Background to this inspection
Updated
8 July 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection team included four inspectors, one medicines inspector and medicines team support officer and two Expert by Experiences. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in supported living settings, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. However, the registered manager had recently left the service and was due to apply to cancel their registration. Another registered manager employed by the provider for a neighbouring location had taken over daily management oversight of the service and intended to apply for registration.
Notice of inspection
We gave a short period notice of the inspection to enable the manager to seek consent from people using the service, their relatives and staff, so we could contact or visit them as part of the inspection.
Inspection activity started on 14 June 2021 and ended on 16 June 2021. We visited the office location on 14 and 15 June 2021.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. join up to last paragraph We used all of this information to plan our inspection.
During the inspection
One inspector, a medicines inspector and a medicines team support officer visited a total of 20 people living in their own homes. We also spoke with seven team leaders and nine members of staff. At the office we spoke with the manager, an area manager and the head of quality and compliance.
Three inspectors spoke with 11 staff and one relative and two experts by experience spoke with 18 relatives over the telephone.
We reviewed a range of records. This included five people’s support plans and care records as well as ten people’s medication records, we also checked medicine storage arrangements. We looked at two staff files in relation to recruitment. In addition, we looked at a wide range of records relating to the management of the service including policies and procedures, significant incidents and associated learning, staff training as well as audits and quality reviews.
After the inspection
We continued to seek clarification from the provider to validate the evidence found.
Updated
8 July 2021
About the service
East Lancashire Branch Office, known to people using the service and staff as AFG (Alternative Futures Group), is a supported living service providing personal care to people who lived in their own homes across East Lancashire.
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. At the time of the inspection, a total of 139 people were using the service, of which 108 people were receiving support with personal care.
People’s experience of using this service and what we found
People told us staff were kind and caring. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were sufficient numbers of staff deployed to meet people's needs and ensure their safety. The provider operated an effective recruitment procedure to ensure prospective staff were suitable to work for the service. The staff carried out risk assessments to enable people to retain their independence and receive care with minimum risk to themselves or others. People were protected from the risks associated with the spread of infection.
Whilst people received their medicines safely, we have made a recommendation about the introduction of a more robust recording system for recording the use of thickening powder. People were supported to eat and drink in accordance with their support plan. Following a specific incident, the provider had carried out a comprehensive review of policies, protocols, staff training and practices in relation to the risk of choking.
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. People’s needs were assessed prior to them using the service. The provider had appropriate arrangements to ensure staff received training relevant to their role. New staff completed an induction training programme. Staff felt supported by the management team.
Care was personalised and adapted flexibly in response to changing needs and preferences. Staff supported people to live full lives and achieve outcomes in a planned way. Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Staff spoke with people in a friendly manner and people’s support plans reflected their likes and dislikes. Our observations during the inspection, were of positive and warm interactions between staff and people.
Staff were motivated and demonstrated a clear commitment to providing dignified and compassionate support. People were supported and encouraged to participate in a range of activities and had the opportunity to join groups and attend meetings. People and their relatives had access to a clear complaints procedure.
The management team monitored the quality of the service provided to help ensure people received safe and effective care. This included seeking and responding to feedback from people in relation to the standard of care. The management team and staff made regular checks on all aspects of care provision and actions were taken to continuously improve people's experience of care.
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 the Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
¿ People had individual tenancies in their own home or small home with a few others. This model of care maximised people’s choice, control and independence. Care and support had been developed around individual assessed needs. Staff worked in a way which promoted people's independence.
Right care
¿ Care was person-centred and promoted people's dignity, privacy and human rights. People confirmed their privacy and dignity was respected. Support plans were person centred and ensured the person was involved in the development and review of their plan as far as possible. Training and support for staff ensured human rights was at the heart of the delivery of care and support.
Right culture:
¿ Ethos, values, attitudes and behaviours of the manager and staff ensured people using services lead confident, inclusive and empowered lives. People’s diverse needs were assessed, supported and respected. People were supported to make choices and live the life they chose.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 11/10/2019, the provider registered a new office location on 13/05/2021. This is the first inspection.
Why we inspected
This was a planned inspection. Prior to the inspection, the provider alerted us to a specific incident following which a person using the service died. We are currently conducting enquiries into the incident. As a result, this inspection did not examine the circumstances of the incident.
The information CQC received about the incident indicated concerns about the management of choking risks. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the effective and well-led sections of this full report.
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.