We carried out a review of the data available to us about Barnet Supported Living Service on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Barnet Supported Living Service, you can give feedback on this service.
Barnet Supported Living Services provides care and support to people with learning disabilities living in four ‘supported living’ settings, so that they can live in their own self-contained flats as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of our inspection 32 people received the regulated activity ‘Personal Care’ from Barnet Supported Living Services. People lived at five different sites, two in Barnet and three in Edgware North London. Each supported living site had shared communal areas for people to socialise or have meals together if they choose and self-contained flats. The four larger sites can accommodate a maximum of nine people and the smallest site can accommodate a maximum of three people. People who used the service had different abilities, needs and communication skills. People who used the service received personal care from approximately 59 staff, these included care workers, senior care workers, team leaders and care co-ordinators.
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.
A manager had been registered with the CQC. 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.’
We rated the service during this inspection outstanding, because staff praised the training that they received highly and told us it equipped them to undertake their role and provide excellent care and support to people who used the service. Training records showed that staff received training which was tailored towards people’s needs and ensured that people who used the service were at the centre of the service. There was a very strong focus on people maintaining their diverse cultural identity. Care assessments and care records were formulated with people’s diverse cultural needs in mind. The service tried to match staff with people who had a similar cultural understanding. The service worked very closely with various health care professionals and had achieved remarkable outcomes for some people with very complex and profound communication difficulties.
People had excellent, meaningful relationships with the staff. Independence was widely encouraged, and innovative methods were used to communicate with people as well as to support people with remaining independent. People felt able to contribute to decisions about the support
needs and always felt staff acted on their wishes. People's rights were always respected. Extra effort was made to recruit staff who showed the same interest as people who used the service to ensure staff and people were well suited and matched.
People received person centred support focused on what mattered most to them. People were fully involved with the on-going development of their support needs. People were encouraged to achieve their goals and to partake in activities that were important to them. People were provided with the information they needed, in a format they could understand, if they wished to make a complaint. People felt able to make a complaint and were confident it would be dealt with appropriately.
The service had a strong leadership presence with a registered manager who had a clear vision about the direction of the service. They were committed and passionate about the people they supported and were constantly looking for ways to improve. The service and everyone involved in the management of the service was committed to provide the best possible service and care to people. Thorough and frequent quality assurance processes and audits ensured that all care and support was delivered in the safest and most effective way possible
People felt safe with the staff who supported them, and we saw people were comfortable with staff. Staff received training in how to safeguard people from abuse and understood what action they should take in order to protect people from abuse. Risks to people's safety were identified and minimised to keep people safe. People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. Staff recorded medicines administration according to the provider's policy and procedure, and checks were in place to ensure medicines were managed safely. There were enough staff to meet people's needs effectively. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people. Staff told us they had not been able to work until these checks had been completed.
People were supported to have maximum choice and control of their lives and staff did support them in the least restrictive way possible; the policies and systems in the service did support this practice. People who used the service were supported to choose, prepare and eat a nutritious, healthy, well balanced and culturally appropriate diet.
The unannounced comprehensive inspection took place on 30 November, 01 and 09 December 2015.
Barnet Supported Living Service is a domiciliary care service that provides care and support to people with a learning disability, mental health needs and autism. There are three self-contained flats and two shared houses. All units had 24 hour staffing. On the day of inspection there were 33 people using the service. There is a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
During our previous inspection on 6 and 7 August 2014 we found there was not enough staff to meet people's needs safely. Staff had not received training in areas such as Mental Capacity Assessment (MCA), Deprivation of Liberty Safeguards and dementia. Although people had care plans and risk assessments, these did not document people's current needs and risks. People's care plans were not always personalised or written in a way people could access. Although there were systems in place to monitor the quality of the service they were not effective. Audits had not identified missed medicines and lack of equipment to prevent the spread of infection.
During this inspection we found the service had addressed most of the concerns from the last inspection. Staff numbers met the assessed needs of the people using the service. Staff had received relevant training and were able to demonstrate to us their knowledge. Care plans were person centred and people had been involved in their care planning. There were now adequate measures in place to control the spread of infection.
We found in one unit house meetings did not take place and some people said they were not receiving the support they required. Daily notes did not reflect people's presentation or views. Staff made daily recordings of tasks undertaken to support people but these did not contain enough information. This could result in crucial information being missed and lead to significant changes in need being unaddressed by staff. We found that although audits were occurring the actions to rectify concerns found had not always taken place.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
This inspection was announced. The provider was given 48 hours’ notice because the locations provided care to people who needed to be prepared that we were inspecting and we were visiting their home. The service met all of the regulations we inspected against at our last inspection on 9 September 2013.
The service has five units across the London Borough of Barnet, which provided care and support to people with a learning disability, mental health needs and autism. Three of the units were self-contained flats and the remaining were two shared houses. All units were staffed 24 hours a day. On the day we visited we saw there were 35 people using the service. A registered manager oversaw all of the services. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.
People’s safety was being compromised in a number of areas. This included how medicines were stored and recorded and infection control related to personal care.
Staff did not understand the Mental Capacity Act 2005 (MCA) and had not received training to support people who lacked capacity to make decisions. For example, the provider had not made an application under the Mental Capacity Act to the Court of Protection for one person, when their liberty may have been restricted.
The registered manager investigated and responded to people’s complaints according to the provider’s complaint procedure. However, relatives said the complaints procedure had never been explained to them.
Staff had not received training in areas such as MCA, DoLS and dementia. Staff had received training in medicine, food hygiene and understanding people’s physical health such as epilepsy. However, they did not put this training into practice. People who used the service and their relatives had concerns about the low numbers of staff. People said that their needs were sometimes not met as they could not attend activities they enjoyed.
People were provided with a choice of food and were supported when needed. In communal fridges we saw food that was out of date and not stored correctly. People were at risk of food poisoning.
Although people had care plans and risk assessments, these did not clearly document people’s current needs and risk. They were not always personalised or written in a way that people could access, such as using pictures for people who were unable to read.
The provider ensured people had access to their GP and other health professionals, however records were not kept up to date and most people did not have health passports. These help professionals in hospital understand how people communicate and their physical and mental health needs. Therefore, professionals may not have had the most up to date information to ensure they provided the most appropriate care.
People told us that staff were caring and kind. We did see some staff that were caring however, others were not and did not have the skills or understanding to care for people who had different needs effectively.
Although systems were in place to monitor the quality of the service, we saw these were not effective. Audits had not picked up issues that were observed on the inspection, such as missed medicines and lack of equipment to prevent the spread of infection.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.
When we asked people living at the location if they felt safe, they said 'Yes, I feel safe.' Staff also said they thought it was safe. They could describe the types of abuse to be aware of and knew to speak to their manager if they had any concerns.
There were enough qualified, skilled and experienced staff to meet people's needs which were listed in their support plans. Sometimes, however, these needs could only be met by exceeding the number of hours the service was contracted to provide.
People told us that staff were 'very nice.' We observed that support workers spoke with people kindly and with respect. Staff received appropriate supervision and their training needs were identified and provided for.
The provider had systems in place to monitor the quality of service people were receiving. People were asked for their views about their care and support in regular tenant meetings and their annual review. Key information was regularly monitored, such as complaints and accidents.
People's support plans were up to date and had been reviewed in the last year. Risk assessments were in place, for meal preparation and personal safety for example. People using the service were protected from the risk of abuse because of the reasonable steps taken by the provider and a person living in the flats told us 'I feel safe here.' Staff we spoke with knew about abuse and clearly understood issues relating to mental capacity and restraint.
Staff appraisals were almost all recorded as having taken place. Despite this, training needs identified, such as dementia care, had not been scheduled. Gaps in training had been highlighted but not acted upon.
The provider had an effective system to regularly monitor the quality of service people received. Learning from incidents took place and appropriate changes were implemented. People were protected against the risks of inappropriate or unsafe care.