Archived: Century Way

Century Way is a 'supported living' service that provides care and support to people living in a tenancy arrangement with a housing association in two separate next door houses in the community. There is an office in one of the houses from where the service is run. The service was registered for the support of up to four people in line with current best practice guidance. Four people were using the service at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people. The service used positive behaviour support principles to support people in the least restrictive way. No restrictive intervention practices were used.

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

At this inspection the registered manager had acted on the issues found at the last inspection and submitted notifications to the Commission as required under the regulations. Issues we had found needed improvement in respect of medicines management at the previous inspection had also been acted on and medicines were safely managed.

However, we found some improvement was needed in the way the service worked in partnership with the housing association to ensure there were robust systems to manage the safety of the service. There were high levels of agency staff in use and gaps in management presence as the registered manager worked across two sites. There was no deputy manager to provide additional management support at the time of the inspection; although the post was being recruited to. We discussed the impact of this with the provider. We found this had already been identified and was in the process of being addressed. We will check on this through our monitoring of the service and at the next inspection.

People told us they felt safe from harm and staff understood their responsibilities under safeguarding procedures. Risks to people were identified assessed and guidance provided to staff on how to minimise the risks. There was a system to flag and review accident and incident reports to ensure suitable action was taken and learning identified. Staff understood how to protect people from the risk of infection.

Relatives and professionals identified there was a high staff turnover and regular use of agency staff. The provider told us they had prioritised recruitment to fill these vacancies and they were working hard to recruit the right staff. There were enough staff to meet people’s care and support needs. Appropriate recruitment checks took place before staff started work.

The service applied the principles and values of Registering the Right Support and other best practice guidance. For example, in the way it assessed people’s needs and worked with people to identify goals that increased their confidence and independence.

Staff received adequate training and support to meet people’s needs. People’s nutritional needs were met. People had access to health and social care professionals as required. 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.

People were supported by staff who were kind and caring. People were involved and consulted about their care and support needs and treated with respect and dignity. Staff worked with people to promote their rights. Staff understood their role in supporting people appropriately, addressing any protected characteristics. People were supported to be as independent as possible.

People had a personalised plan of care to guide staff on how to meet their needs. People’s communication needs were assessed. People were supported to access community services and to participate in activities of their choosing that met their needs. The outcomes for people using the service reflected the principles and values of Registering the Right Support by 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.

There were systems in place to assess and monitor the quality of the service. The registered manager promoted an open and inclusive service. Staff spoke highly of the registered manager. The service worked in partnership with health and social care professionals to plan and deliver an effective service that met people’s needs. People and their relatives’ views about the service were sought and the feedback used to consider improvements.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was ‘Requires Improvement’ (published 16 October 2018)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. Since this inspection the name of the registered provider has changed. 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 we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The care service has 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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 2008 and associated Regulations about how the service is run.

This was the first inspection of the service. At this inspection we found a breach of regulations because the registered manager had not always submitted notifications about certain events to CQC, where required.

You can see what action we have told the provider to take at the back of the full version of this report.

People received their medicines as prescribed from staff who had been trained in medicines administration but improvement was required to ensure people’s medicines were safely stored. Risks to people had been assessed and action taken to mitigate identified risks. People were protected from the risk of abuse because staff were aware of the types of abuse that could occur, the signs to look for, and the procedures for reporting abuse allegations. Staff were also aware of the provider’s whistle blowing procedure and told us they felt confident that they would use it if needed.

The provider followed safe recruitment practices. There were sufficient staff on each working shift to safely meet people’s needs. Staff were aware of the action to take to reduce the risk of infection when supporting people. The registered manager maintained a record of any accidents or incidents which occurred and shared learning with staff in order to reduce the risk of repeat occurrence.

People’s needs were assessed and their care planned and delivered in line with nationally recognised guidance. Staff received an induction when they started work for the provider. They were supported in their roles through a programme of training and received regular supervision. The registered manager had staff annual appraisals planned for the end of their first year working at the service.

People received the support they required to maintain a balanced diet. They had access to a range of healthcare services when needed, and staff sought to ensure they received consistent, joined up care when moving between different services. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff sought people’s consent when offering them support. They were aware of how the Mental Capacity Act 2005 (MCA) applied to their roles when supporting people. The registered manager was working with the local authority to start the process of seeking lawful authorisation to deprive one person of their liberty, in line with the MCA.

Staff treated people with kindness and consideration. People were supported to express their views and were involved in decisions about their care and treatment. They were also treated with dignity and their privacy was respected. Staff encouraged people to develop their skills and maintain their independence. They were committed to supporting people's needs in regard to their race, religion, sexual orientation, disability and gender. People knew how to complain and expressed confidence that any issues they raised would be addressed.

People had been involved in the planning of their care. They had care plans in place which reflected their individual needs and preferences. People’s views on the support they received were sought through regular keyworker meetings and surveys conducted by the provider. Staff supported people to take part in a range of activities which people enjoyed. People’s preferences for the support they wanted to receive at the end of their lives had been discussed with them, where they wished to do so.

The registered manager held regular staff meetings to discuss the running of the service and ensure staff were aware of the responsibilities of their roles. Staff worked well as a team and had a strong focus on meeting the provider’s aim to maximise the potential of the people they supported. The provider had systems in place to monitor the quality and safety of the service, and staff acted to address any issues identified through the provider’s quality assurance processes. The registered manager worked openly with other agencies to provide a high-quality service.