3 February 2016
During a routine inspection
Real Life Options provides an outreach service to people based in the community. They also provide services to people with learning disabilities in a total of seven supported living locations.
At the time of our inspection the service had 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 and associated Regulations about how the service is run.
In the supported living services we visited, people were well looked after. Due to people’s complex communication needs, we spoke with their relatives to find out about their experience of the service their family member received.
Relatives told us their family members were safe receiving services from the provider. Staff received safeguarding training and were able to recognise and respond to signs of abuse. The provider took appropriate action in response to safeguarding concerns we looked at.
We found shifts were not always covered when regular workers were not available and alternative provision was not always suitable. Recruitment practices were safe as background checks were carried out to ensure staff were suitable to work with vulnerable adults.
Medicines were safely managed by staff who received training and competency checks. Staff received an induction and records we looked at showed they were mostly up-to-date with their training. Supervision and appraisals were carried out but the provider had not provided this support on a regular basis for all staff.
Risk assessments were in place for people living in supported living services and these had been reviewed. However, risk assessments were not always completed for people using the community outreach service.
People were supported to enjoy a balanced diet and they were encouraged to make choices around meals and to participate in cooking. The service worked with a range of health professionals to ensure people received support which met their healthcare needs. However, we found one person’s health check record had not been reviewed since December 2013.
Staff demonstrated how they provided people with choice and encouraged people to make decisions. We saw staff had received training in the Mental Capacity Act (2005), although some staff were unsure how this affected their roles. We saw people in supported living had information on mental capacity in their care plans.
Relatives spoke positively about the staff who worked with their relatives. Staff spoke to people with kindness and patience and found they knew the people they supported well. Staff could describe the action they took to protect people’s privacy and dignity. People were supported to participate in community life through a range of activities.
Relatives knew how to complain and those who had made complaints told us they were satisfied with the response they received.
People had detailed care plans in both community outreach and supported living services which described how staff should provide their care and support. Reviews were taking place which people and staff were involved in, although these were carried out by other professionals, but not used to develop care plans.
Relatives and staff spoke positively about the management team, although additional management support was identified as a need. The provider used a number of different audits to manage continuous improvement of the service, although the schedule of quarterly audits had not been maintained. There were some gaps in engagement with staff and relatives which the registered manager told us they would respond to.
We found breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the end of this report.