Creative Support - Bolton Service

This inspection took place on 25 July 2018. The provider was given 48 hours' notice of our intention to visit. This was because we needed to ensure there would be someone present at the office to facilitate the inspection.

We were assisted throughout the inspection by the registered manager and three project managers. 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 registered manager at Creative Support – Bolton Service had been registered since October 2011.

We spoke with a number of people during the inspection including relatives, staff and community professionals. People who used the service had limited means of communication and were unable to share their experiences. People who used the service relied on families or advocates to support them with decision making.

The service was last inspected on 18 May 2017 and was announced. The service was rated as Requires Improvement.

At the last inspection we found procedures were in place to manage people's medicines safely. However, these had not always been followed, which had resulted in some errors being made with medicines on several occasions. Arrangements for the safe recording and administration of people's medicines required improvement to ensure people were protected from the risk of unsafe medicines management.

This was a breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found that medicines management had improved and systems were now safe. The service had sought advice around medicines management from a healthcare professional external to the organisation and had incorporated a new system for auditing medicines.

Mandatory training had been completed by all staff.

There were systems and processes in place to protect people from harm. Staff had a good understanding about the signs of abuse and were aware of what to do if they suspected abuse was taking place.

The service had developed positive working relationships with health and social care professionals which led to joint working to expand people's communication skills.

A robust system for staff recruitment, induction and training was in place. This enabled the staff to support people effectively and safely.

People's needs were assessed before using the service and on an ongoing basis to reflect changes in their needs. Clear and well thought out arrangements were in place for people moving into the service which helped to significantly reduce possible anxiety about this change.

There were enough staff so people could take part in the activities they wished and be supported in meeting their individual needs. People had access to activities that were important and relevant to them, both inside and outside their home. People were protected from social isolation because of the support and range of opportunities offered by staff.

We observed positive relationships and observed the management team and staff interacting with people in a caring, good humoured and friendly manner. Management and staff demonstrated insight and understanding of people's personal preferences and needs.

The service had been developed and designed in line with the principles that underpin the Registering the Right Support and other best practice guidance; these values include choice, promotion of independence and inclusion. This policy asserts that people with learning disabilities and autism using a service should live as ordinary a life as any citizen. This policy can be found on the Care Quality Commission website.

The last inspection of the service took place on 09 and 15 December 2015 and was announced. The service was rated as Requires Improvement.

This inspection took place on 18 May 2017. The provider was given 48 hours’ notice of our intention to visit. This was because the location provides a domiciliary service and we needed to ensure there would be someone present at the office to facilitate the inspection.

We were assisted throughout the inspection by the registered manager and project managers in the houses. 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 registered manager at Creative Support – Bolton Service had been in post for several years.

We spoke with a number of people throughout the inspection including, relatives, staff and community professionals. People who used the service had limited means of communication and were unable to share their experiences. People who used the service relied on families to act on their behalf in making decisions.

The service had a robust recruitment procedure in place, to help ensure that staff employed were suitable to work with vulnerable adults. There were sufficient staff on duty to ensure the needs of people who used the service were supported appropriately. Staffing numbers were looked at on a daily basis to ensure that appointments and trips and planned activities were covered.

New staff undertook an induction programme, which involved classroom based training and shadowing of experienced staff. Training was on-going, however we noted that some annual training had not been completed.

We looked at the supervision and annual appraisal record and staff spoken with confirmed they received regular supervisions. Supervision meetings enabled managers to assess the development needs of staff and to address training and personal needs in a timely manner.

Staff worked positively with external professionals to help ensure people received safe and effective care.

Procedures were in place to manage people’s medicines safely. However, these had not always been followed, which had resulted in some errors being made with medicines on several occasions. Arrangements for the safe recording and administration of people’s medicines required improvement to ensure people were protected from the risk of unsafe medicines management.

Systems were in place in relation to ordering, storage, administration and disposal of medicines. Health and safety measures were in place and up to date.

Care plans were person-centred and included information about people’s likes and dislikes, interests, family backgrounds and personalities. Care plans included a range of health and personal information to ensure that the needs people who used the service were supported.

Each person had their own bedroom and communal areas were available. Two of the premises seen were clean, tidy and well maintained. One property was clean and tidy but would benefit from a refurbishment.

Staff we spoke with had a good understanding of the basic principles of the Mental Capacity Act (2005) (MCA) and decision making process. However, the service had been unsure of the procedures with regard to notifying CQC of applications to the Court of Protection. We advised them to notify CQC of all Court of Protection applications as per requirements

We observed staff interacting in a kind and friendly manner throughout the day, there was a good relationship observed between staff and people who used the service.

People’s privacy and dignity was respected and we saw that the staff promoted independence as much as possible.

There were a wide range of activities on offer for people to participate in. Some had their own mobility cars.

The service had good links with the local community, which helped people who used the service to mix and integrate with the community.

Systems were in place for dealing with complaints and concerns.

A number of quality audits and checks were carried out by the service; however a recent audit two days before the inspection had failed to pick up on the medication issues found on inspection.

We spoke with staff and where possible with some people who used the service. We did not ask people direct questions as for some this would have been difficult for them to respond. We saw from people's body language and gestures they were comfortable with the staff that cared for them.

We spoke at length with the family of one person who used the service. They told us that they were always involved in any decision making. They were always made welcome when visiting the home. They were pleased with the commitment of the staff that cared for X. They were delighted with the progress that X was making. They said they had finally got the right support that X required and the support for them as a family which was much appreciated. We were told X had been at a low point for some time but things had greatly improved since Creative Support had become involved.