Archived: Aspirations Southwest Adults

Aspirations Southwest Adults provides domiciliary care and supported living services to adults with a learning disability or mental health condition in their own homes. At the time of our inspection there were 17 people receiving the regulated activity of personal care.

Aspirations Southwest Adults 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.

People were at risk of receiving care from unsuitable staff because robust recruitment procedures were not being applied.

Since our previous inspection there had been improvements to the service. Staff received improved support through regular individual and group meetings and commented on better communication from managers. People using the service now enjoyed a wider range of activities and benefitted from improved management of the service.

People were enabled to live safely; risks to their safety were identified, assessed and appropriate action taken. People's medicines were safely managed.

People were satisfied with their support and the approach and effectiveness of staff. People had achieved positive relationships with staff. People were treated with kindness, their privacy and dignity was respected and they were supported to maintain their independence and engage in activities. People and their representatives were involved in the planning and review of the support they received.

Staff received support to develop knowledge and skills for their role and were positive about their work with people. Managers were accessible to people using the service and staff. Systems were in place to check the quality of the service provided including gaining the views of people who used the service.

There had not been a registered manager in post since February 2016. 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. A manager had been appointed and had started the process to apply to the Care Quality Commission to be considered as a Registered Manager.

Aspirations Southwest Adults had been through considerable changes in the past three months including a new manager and a new management structure which had increased the level of management support to people using services. In addition a review of staff supporting people in their homes had allocated staff teams to work in specific services rather than across multiple services. Additional staff resources had also been allocated such as the support of the quality assurance manager and a training mentor to work alongside the new managers. Service managers had started to set up individual meetings with their staff teams to offer them one to one support and to implement the use of new records detailing people’s daily lives and any accident and incidents. These changes were starting to have positive effects for both people using the service and staff but as staff commented, “It’s too early to say, we can see from what they say we are moving forward, this can only be good.”

People’s experience of the service they received was varied. There were still some inconsistencies in their access to activities in their home and their local community. Some people lived full and busy lives whilst others spent considerable amounts of time in their homes. For some this was a lifestyle choice but for others this was said to be due to the availability of staff. Plans had been developed with people to try new activities or to be more engaged in their homes and for some this had already shown signs of success. People kept in touch with their families and friends.

People’s rights were upheld and they were supported by staff who had a good understanding of how to keep them safe. People were encouraged to take risks whilst any hazards were reduced as far as possible. They made choices and decisions about their day to day care and support and if they needed help to make larger decisions this was provided in the form of best interests meetings. People’s medicines and finances were monitored closely to make sure they were managed safely.

People benefitted from staff who had access to training to equip them with the skills and knowledge to meet people’s needs. Staff completed an induction which included a nationally recognised care certificate and had the opportunity to develop professionally. Staff said “communication had improved” and were positive about the changes to the management structure which made service managers more accessible to them. People had been involved in the recruitment of staff and had been asked about the qualities they would like their staff to have. They listed being “fun” and “listening to them”. Staff teams had been allocated to people in their homes providing consistency and continuity of care, which relatives confirmed was so important.

People had been asked about their views of their care. They were asked to respond to an annual survey, invited to bi-monthly coffee mornings and reviewed their care with staff each month. The provider had a range of quality assurance audits in place monitoring the service provided and taking action when needed to make the necessary improvements.

Two adult social care inspectors carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led? We undertook this inspection because concerns had been raised with us by relatives and professionals about the quality of support being provided. The concerns primarily related to managing people's finances, poor practice going unaddressed by managers, staffing levels and a lack of staff experience and knowledge.

We used a number of different methods to help us understand the experiences of people using the service because some people using the service had complex needs which meant they were not always able to tell us their experiences. As part of this inspection we spoke with five people who use the service, five relatives, five senior staff, seven care staff and three health and social care professionals. We also observed support being provided to three further people and reviewed records which included five care plans, daily care records, staff training records and relevant policies and procedures. Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were kept safe from abuse because staff knew what to do if they became aware abuse was taking place. Information was shared with the correct agencies in a timely fashion and action was taken by the service. The system in place to safeguard people's money had recently been improved following allegations of financial abuse.

Risk assessments were in place for each person and had been used to inform people's support plans. These risk assessments balanced the need to keep people safe with the person's right to make choices and be as independent as possible. Staff were able to provide safe care that reflected people's needs as the support plans accurately recorded the needs and preferences of each person.

Although there were enough staff on duty during our inspection to provide safe care, we were told by relatives and professionals that low staffing levels sometimes prevented people being able to have individual time with staff or go out as much as they may want to.

Is the service caring?

Each person's care plan identified how involved they had been in the care planning process. People were being supported to take part in meetings to plan their care. This allowed them to tell staff what was working well for them and what was not. It also allowed them to set outcomes they wanted to work towards.

The support we observed was provided by staff who were patient and kind. We received positive feedback from some relatives about the support currently being provided. Some negative feedback was also received and has been shared with the provider for investigation.

Is the service responsive?

People were asked for their views on the quality of care. A survey had been completed in 2012 and a review of the responses had resulted in action being taken by the provider. We were told by most relatives they felt listened to and that their concerns were addressed.

Is the service effective?

We saw health action plans that monitored people's health needs. These documents helped staff ensure people stayed well. The training needs of staff were monitored to ensure they had the training they needed to support people safely. Some professionals visiting the service told us staff had the knowledge they needed to meet people's immediate needs but sometimes lacked an understanding of wider health and social issues affecting the person. This could result if people not receiving the most appropriate support.

Is the service well-led?

The level of oversight and support provided for staff had recently been increased. We received positive feedback from staff, professionals and relatives regarding these changes. There had also been an increase in the quality monitoring taking place. This had resulted in poor practice being challenged and ongoing problems being addressed.

The provider wrote to us and told us that all care records would be updated to reflect people's needs and people's capacity to be involved in their care. Staff would receive training with regard to assessing people's mental capacity and dignity and choice. The quality monitoring system would be reviewed so that there was a greater focus on care delivery and people's experience. The provider told us that these changes would be implemented by 30 September 2013.

We found that the compliance actions set in May 2013 were met. Care records had been updated to accurately reflect people's needs and this included an assessment of people's mental capacity to make daily decisions. We saw that people were involved in developing their care and support plans. The provider had revised the management structure and staff told us that this had resulted in better communication and a clearer definition of their roles. The provider had implemented a system for monitoring the quality of the care being provided.

We found that the provider was not carrying out assessments of people's capacity to make day-to-day decisions. We saw that where people had capacity they had not been involved in writing and reviewing their care plans. This meant that staff had insufficient information to consistently know how and when to involve people in making day-to-day decisions.

We spoke with five locality managers/deputies and it was clear that they had started to review people's care plans and were committed to setting up systems to monitor the quality of the service. However, there was no systemic programme in place to review people's care and not all care plans reflected people's current needs. This meant that there was a risk that people's needs may not be met because staff did not have accurate information to follow. There was also no system in place to monitor the quality of the care provided to people.

During our visit we spoke with seven care staff and they all told us they had received the relevant training to carry out their roles. They also told us that they felt supported by the new management structure because they knew who to speak to.