Archived: Durham & Sunderland Supported Living

Durham & Sunderland Supported Living provides personal care to people living in supported living services. This service primarily offers support to adults with learning disabilities or autistic people. At the time of our inspection the service was supporting 98 people in supported living settings across County Durham, Sunderland and Gateshead.

Before this inspection, the provider applied to CQC to register the supported living services in Gateshead as a separate service. During this inspection CQC approved this application. Gateshead services were inspected as part of this inspection, so the findings and overall rating for this service also apply to the newly registered Gateshead Supported Living service (https://www.cqc.org.uk/location/1-14623451556).

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

Staff focused on people's strengths and promoted what they could do, so people had a fulfilling and meaningful life. The service worked with people to plan for when they experienced periods of distress, so their freedoms were restricted only if there was no alternative. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs. 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.

Right care

Staff promoted equality and diversity in their support for people. Staff understood and respected people's religious and cultural needs and supported them accordingly. People received kind and compassionate care. Staff protected and respected people's privacy and dignity. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people's needs and keep them safe.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People could take part in activities and pursue interests that were tailored to them. Staff supported people to try new activities that enhanced and enriched their lives. Staff and people co-operated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management team and staff. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff placed people's wishes, needs and rights at the heart of everything they did. Staff valued and acted upon people's views. People's quality of life was enhanced by the service's culture of improvement and inclusivity.

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 19 July 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can read the report from our last inspection by selecting the ‘all reports’ link for Durham & Sunderland Supported Living on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Community Integrated Care Northern Regional Office provides personal care to people living in supported living services. At the time of our inspection the service was supporting 178 people in different types of accommodation across the north east.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture in some of the individual supported living services.

Right support:

• Staff were using people’s homes as an office base. Documentation in relation to the service provision was evident in people’s homes.

• People’s homes were not sufficiently adapted to include them in domestic activities and promote their independence.

Right Care

• People were given choices by staff and were encouraged to pursue their individual likes and interests. People were treated with dignity and respect.

Right culture:

• The managers of the services demonstrated they had the right values and ethos to lead a supported living service. However, audits failed to identify where services could be improved to further develop and enhance people’s experience of living in their own homes.

Staff reported safeguarding incidents on an electronic system and allocated a rating for the harm caused. Some of the reported safeguarding incidents were avoidable.

Although no one had been harmed by medicine errors, there were a number of repeated errors which had put people at risk of being harmed.

The provider had a range of audits in place to monitor the individual supported living services. Actions were put in place to make improvements. The audits did not include a robust overview of the safeguarding concerns and medicines errors.

Staff learned lessons about how to meet people’s needs when their behaviour changed, or people showed distress. They engaged family members and other professionals to assist them. People’s personal risks were well-documented.

Staff were clear about to whom they were accountable and felt supported by their service leads. One staff member said, “[service lead’s name] is a good manager.”

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.

Staff promoted people’s inclusion in their community and engaged them in events according to their wishes and interests.

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 30 August 2017).

Why we inspected

The inspection was prompted in part due to the length of time since our last inspection and the number of notifications we received from the provider which either did not meet with legal requirements or contained information of concern. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. No areas of concern were identified in the other key questions. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at 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.

You can see what action we have asked the provider to take at the end of this full report. The provider has taken steps to address the risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Integrated Care Northern Regional Office on our website at www.cqc.org.uk.

Our inspection was carried out at this time because of concerns we had due to the notifications we received from the service. Notifications are changes, events or incidents the provider is legally required to let us know about. The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to a criminal investigation and as a result this inspection did not examine the circumstances of the incident.

We planned to carry out a focussed inspection to consider the incidents detailed in the notifications, but due to the evidence we gathered and the improvements made in the service we changed this inspection to a comprehensive inspection to more accurately reflect our findings.”

The service provides support to over 160 people living in their own accommodation. There were four regional managers in post who line managed supported living services grouped by local authority areas. A supported living service enables people to live in their own home and receive care and/or support in order to promote their independence. People who live in such services have a tenancy agreement in place for their accommodation and are provided with support by a provider who is independent of their accommodation provision. In each area services had been clustered together for management purposes and each cluster was managed by a service lead. At the time of our inspection there were 17 clusters across 10 local authorities.

At our last inspection in August and September 2016 we found the service was in breach of the following regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Regulation 12 Safe care and treatment

Regulation 17 Good governance

Regulation 18 Staffing

We asked the provider to take action to make improvements. Following the inspection the provider submitted an action plan to tell us how they intended to improve the service. We found during this inspection the provider had made improvements in each of these areas.

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. The provider had taken the decision that the four regional managers should apply to become registered managers. Each registered manager would then be responsible for services in a defined geographical area. At the time of the inspection two managers had their applications to become registered accepted by CQC and two managers had begun the process to become registered.

Staff were supported through induction, training, supervision and appraisal to carry out their duties. Checks were in place in the provider’s recruitment practices to ensure people employed in the service were suitable for their roles.

Staff had received training on how to administer people’s medicines. They were then observed giving people their medicines and assessed as competent. We found people’s medicines were administered in a safe manner.

People were protected from the risk of abuse because the staff understood how to keep people safe and what actions they needed to take if they were concerned a person may be at risk of harm.

We found there were sufficient staff on duty to meet people’s needs.

Staff had identified and assessed risks to people and actions had been put in place to mitigate the risks. We saw where accidents had occurred these were reviewed and risk assessments were updated to prevent future occurrences.

The service was in a period of transition from introducing a new format of care plans. Staff were positive about the new format. We asked to see the current care plans in use for people and found these had been updated and contained relevant information to guide staff on how to provide care and support to meet people’s care needs.

We found staff promoted people’s independence and encouraged and support people to do things for themselves. Staff supported people to welcome the inspector into their home and make introductions.

Relatives told us staff were kind, supportive and respectful. We observed people approach staff with confidence. Staff were able to tell us about people’s needs and their likes and dislikes. We found staff knew people well.

People were enabled to do their own food shopping and were supported by staff to cook. We found staff supported people to eat. There was guidance in place to tell staff about people’s dietary requirements.

The supported living services complied with the requirements of the Mental Capacity Act 2005. Mental capacity assessments were in place and where people were unable to make decisions for themselves we found best interest decisions had been taken.

People chose what they wanted to do each day. For some people they preferred a regular weekly routine. Other people preferred to choose what they wanted to do each day. We found people were supported by staff to live the lifestyle they chose.

Relatives felt they were kept informed about their family member and confirmed to us they were invited to be involved in reviews undertaken about people’s care.

The supported living services were regularly audited; actions with target dates were put in place to improve the service. The provider had put in a place a new electronic dashboard. This allowed managers to monitor the performance of each service.

People who used the service accessed community resources with the support of staff in order to meet their needs and support their well-being.

Staff were open and transparent during the inspection. They showed us what they had done to safeguard people and were aware of what they needed to do next to continually improve the service.

Community Integrated Care is a domiciliary care service that provides personal care and support to people with a range of needs, including learning difficulties, physical disabilities, complex needs (including dual diagnosis), mental health concerns, sensory impairments and autistic spectrum disorders. These people live in their own homes and supported living services. The service is provided across Newcastle, North Tyneside, Gateshead, South Tyneside, Sunderland, Middlesbrough, Stockton, County Durham and Northumberland areas.

The service had a registered manager. 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.

At the time of our inspection the registered manager was absent from the service and one of the regional managers was covering the duties of the registered manager.

At the last inspection in July 2013 we found the registered provider was meeting the regulatory requirements.

Staff had received training in safeguarding. We found staff understood what actions to take if they thought people were unsafe.

There was robust oversight of accidents and incidents by the management team to ensure the risks of any accidents re-occurring would be reduced.

Staff employed by the registered provider had undergone a number of checks to ensure they were suitable to work in the service.

Where people lived with others in joint homes we found the arrangements for fire safety to between the landlord and the registered service to be at times unclear. People had not been able to practice emergency evacuations.

Staff were not always up to date in their medicines training and some assessments of them to determine their competency to give people their medicines were not up to date.

Staff had not received regular support through supervision and training to enable them to care for people. The service had introduced a new system for giving support to people through supervision meetings with their manager. This had yet to be fully implemented.

The service adhered to the requirements of the Mental Capacity Act. This meant people’s capacity to make decisions had been assessed. Where required we found decisions had been made in people’s best interests involving their family members and other professionals.

People were able to choose the food they wanted to eat and were supported to eat and drink when required.

The service had introduced a new system for people’s care planning. We saw the implementation of the system was at different stages. Staff saw the advantages of the new system.

We found that people’s care plans had not always been reviewed in a timely fashion. This meant that any changes to people’s care plans identified in the reviews had not been carried out.

People were supported by staff to participate in a range of activities of their own choosing. We saw people had in place regular visits to places where they enjoyed going.

We found regional managers fed back to the registered manager at monthly meetings about the regulated activity and updated the registered manager on events which had taken place in the service.

We found that some staff were unclear about which of the provider’s registered office location they were accountable to. The office arrangements were clarified for us and the regional director explained there may be some further review of these to ensure the service is working in the most effective way.

During our inspection we found a number of breaches of the Health and Social Care Act 2008

(Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.