Consensus Support Services Limited - Shrewsbury

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.

The provider was aware of the principles of Right support, right care, right culture. However, we found areas of improvement were required to ensure the principles were fully realised for each individual.

Right Support:

People were supported by staff who were safely recruited and had received training relevant to their role. Some additional training was required and supervisors told us they wanted to spend more time supporting the new staff.

People’s medicines were not always stored correctly, and guidance was not always where the care plan directed.

People’s records were not always completed fully and there were times when reviews of the records did not happen within the time scales set. People had access to activities, but we received feedback that the activities were limited, and more was needed both in the community and in the home.

Right Care:

Risks to people’s safety were not always considered. We found a number of risks in the environment which the provider needed to address. People were supported by staff who had been trained in recognising abuse and felt confident speaking up on people’s behalf.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. However, we found some of the paperwork needed to be reviewed to ensure the decisions being assessed were not written as a forgone conclusion even when it was apparent the person lacked capacity in the areas being assessed.

Right Culture:

People were supported by staff who were dedicated to their needs however staff felt better leadership was required. Governance systems were in place, but these were not always effective at highlighting the improvements needed.

The views of stakeholder’s were sourced and the feedback was used to inform future planning. The service did work in partnership with others however we received some feedback to say better dissemination of information was required. The provider was responsive to the concerns raised and has taken action to address the shortfalls.

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 (published 16 November 2019).

Why we inspected

We undertook this inspection following concerns that the overall quality of care was not meeting people’s needs. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement

We have identified breaches in relation to the management of risk, people’s medicines and the overall governance of the service at this inspection.

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.

Consensus Support Services Limited - Shrewsbury is a residential care home providing personal care to 12 people at the time of the inspection. The service can support up to 15 people, aged between 18 and 65 who have learning disabilities or an autistic spectrum disorder.

The home accommodates people in two separate buildings, each with their own facilities. One building accommodates nine people and the other building accommodates six people.

The service was registered for the support of up to 15 people. This is larger than current best practice guidance. The service has been developed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The provider had not ensured staff consistently completed and recorded the required quality checks on the service. Documentation relating to quality checks were not always kept in one place, so it was sometimes difficult to find this information when needed.

People were happy living at the home and staff helped to promote a positive culture.

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

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People felt safe living at the home. The provider’s systems helped to protect people from the risk of abuse. Risks associated with people's care and the environment had been identified and measures were in place to help reduce the risk. People received their medicines when they needed them. People contributed to keeping the home clean and tidy.

Staff had received training to be able to support people effectively and in line with current good practice. Staff supported people to access health care services when they needed them.

People's right to privacy was respected, their dignity was maintained and people were encouraged to be independent. Staff made sure people were involved in and able to make decisions about their own day to day care and support.

People received personalised support from staff who knew them well. People were supported to take part in a range of social activities they enjoyed. People had the information and knowledge they needed to make complaints about their care, if they wanted to.

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 (published 9 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Consensus Support Services Limited - Shrewsbury is registered to provide accommodation with personal care to a maximum of 15 people who have a learning disability or autistic spectrum disorder. There were 13 people living at the home on the day of our inspection.

A registered manager was in post and was present for part of our inspection. 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.

The home was last inspected on 28 and 29 July 2015 where we gave it an overall rating of requires improvement. At the last inspection we asked the provider to make improvements to ensure staff understood how to support people to make decisions when they did not have capacity to make their own decisions. We also asked the provider to make improvements to ensure the quality systems they had in place were being consistently monitored and completed by staff. We found that these improvements had been completed.

Staff had received training in and understood how to protect people from any harm and abuse. Staff knew how to and were confident in reporting any concerns they may have about a person’s safety. Risks to people’s safety were assessed and monitored. Staff understood how to keep people safe and supported them to live their lives safely whilst respecting their freedom.

People were supported by sufficient numbers of staff on the day of our visit to safely meet their needs. When people needed help and support they were not kept waiting and staff responded quickly. The registered persons monitored how many staff were needed based on people’s individual needs.

People were involved in and supported to take their medicines safely and when they needed them. People’s medicines were managed safely by staff both within and outside the home.

Staff received training to give them the skills and knowledge needed to meet people’s needs. Training was focused on the specific health and medical conditions people had to enable staff to support people effectively. Staff were supported in their roles by managers and their colleagues.

People were asked for their consent and their right to make their own decisions respected. The registered manager consulted with other professionals when decisions needed to be made on people’s behalf to ensure their rights were upheld.

People were supported to have enough to eat and drink and to maintain a balanced diet. Staff worked with other professionals to make sure people’s healthcare needs were met and they had access to healthcare services when they needed them.

People were supported by staff who they had positive relationships with. People received care and support in a friendly and compassionate way by staff who knew them and their personalities well. Staff respected people’s privacy and encouraged them to identify and work towards goals to improve and maintain their independence.

People received care and support that was personal to them and responded to any changes in their needs. They were supported to spend their time as they wanted to and to pursue their own hobbies and interests.

The home had a positive and friendly culture where staff worked for the benefit of the people they supported. The provider had systems in place which assessed and monitored the quality of care that staff provided at the home.

We used a number of methods to help us understand the experience of people who used the service, because most of the people we met were unable to share their views with us. We observed how people were being supported, spoke with two senior managers and a number of staff on duty and reviewed care records held for two people.

People appeared happy in their home and were comfortable with the staff and their surroundings. Staff demonstrated a clear understanding of the individual needs of the people whose care we looked at in detail. People's needs were assessed and care and support was planned and delivered in line with individual support plans. A member of staff told us, “People get first class care and we do our best”.

We toured most parts of both homes including all shared areas and a number of bedrooms and bathrooms. We were told people were involved in keeping their home clean and tidy as part of promoting their independence. An odour issue within one home was known to the provider and plans were in place to address this. However, we found further improvements were needed to ensure people lived in a clean and hygienic environment.

We found there were enough staff on duty to meet people’s individual needs. We saw staffing was planned in advance and that staffing levels were flexible dependent on people’s needs and activities.

Staff received a range of training to give them the skills and knowledge they needed to keep people safe and to meet their individual needs. Staff told us they enjoyed their work and most staff told us they were well supported in their work.