using protective clothing appropriately.

Whilst action had been taken to address the various concerns that had been raised, further work was needed to ensure these improvements were sustained.

Relatives and health and social care professionals who provided feedback raised concern at the range of meaningful activities people were supported to take part in. The registered manager told us the support for people to take part in meaningful activities was something that needed to be improved upon. The registered manager told us things had started to change, with examples of people taking part in individual activities they had not previously had opportunity to do, but further work was needed.

Feedback from some relatives was that it had taken a long time for staff to amend the way they worked and to change the culture of the service following the move from a care home to supported living. Relatives said they were beginning to see some changes in this culture, but more were needed to ensure people received a genuinely person-centred service.

There was a team leader based at the supported living service. However, there had been frequent changes in the team leader post since the service opened. At the time of the inspection a new team leader had been in post for approximately four weeks. Relatives told us the service needed a strong management presence on site, which had been missing at times in the past.

Although some relatives raised concerns about the overall management of the service, we also received positive comments about the registered manager and his efforts to change the culture of the service. Comments included, “I can’t thank [the registered manager] enough for hanging on in there. We now have the best management team we’ve ever had” and “It has taken the present manager the last 18 months, to try and change staff attitudes. Which is slowly happening and improving”.

People told us they liked the staff who supported them and said they were happy living at the service. We observed staff interacting with people in a way that was friendly and respectful. For example, we saw staff respecting people’s choices and privacy and responding to requests for support. Staff had developed a strong relationship with people and demonstrated this in their interactions. Staff showed respect for people in the way they spoke about them.

There were systems in place to protect people from abuse and harm and staff knew how to use them. Staff understood the needs of the people they were supporting.

Staff received training suitable to their role and an induction when they started working for the service. They demonstrated a good understanding of their roles and responsibilities, as well as the values and philosophy of the service.

The provider assessed and monitored the quality of the service provided and had developed a clear service improvement plan to address concerns that had been raised.