Creative Support - Trafford Supported Living Service

Creative Support - Trafford Supported Living Service is a supported living service providing personal care for people with a learning disability and autistic people. Some people also had a physical disability. At the time of our inspection there were 26 people using the service, living in 8 supported living houses.

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.

Right support:

Risk assessments and associated guidance had not always been reviewed in a timely way. Medicines records and storage were not always robust in some properties. Environmental risks in one house had not been identified. The model of care met the right support, right care, right culture guidance. There were enough staff to meet people’s needs and support people to take part in activities of their choice. Staff were safely recruited. 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. However, records of best interest decision were not always kept.

Right Care:

Care plans were person-centred and promoted people’s privacy and dignity. Relatives were positive about the support and kindness of the support workers.

Right Culture:

The quality assurance systems did not give the registered manager and project managers full oversight of the service. In some properties, issues had not been identified, in others identified issues had not been escalated to the project or registered managers to ensure they were resolved in a timely way. Incidents were recorded and reviewed to identify any patterns and ensure actions had been taken to reduce any reoccurrence. The registered manager took action straight after our inspection visit to address the concerns we identified.

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 26 November 2018).

Why we inspected

We received concerns in relation to staff not meeting people’s needs, record keeping, and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. 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. Please see the safe and well-led sections of this full report. The provider took immediate action to begin addressing the issues we found.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Creative Support - Trafford Supported Living Service on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to managing medicines, risk assessments not always being reviewed, environmental safety and the quality assurance and oversight of the service at this inspection.

We have made a recommendation about introducing an escalation system to ensure all care plans are reviewed in a timely way and for following best practice in recording best interest decisions.

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.

Creative Support – Trafford Supported Living Service provides care and support to people in ‘supported living’ settings to enable people to live 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 as people’s personal care and support.

Creative Support – Trafford Supported Living Service supports people with learning and physical disabilities and autism. At the time of inspection, there were 35 people receiving personal care living across ten properties situated in the Trafford area.

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 on the Health and Social Care Act 2008 and associated regulations about how the service is run.

People received their medicines safely. Staff received training and had their competency to administer medication checked. People were supported to administer their own medicines if deemed safe to do so.

Risk assessments were person centred and highlighted how risks should be managed. Risks where people may become challenging, were clearly recorded with actions for staff to take to prevent people’s anxieties from escalating. Staff were knowledgeable about how to manage each person’s anxieties.

Staff confidently explained their responsibilities in safeguarding vulnerable adults from abuse. Staff had full confidence in the management team should they raise an allegation. Staff received training in safeguarding vulnerable people.

Staff were recruited safely. The service completed robust checks to ensure new staff were suitable to work with vulnerable people.

Property safety checks were regularly completed.

The service worked in line with the Mental Capacity Act 2005 and people had their capacity assessed if required. Where people did not have capacity to make a specific decision, decisions were made in people’s best interests which included family and / or professional involvement. Best interest’s meetings were clearly documented.

People received support with their health needs. The registered manager had worked with local learning disability teams and primary care providers to ensure people had access to health support services quickly and when required.

Staff received training appropriate for their job role. Where people had specific care needs, staff received training to enable them to support these needs. Staff had the opportunity to pursue additional qualifications to enhance their knowledge.

People were supported to receive healthy and nutritious diets. Staff could describe the types of diets people required. Menus were devised with people based up on their personal likes and dislikes. Where people were at risk of malnutrition, weights were monitored, and any concerns reported to health professionals promptly.

We observed staff treating people with dignity and respect. Caring interactions were seen throughout our inspection and staff supported people with complex needs in a calm and supportive manner.

The service ensured people who identified at lesbian, gay, bisexual or transgender (LGBT) had their characteristics protected. LBGT was championed throughout the service with people being able to support local PRIDE events.

Confidential information relating to people was stored securely.

Person centred care was at the heart of the service and care was wrapped around each person to ensure they were at the centre of the care and support given. Person centred care plans were in place and reviewed. The plans captured people’s needs, choices, preferences and goals. People and their families were involved in the plans.

Care plans were clear, and staff could describe in detail the care needs each person required support with. Care plans were regularly reviewed.

People were supported to access activities in and away from the home. Creative Support organised a number of activities at the registered office. This was to engage people they supported to integrate into the community. A theatre workshop had been a popular event to builds people’s confidence.

Complaints were responded to in a timely manner with outcomes recorded and shared.

People were supported to make dignified decisions about the care they wanted to receive at the end of their life.

There was a theme of continuous improvements across the service. The management team continually monitored and reviewed what they offered to ensure they provided a quality service. Improvements made to access to health care services for people were seen throughout our inspection.

The service engaged with families to keep them involved in the lives of the people supported.

The wider management team had worked at the service for a number of years and could describe the needs of each person they supported. We observed at ease interactions between people and the management team and they clearly knew each other well.

The staff team were very positive about the management team in particular the registered manager and the chief executive officer. The staff team were well supported and were guided to provide person centred care to people. Staff received regular, supervision and appraisal and the opportunity to attend staff meetings.

Creative Support Trafford Supported living is a Domiciliary Care service that provides personal care and support to people with learning disabilities who live in their own home. The service covers the Trafford area and at the time of our inspection provided support to 40 people.

The service had registered manager in place. 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 spoke with support staff who told us that the registered manager was always available and approachable. Throughout the day we saw people who used the service and staff were comfortable and relaxed with the manager and each other. The atmosphere was relaxed and we saw that staff interacted with each other and the people who used the service in a person centred way and were encouraging, friendly, positive and respectful.

From looking at peoples care plans we saw that they were written in plain English and in a person centred way and made good use of pictures, personal history and described individuals’ care, treatment, wellbeing and support needs. These were regularly reviewed and updated by the the manager.

Individual care plans contained personalised risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The daily records we viewed also showed us that people’s health was monitored and referrals were made to other health care professionals where necessary for example: their GP and care managers.

Our observations during the inspection showed us that people who used the service were supported in a person centred way by sufficient numbers of staff to meet their individual needs and wishes within their own homes and within the community. The recruitment process that we looked into was safe, inclusive and people were involved in choosing their own staff.

When we looked at the staff training records and spoke with the registered manager we could see staff were supported to maintain and develop their skills through training and development opportunities. The staff we spoke with confirmed they attended a range of learning opportunities. They told us they had regular supervisions with the manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs.

We were able to observe how the service administered medicines on the day of our inspection we were able to establish how people managed them safely in their own home. We looked at how records were kept and spoke with the manager about how staff were trained to administer medicines and we found that the medicines administering process was safe.

During the inspection it was evident that the staff had a good rapport with the person who used the service and we were able to observe the positive interactions that took place. The staff were caring, positive, encouraging and attentive when communicating and supporting people in their own home with daily life tasks, care and support.

People were being encouraged to plan and participate in activities that were personalised and meaningful to them. For example, we saw staff spending time engaging with people on a one to one basis in activities and we observed and saw evidence of other activities such as art, drama and socialising. People were being supported regularly to play an active role in their local community both with support and independently.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Any DoLS applications must be made to the Court of Protection.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. We checked to see if the service had procedures in place and was working within the principles of the MCA. At the time of our inspection no applications had been made to the Court of Protection. From speaking to staff and looking at the training records we could see that training for staff was provided regarding MCA and DOLS.

We saw a complaints procedure was in place and this provided information on the action to take if someone wished to make a complaint and what they should expect to happen next. People also had access to advocacy services and safeguarding contact details if they needed it.

We found that the service had been regularly reviewed through a range of internal and external audits. We saw that action had been taken to improve the service or put right any issues found. We found people who used the service and their representatives were regularly asked for their views via an annual quality survey to collect feedback about the service.