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.