Knutsford Supported Living Network

Knutsford Supported Living Network is run by Cheshire East Council and provides care and support to people living in a ‘supported living’ setting, so they can live in their own home as independently as possible. There were 24 people being supported by the service at the time of the inspection.

People shared communal areas within their homes and had their own bedroom personalised to their preferences and needs. An office was located centrally to the supported living homes. Waking night staff were available.

The service had not originally 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, so that people with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found people were given choice, their independence was promoted, and the service had an inclusive culture.

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support and in 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.

Safe recruitment practices were in place and people were supported by regular staff that knew them well. All staff had completed an induction and undertaken training relevant to their role. Enough staff were employed to meet the needs of the people supported by the service. Staff were supported through supervision and team meetings.

People’s needs were assessed prior to them being supported by the service. Individualised care plans and risk assessments held sufficient detail to reflect people’s needs, routines and preferences. Care records were regularly reviewed to ensure the most up-to-date information was available for staff. Staff had developed positive relationships with people and had a good understanding of their needs.

People were protected from the risk of harm and abuse. Clear policies and procedures were in place and staff felt confident to raise any concerns they had.

Medication was managed safely, and staff had access to medicines policies and procedures as well as best practice guidelines. Medication administration records (MARs) were consistently completed and audited to identify any areas for development and improvement. Staff understood how to minimise the risk of infection being spread and had access to personal protective equipment (PPE).

People’s independence was promoted, and their privacy and dignity was respected. People and their relatives spoke positively about the staff and management team. Staff were described as kind, caring and accommodating.

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.

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 requires improvement (published 27 February 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow-up

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

At the last inspection on 7 July 2016, the service was rated good. At this inspection the service had not maintained this rating and required improvement. This is the first time it had been rated requires improvement. We also found three breaches of the regulations relating to staff training and supervision, compliance with The Mental Capacity Act 2005 (MCA) and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Knutsford Supported Living Network is run by Cheshire East Council and provides care and support to people living in a 'supported living' setting, 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 (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support. There were 23 people being supported by the service at the time of the inspection.

The care service had not originally 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, so that people with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, we found that people were given choice, their independence was promoted and the service had an inclusive culture.

There was a registered manager in post. 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.

Overall people and relatives were very complimentary and positive about the support they received.

The provider could not demonstrate that all staff had undertaken required training and refresher training. Training was provided by a training department; however we were advised training was not always available or there were limited spaces. Staff had not received consistent and frequent one to one supervisions or appraisals with their line manager. The management team expressed that staffing shortages in the senior team had impacted on this.

Staff understood the need to seek consent and the principles of the MCA. However, records were insufficient to demonstrate where decisions had been made for people, they had been made in accordance with the MCA.

The provider’s audits to monitor the service were not fully effective as they had not identified all the issues highlighted in this inspection. Further improvements to the quality monitoring processes are required to ensure there is a clear overview of practice within the service.

Staff understood the importance of reporting any signs of abuse, knew how to report concerns and felt confident that the registered manager would act on any concerns they raised. We saw one incident which had not been reported to the local authority but had been dealt with by the provider. All other concerns had been dealt with appropriately.

There were sufficient staff to meet the needs of the people they supported. There were some vacancies and staff covered extra shifts to meet people’s needs. The senior team had found this had impacted on their management time.

Policies and procedures were in place to support the proper and safe use of medicines, records demonstrated that people had received their medicines safely. However, we found that the provider had not ensured staff training or competency checks around medicines were kept under review.

Risks were assessed and people were supported to stay safe. Staff understood their responsibility to report any accidents or incidents.

People were involved in decisions about what they wanted to eat or drink. Where necessary risk assessments had been completed in consultation with appropriate professionals such as speech and language therapists (SALT). We were concerned in one case that staff had occasionally not followed SALT guidance, which was addressed with the registered manager.

The service supported people to live healthier lives and people had access to health care as needed.

Staff had developed positive and caring relationships with the people they supported. They had time to spend with people and opportunities to listen and talk to people in a way they understood. People were treated with dignity and respect.

People received care that was personalised and responsive to their needs. Staff were knowledgeable about people's needs and understood the importance of supporting people as individuals. The service promoted inclusion and supported people to take part in activities which reflected their interest.

People and their relatives told us it was easy to raise a concern or complaint. The management team were in regular contact and people felt comfortable in raising any issues with staff.

Staff were motivated and those spoken with demonstrated a passion and commitment to the role.

There was a person-centred culture shared by managers and staff which aimed to support people to achieve positive outcomes. People and relatives were satisfied with the care provided and were happy with the support they received from the management team.

Knutsford Supported Living Network is located in a residential area of Knutsford. It provides domiciliary care to people who live in their own homes. Some people who use the service are tenants of East Terrace, which is a supported living scheme and also the agency’s registered office. The service provides care and support for people with learning disabilities. The office is easily accessible by public transport and rooms are available for training purposes or private meetings. At the time of the visit 21 people supported by the service.

There was a registered manager in place. 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.

At the last inspection in January 2014 the service was meeting the requirements of the regulations that were inspected at that time.

We found the service had systems in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to provide safe care for people.

There were appropriate numbers of staff deployed in the supported houses to meet people’s needs and provide a flexible service. Staff had been safely recruited to ensure people would be supported by suitable employees. However the application form for employment required updating to ensure a full employment history was obtained for new employees. We have made a recommendation about this.

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 support provided.

Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

People were supported by caring staff who were supportive, caring and respectful. One person who lived in one of the supported houses said, “Yes they all very kind.”

Staff knew people they supported and provided a personalised service. Care plans were in place detailing how people wished to be cared for. Relatives and people who lived in the supported houses were involved in making decisions about their care. Records looked at confirmed this.

People who lived in the supported houses were supported to be as independent as possible with food preparation and buying of supplies. People were encouraged to attend to their own dietary requirements as much as possible. Support and guidance was always available if required. One person who lived in a supported house said, “I like choosing what we eat and going to the shops.”

Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

People who received a service told us they were comfortable raising any issues, concerns or complaints with their staff and the registered manager. The service had arrangements in place to deal with these appropriately.

We found a number of audits were in place to monitor quality assurance. The registered manager had systems in place to obtain the views of people who lived in the supported tenancy schemes and their relatives.

Comments received from people using the service included:

"I love it here, best thing I ever did" and "I know all the staff, they are lovely."

Various quality assurance checks on the service helped to show systems were in place to ensure that the service was effectively managed and had evidence of being compliant and promoted good practices especially in the management of all records maintained. Staff were positive about working for the service and felt they were well managed.

Comments we received included:

"They (the staff) are fine."

"I love shopping and they take me to do some shopping. We are going to the shops this afternoon."

"I like to keep myself busy, so I clean and hoover. They help me to do this."

During our inspection we assessed standards relating to care and welfare and how people were supported to be involved in the planning of their own care. We also looked at how they were safeguarded from abuse. Standards relating to staff training and monitoring the quality of service provision were also inspected.