Archived: Scope Inclusion South West

We last inspected the service on 26 July and 2 August 2016. We found breaches of Regulations in respect of how the service was ensuring they were staffed safely and meeting people’s needs in a personalised manner. The service was judged to be Requires Improvement overall. They were also Requires Improvement in respect of the whether the service was safe, effective, responsive and well-led. Whether the service was caring was judged to be Good. The registered manager sent us an action plan on how and when they were going to put this right. They told us this would be put right by December 2016. We checked on this inspection and found the issues raised in 2016 had been addressed.

Scope Inclusion South West (referred to as Scope South West) provides care to people in their own homes. Care can be provided to all ages from children to older people. At the time of the inspection eight people were receiving personal care and were aged between four and 64 years. People’s needs could include physical disabilities, sensory impairment, learning disabilities and autistic spectrum disorder.

A registered manager was employed to manage the service locally. 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.

Systems were not operated effectively to ensure there were enough staff to meet the requirements of people’s care plans at all times. The provider had recruited more staff since the last inspection and the percentage of missed shifts had fallen. However, the contingency plan was not always working to make sure staffing needs were met where there was advance or short term notice. The provider’s quality auditing had not ensured staffing was identified as an on-going need. Having identified the service was not meeting 100 per cent of staffing, this had been challenged further.

Staff were recruited safely and trained to meet people’s individual needs. Wherever possible people were only cared for by staff known to them and trained to meet their needs. Relatives told us they felt staff were caring, considerate and able to meet their loved ones needs in a caring way.

People’s care was planned in a personalised way and people’s relative and relevant professionals were involved in planning and meeting their needs. People had the necessary risk assessment in place to keep them safe. People’s health needs were identified and acted on. Staff understood how important consent was and the requirements to ensure they were acting in people’s best interests (adults) or parental consent (children) where this was required. People were supported to stay active in their community and access local facilities.

Relatives felt their loved one was safe with staff. Staff were trained in safeguarding adults and children and understood how to raise a concern. Staff felt the registered manager and other senior staff would act to keep people safe. The provider had a whistle blowing policy which staff knew about and would use if their concerns were not listened to.

People’s needs were met where staff were responsible for people’s medicine and ensuring people had enough to eat and drink. Clear records were kept and issues followed up on.

Staff liked working for the service and told us the registered manager and other senior staff were approachable and supportive. Relatives were involved in planning the care of their loved one and asked their view of the running of the service. Complaints were investigated and ensured they were fully concluded to the complainant’s satisfaction.

Scope Inclusion is part of a national organisation (Scope). Scope Inclusion (Plymouth branch) support people in the community with complex needs which included children (0-18 years), and younger adults with learning, physical and sensory disabilities. The office is based in the centre of Plymouth city centre and is accessible to people with physical or sensory disability. At the time of the inspection there were nine people being supported. Managers, staff and records referred to people using the service as customers therefore this terminology will be reflected in this report.

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.

People were not always receiving the level of care and support they had been assessed for. Staff were not always available to cover some shifts which meant families were helping staff to support their relative. A relative told us, “This happens a lot at the moment and I do not always get the respite I am supposed to get and “We get a lot of cancellations because of staff shortages.”

There was an on-going staff recruitment programme taking place to improve current staffing levels. Four staff had been recruited but were still going through checks to ensure they were suitable to work with people who were vulnerable and had complex needs. Another recruitment drive was due to take place in early August 2016.

Staff who had worked at the agency for some time said they had received training in a range of subjects relevant to the needs of the people they supported. They told us, “Training is good, especially supporting customers with special needs” and “Where customers have special needs especially epilepsy we get the training we need to deal with situations”. Training records showed staff training was monitored to highlight when updates were required, for example epilepsy or specialist feeding. There was a current vacancy for a nurse who had been providing specific clinical training to support staff when responding to situations which may arise. In the interim the agency was asking community nurses to support staff.

New employees undertook a structured induction programme which prepared them for their role.

The staff team were supported by the service manager through daily communication and regular supervision to support their personal learning and development needs.

The registered manager 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 report any unsafe care or abusive practices.

The service had recently introduced a mental capacity assessment process to ensure where people did not have the capacity to make certain decisions; the service referred the assessment to the local authority who had the legal responsibility under court of protection.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people needed to be supported. The service had risk assessment procedures in place. However, in one instance the most current information was held at the central office and not at the person’s home where staff required the information. The registered manager acted on this when it was pointed out.

Suitable medicine procedures were in place should the agency be required to administer medicines. Staff told us they had received training which gave them confidence to support people with medicines safely. A recent error was reported immediately and the registered manager was investigating the issue in order to take appropriate action.

People knew how to raise concerns and make complaints. There were plenty of opportunities for people, relatives and staff to voice how they felt about the service and any concerns they had. A family member said they had raised a concern about the variations in staff supporting their relative. They told us they were generally satisfied with the response. There were no current on-going complaints at the time of the inspection.

As the service was newly registered there was limited information of how relative’s views of the service had been obtained. However, the registered manager said they had an open dialogue with families to make sure their voices were listened to. A relative told us, “I have regular discussion with the manager who tells me they are doing everything they can to improve the staffing issues.” Where people had received surveys they had voiced their concerns in respect of staffing issues.

The agency had a system of regular audits to monitor performance and quality assurance. However the most recent visit from an area manager did not report on staffing issues found during this inspection and which had been on-going for some time. Most people told us the service was ‘open and honest’, however one person told us, “It is badly managed”, “Staff are unhappy.”

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.