Zeno Limited

Zeno Limited is registered to provide personal care services to people in their own homes or supported living. People the service supports have a range of needs including learning disability, autism and complex needs.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection there were 57 people receiving personal care which was overseen by 4 registered managers across 19 supported living houses.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

People were not always supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people's best interests. People were not always protected from the risk of harm; we identified several potential environmental hazards. People were able to choose how they spent their time and were supported by staff to take part in activities and pursue their interests in their local area or access to the providers outreach college. We found 2 staff employed had not had all the required checks completed for working with vulnerable people, gaps in their employment histories were not always explored. There were enough staff available to provide care and support to people as they needed it and in the event of an emergency.

Right Care:

The ethos and values of the provider was not always embedded in care delivery. We visited the different supported living settings and were concerned to see aspects of people’s environments did not uphold their dignity or meet the values of the right support, right care and right culture. People's care and support plans were reflective of their range of needs. Staff spoke to people in a dignified and respectful way, and it was clear from what we were told that people and staff had developed good relationships.

Right Culture:

The provider had not always ensured that the safety and quality of the service had been effectively assessed. The registered provider responded quickly to the concerns we identified on inspection; however, it was acknowledged the existing systems and processes in place were not providing them with effective oversight of the service.

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 good (1 February 2019)

Why we inspected

The inspection was also prompted in part due to concerns received about the service. A decision was made for us to inspect and examine those risks.

Enforcement and Recommendations

At this inspection, we have identified breaches in relation to failings in how the provider monitored the safety of the service, a failure to ensure all restrictions were considered in line with the mental capacity act and with good governance due to the provider failing to monitor the quality and safety of the service.

We have made a recommendation about ensuring all of the required checks are made during the recruitment of staff and assessing the service using the principles of Right Support, Right Care, Right Culture.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The breaches we identified at that time were in relation to failure to deploy sufficient numbers of suitably qualified, competent persons to deliver care; a failure to ensure staff received appropriate support, training, professional development, supervision and appraisal; and quality assurance systems were not effective in identifying and generating improvements in relation to the shortfalls we identified. We also made recommendations about staff awareness of safeguarding protocols and record keeping for mental capacity assessments. Following the inspection, we asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions, is the service safe, effective and well-led to at least good.

At this inspection we found that improvements had been made and have rated the service good in all domains.

Zeno is registered to provide personal care to people in their own homes. The service specialises in providing support to people with a learning disability and complex needs. Support is provided both to individuals and to people living in small group settings. At the time of our inspection there were 46 people using the service.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 had a manager who was registered with the Care Quality Commission and was qualified to undertake the role. They demonstrated a commitment to delivering quality care to people with complex support needs.

Staff had been safely recruited and there were enough staff to meet people's needs.

Staff received induction, training, supervision and appraisal to help ensure they were able to deliver effective care.

People told us they felt safe and there were appropriate safeguarding polices in place, and safeguarding concerns were fully investigated.

People’s records demonstrated that the service was working within the principles of the Mental Capacity Act. People had individual capacity assessments which were detailed and decision specific.

Quality assurance systems in place were used to drive improvements within the service. These included audits of care records, staff training and development, medicines and environmental checks.

Information from accidents, incidents, safeguarding and complaints were analysed for themes and trends and action taken to minimise future risks to people.

People received support from consistent staff teams who knew them well and worked creatively to support their needs.

People who used the service, depending on their ability, were responsible for household tasks in their own homes with support from staff as necessary. Independence and choice was promoted.

Systems were also in place to reduce the risk of cross infection, dependent on individual needs, and the homes we visited were clean.

People’s care records and risk assessments were person-centred and detailed and staff told us they provided them with all the guidance necessary to best support people.

People were supported to have daily access to a wide range of community activities.

People were supported to communicate according to their communication preferences which included pictorial exchange communication systems (PECS) and Makaton.

Adaptations to the environment had been made to ensure people’s homes were safe and suitable for their individual needs.

Staff told us they enjoyed working for Zeno and felt well supported by the management team.

People, relatives and staff felt able to contribute ideas about the service and felt these were listened to and action taken.

Zeno Limited is registered to provide personal care and support for people living with mental health needs and/or living with a learning disability or autistic spectrum disorder. This service provides care and support to people living in 12 ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the visit there were 37 people who used the service.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This inspection was the first inspection since the service was registered with the Care Quality Commission in September 2017. The service was previously registered at a different address where we inspected on 15 April 2014. We found the service to be compliant with regulations at that time.

During this inspection in November 2017, we found the service to be in breach of three regulations under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to a failure to deploy sufficient numbers of suitably qualified, competent persons to deliver care, a failure to ensure staff received appropriate support, training, professional development, supervision and appraisal. The quality assurance systems were not effective in identifying and generating improvements in relation to the shortfalls in staff training, staffing levels and safeguarding processes. We also made recommendations about staff awareness of safeguarding protocols and record keeping for mental capacity assessments. You can see what action we told the registered provider to take at the back of the full version of the report.

The service had a registered manager as required. A registered manager is a person who has registered with the CQC 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 was not present on the day of the inspection visit however; we spoke to them following the inspection visit. We were supported by the deputy manager and the nominated individual who is also one of the directors of the company.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. During the inspection we received allegations of abuse from a former staff member. We informed the local safeguarding authority. They are undertaking enquiries. There was a lack of guidance and awareness on how to raise safeguarding concerns outside the organisation. We have made a recommendation about staff knowledge and awareness of safeguarding protocols.

People and their relatives confirmed people were encouraged and supported to maintain and increase their independence. Some people who used the service had limited ability to provide us with feedback on the service due to their needs. Feedback from relatives about care staff was positive.

Recruitment checks were carried out to ensure suitable people were employed to work at the service.

Feedback from staff demonstrated that there were concerns about staffing levels in three of the properties managed by the provider.

Staff had received induction, supervision and training. However we found a significant number of staff had not updated their training.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.

Risk assessments had been developed to minimise the potential risk of harm to people who used the service. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care. People’s independence and choice was promoted. However, mental capacity assessment records were not always provided to staff who provided care. We made a recommendation about following best practice in record keeping for mental capacity records.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.

People’s care needs were discussed with care commissioners before they started using the service to ensure the service was able to meet their assessed needs. Care plans showed how people and their relatives were involved in discussion around their care. People were encouraged to share their opinions on the quality of care and service being provided.

Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed. People’s nutritional needs were met.

There was a variety of meaningful activities to keep people occupied and to promote social inclusion.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

There was a policy to support people at the end of their life to have a comfortable, dignified and pain-free death.

We received mixed feedback from staff regarding the management and culture in the service. The registered manager understood their responsibilities, and were supported by the provider and other managers to deliver what was required. They used a variety of methods to assess and monitor the quality of service provided to people. These included regular internal audits of the service, surveys and staff and relatives meetings to seek the views of people about the quality of care being provided. The quality assurance systems were not always effective to identify the shortfalls we found during the inspection.