Tameside Link

The service has been developed 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. By following these principles, services can support people with learning disabilities and autism to live as ordinary a life as any other citizen.

At our last inspection in February 2017 we identified a continued breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service was not always working within the principles of the Mental Capacity Act (MCA) 2005. At this inspection we found improvements had been made and the service was no longer in breach of any of the regulations.

Systems were in place to help safeguard people from abuse. Staff knew how to identify signs of abuse and what action to take to protect people they supported. Risk assessments had been completed to show how people should be supported with everyday risks, while promoting their independence. Recruitment checks had been carried out to ensure staff were suitable to work with vulnerable people. People were looked after by small teams of staff who were committed to providing support in a person-centred and caring way.

A safe system of medicine management was in place. Records showed that staff received training and competency assessments before they were permitted to administer medicines.

Staff had undergone training to ensure they had the knowledge and skills to support people safely. All staff received regular supervision. This gave them the opportunity to discuss their work, reflect on what was working well for the person they supported and plan any changes that were needed.

The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the

Deprivation of Liberty Safeguards (DoLS). People were encouraged and helped to make their own choices where able, such as what they would like to eat and wear and what activities they would like to do. People were supported to take part in a range of recreational activities both inside and outside their home.

Staff worked closely with health and social care professionals to ensure people were supported to maintain good health and remain as independent as possible. People's support plans contained detailed information about their preferred routines, likes and dislikes and how they wished to be supported. People and their families were involved with planning and reviewing their care. This ensured it was tailored to meet their needs.

The service had a formal process for handling complaints and concerns. We saw that complaints had been dealt with appropriately.

The service was well-managed. The registered manager and chief executive provided good leadership of the service and were committed to maintaining and improving standards. Audits and quality checks were undertaken on a regular basis and any issues or concerns addressed with appropriate actions.

Tameside Link provides support to people with learning disabilities in and around Ashton-under-Lyne. The people live in their own houses or in flats. Some people have care workers supporting them throughout the day and night time. Other people receive visits once or more often each day. Tameside Link supports people according to each person's individual needs. At the time of the inspection the service was supporting 13 people.

The service had a registered manager however they were no longer in day to day responsibility. A new manager had been appointed and was in the process of completing their application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During this inspection we identified a continued breach in regulation with regards to capacity and consent. Systems in place did not ensure the principles of the Mental Capacity Act 2005 were understood and followed ensuring people’s rights were protected. Staff did however seek people’s consent when offering support. You can see what action we have told the provider to take at the back of the full version of the report.

Suitable arrangements were in place with regards to people’s prescribed medicines. We have made a recommendation with regards to the arrangements for ‘over the counter medicines’ and that people’s consent is sought in relation to how they wished their medicines were managed.

Some checks were now being completed to monitor and review the service provided. Thorough oversight of the service and effective communication between all stakeholders will help to ensure that robust systems are in place to sustain the improvements made so that people who use the service are protected.

Opportunities for staff training and development had been planned for so that they had the knowledge and skills needed to safely meet people’s needs. Staff we spoke with said they felt supported in their role and opportunities to improve their knowledge and skills were being provided.

Checks were being completed on newly appointed staff. The manager was aware all checks were required prior to staff commencing work ensuring their suitability for the position so that people were kept safe. Sufficient numbers of staff were available to meet the needs of people.

We received lots of positive comments from people and their relatives about their experiences and the care and support provided. Staff were described as being friendly, caring and respectful towards people and their relatives.

Systems were in place to ensure staff understood their responsibilities in protecting people from abuse. Staff spoken with demonstrated their understanding of the procedures and confirmed they were to attend the planned training.

Care plans were person-centred and contained good information about the current needs, wishes and preferences of people. Where risks had been identified, additional plans had been put in place so that staff could quickly respond to people’s changing needs.

Some people were supported to shop and offered support in meal planning so that their nutritional needs were met. 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.

Social and recreational opportunities were provided to enable people to maintain their independence and encourage their involvement. Recent changes in staff shift patterns had been made to provide more flexibility in support.

Relevant checks were made to people’s homes to help keep them and staff safe in the event of an emergency arising.

The manager had a system in place for reporting and responding to any complaints brought to their attention. People and their relatives told us the manager and staff were approachable and felt confident they would listen and respond if any concerns were raised.

Information in respect of people’s care was held securely, ensuring confidentiality was maintained.

Tameside Link provides personal care and support to 13 people who live in their own homes. This includes three people who live in a block of flats and two people who share a home. Other people live in their own homes.

The overall rating for this service was 'Inadequate' and the service was placed in 'Special measures'. This is where services are kept under review by CQC and if immediate action has not been taken to propose to cancel the registered provider's registration of the service, the location will be inspected again within six

months. The expectation is that registered providers found to have been providing inadequate care should have made significant improvements within this timeframe

The service had in place a registered manager. 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 found the registered provider did not have in place their own care plans or risk assessments. This meant staff were not given guidance on how to provide people’s care and reduce any potential risks to people. Professionals connected with the service raised concerns with us about care planning for people.

We saw the registered manager had reviewed the local authority care plan one year after the plan had been dated. People had not been included in their reviews.

We found the administration of people’s medicines to be unsafe. Staff had not received up to date training in medicines administration or had been assessed as being competent to give people their medicines. We found gaps in people’s medicines administration records and could not be reassured people had been given their medicines as and when they were prescribed or needed them.

Staff had recorded when people had accidents, however we found these had not been reviewed and actions taken to prevent a reoccurrence.

Staff helped to keep people safe in their own tenancies by checking smoke and carbon monoxide detectors.

The registered provider had carried out recruitment checks on staff to ensure they were safe to work in the service.

Staff were able to tell us about how to manage behaviour which challenged the service and told us they had been trained in breakaway techniques. However, we found staff were not supported to carry out their role through the use of regular supervision, appraisal and training which addressed how to care for people with specific needs.

Best interest decisions were not in place to deprive people of their liberty. We found the service did not permit some people for whom they provided personal care to go out on their own and they had not followed the principles of the Mental Capacity Act in making decisions which were in people’s best interests.

Staff demonstrated to us they knew people well, their likes and dislikes and how they provided care for people. We observed one staff member on the phone talking loudly about a person and another staff member spoke to us about the person in front of them without including them. We found this showed a lack of respect.

The registered manager told us no one in the service had an advocate and family members acted as advocates for people. Staff told us they had not yet felt directions given to them by family members about people’s care needs were not right for people.

We found staff supported people to be independent by encouraging people to cook and taking care of their accommodation.

People were engaged in a range of activities. Some people felt they had enough to do, others wanted more things to do. We saw staff supported people to access their local communities and have contact with their family and friends.

The audits carried out by the registered manager did not address the regulatory requirements and did not find the deficits we saw during the inspection.

The documentation in the service was not dated and we found there were no updates in place for people’s care plans. We found the staff had not been provided with systems for them to provide people’s care safely and which the registered manager could use to monitor the quality of the service.

The registered provider had notified local care managers of safeguarding incidents but had failed to notify CQC of the same incidents. This meant they were not complying with their registration.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

One person said: "I've done well living here. I like it. I get on well with the staff. They take me to places. I go on holiday with them every year." Another person said that when they went out shopping with a member of staff they could choose where to go and which shops to visit. Another person said: "I like it here, I keep busy."

We found that people were treated with respect and were encouraged to be as independent as possible. We found that people's individual needs were catered for and that their welfare and safety were promoted.

We found that there were suitable methods for managing medicine, where needed.

We found that there were procedures to ensure that new staff were suitable and well qualified, and relevant documents were retained. There were systems to monitor the quality of the service.

On a previous inspection we found that care plans were not being created by Tameside Link, and that the service was not compliant with the standard relating to records. We found on this inspection that care plans had been created, although there was more that could be done to ensure they were used as working documents.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People told us they were happy with the service they received, they liked the staff and they got to choose how they spent their time and were able to have a lifestyle that best suited them.

We found that peoples care plans and risk assessments were not reviewed by the service provider.

People who used the service told us they were well cared for and they felt safe. Relatives described the service as, 'Excellent and very supportive.'

People who used the services of Tameside Link told us they were very happy with the service they received and that they didn't have any complaints.