Background to this inspection
Updated
28 October 2017
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.
This inspection took place on 26 and 27 September 2017 and was carried out by one inspector. The provider was given 24 hours’ notice of the inspection. This was because the location provides a supported living service and we needed to make sure that appropriate staff and managers would be available to assist us with our inspection.
This was the first inspection of the service since it was registered with the Commission on the 6 October 2016. This inspection was a comprehensive inspection to provide a rating for the service.
Prior to this inspection we reviewed the Provider Information Record (PIR). The PIR is a form that the provider submits to the Commission which gives us key information about the service, what it does well and what improvements they plan to make. We contacted health care professionals involved with the service to obtain their views about the care provided. We have included their written feedback within the report.
During the inspection we spoke with the registered manager and five staff. We spoke with eight people living in the supported living scheme. We spoke with two relatives during the inspection and spoke with two relatives by telephone after the inspection.
We looked at a number of records relating to individuals’ care and the running of the service. These included seven care plans, medicine records for seven people, six staff recruitment files and staff supervision records, accident/incident reports and audits.
We asked the provider to send further documents after the inspection. The provider sent us documents which we reviewed and used as additional evidence.
Updated
28 October 2017
This inspection took place on 26 and 27 September 2017. It was an announced visit to the service. This meant the service was given 24 hour notice of our inspection. This was to ensure staff were available to facilitate the inspection.
The service is registered for the regulated activity personal care. It provides care and support to people living in a supported living service. The registered office is on site and is situated on the second floor. The supported living scheme is on the ground and first floor. At the time of the inspection they were providing personal care support to 11 people.
There was a registered manager in post as required. 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.
This was the first inspection of the service since it was registered with the Care Quality Commission. It was a comprehensive inspection to enable us to rate the service.
We found the service was providing effective, caring, responsive and well-led care to people. Improvements were required to ensure consistent safe care was provided.
The majority of people and relatives spoken with were happy with their care and individual staff. However, most people and one relative were dissatisfied with the staffing arrangements. They felt the staffing was not what they were promised, they did not get the support they required and when required. There was a high use of agency staff which they felt led to inconsistent care for them. The shifts were not appropriately managed either to ensure the right skill mix of staff were available to people which had the potential to impact on the care people received. This was being addressed through recruitment of new staff and the introduction of a shift leader and a shift planner to ensure tasks were delegated appropriately. A recommendation has been made for the staffing levels to allow for the delivery of all aspects of the agreed care packages.
Staff took responsibility for people’s medicines. Medicines were not kept secure and interim prescriptions were not recorded and signed appropriately on the medicine administration record. A recommendation has been made to address this.
Systems were in place to safeguard people. Risks to people were identified and managed which promoted people’s independence. People were assessed prior to moving into the service to ensure the service could meet their needs. They had support plans in place which provided guidance to staff on the support required. People were not involved in their support plans. A new support plan format was being introduced across the organisation which would promote people’s involvement.
People were consulted with on their care and the service worked to the principles of the Mental Capacity Act 2005. People's health and nutritional needs were identified and met. They had community access included in their package of care to enable them to pursue their hobbies and interests. Some people felt this was not clear to them and not sufficient. The registered manager confirmed they clarified this in the tenants meetings held after the inspection.
Staff were suitably recruited, inducted, trained, supervised and supported. This enabled them to have the right skills and training to support people effectively.
Staff were kind, caring and promoted people’s privacy and dignity. They were aware of people’s communication needs and encouraged their involvement in the service. Information was provided in an accessible way to benefit individuals.
People were provided with information on how to raise a concern or a complaint. Monthly tenants meetings had recently commenced to enable people to raise issues which affected them as group. An annual survey was to be undertaken to enable the provider to get feedback on the service. Systems were in place to audit the service to enable the provider to satisfy themselves the service was running effectively. Where issues were identified action was taken to make improvements.
The service had built positive relationships with professionals. We received mixed feedback on the management of the service. Most people, staff and relatives were happy with the way the service was managed. Some people were dissatisfied with the way the service was managed. This was fed back to the registered manager to explore further. The registered manager was committed to developing a bespoke service to individuals and in getting the service established and involved in the local community.