South West Supported Living

South West Supported Living is provided by Community Integrated Care and is a supported living service. Not everyone who uses the service receives 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, the service was providing personal care to 17 people with a learning disability and autistic people across six settings in the Bournemouth area. There was a central office in Wareham.

The supported living settings varied between individual flats with sole occupancy to houses with shared living areas, kitchens and individual bedrooms. Each of the locations had a staff sleep-in room and an office.

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

Improvements had been made by the provider which ensured risks to people’s health and safety were effectively managed. Staffing levels had improved with the service employing more permanent members of staff and considerably reducing the reliance on agency staff. When required, a small team of agency staff were employed to help ensure consistency of care for people.

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:

Risks were managed with the least possible restriction and people were supported to maintain and develop an independent lifestyle.

People and relatives told us how they or their family member could choose how they wanted to live and received the support they needed to do this. Staff encouraged and supported people’s choice and independence.

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 encouraged and supported to maintain a healthy lifestyle and supported to enjoy a variety of hobbies and interests which maintained their sense of well-being.

Right Care:

Care and support were provided according to people’s individual needs and wishes. Staff ensured people’s privacy and dignity were respected. People felt safe with staff and enjoyed spending time with staff who they knew well. Staff had a good understanding of people's care needs and ensured care and support was personalised.

Risk assessments provided up to date guidance and information for staff. They gave information for how staff could ensure people made informed choices and lived their lives.

Robust recruitment practices were followed. Appropriate checks were completed to ensure only suitable staff were employed. There was an ongoing process of staff recruitment to ensure people were supported safely and effectively. Staff received an induction and were well supported through a programme of regular supervision, spot checks and training. There were enough staff on shift to ensure people received safe care and support.

Staff had training on how to recognise and report potential abuse. There were enough staff on each shift to ensure people were supported safely. Staff received an induction and completed specialist training, to ensure their knowledge remained current.

Right Culture:

People, relatives and staff had confidence in the leadership of the service and felt it was well-led. The manager and provider-maintained oversight of the service through regular conversations with people, relatives and staff, as well as through a programme of quality assurance audits to ensure the service was working to the provider’s policies and procedures.

The provider’s monitoring processes were effective in helping to ensure people consistently received appropriate care and support. Staff knew and understood people and were responsive to their needs. People and those important to them were involved in planning their care.

The manager demonstrated joint working with health professionals which provided specialist support to people, involving their families and other professionals as appropriate. Staff demonstrated good understanding around providing people with person centred care and spoke knowledgably about how people preferred their care and support to be given.

People, relatives and staff felt confident in raising any concerns with the manager and told us any concerns would be listened to and acted upon.

Staff and relatives spoke of a supportive and friendly culture within the service, that was open and approachable and provided people with appropriate care and support.

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 requires improvement (published 11 February 2022).

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 the provider had made the required improvements and was no longer in breach of regulations.

Why we inspected.

We carried out an announced inspection of this service on 10 and 15 December 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At our last inspection we found breaches in relation to safe care and treatment, risks to people were not effectively managed, and the high use of agency staff had impacted negatively on people.

We undertook this focused inspection to check the service had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for South West 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.

South West Supported Living is a supported living service. Not everyone who uses this service receives 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, the service was providing personal care to 15 people with a learning disability and autistic people across six settings in the Bournemouth area. There was a central office in Wareham.

The supported living settings varied between individual flats with sole occupancy to houses with shared living areas, kitchens and individual bedrooms.

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

Improvements have been made to the governance systems since our last inspection. Quality audits were completed, reviewed and analysed to identify trends and themes and learning was taken from these and shared with staff. Audits included medicines, care plans, fire systems, health and safety, finance and accidents and incidents.

There were robust audit processes and systems in place that guided staff to ensure people were cared for safely. The service manager told us staff appreciated the changes that had been made and understood the importance of ensuring people received safe, effective, responsive care and support. The registered manager told us the staff worked well together and morale was good.

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 21 January 2022) and there were multiple breaches of regulation. Following the inspection, we told the provider when they must be compliant and meet the regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 17.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

South West Supported Living is a supported living service. Not everyone who uses the service receives 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, the service was providing personal care to 15 people with a learning disability and autistic people across six settings in the Bournemouth area. There was a central office in Wareham.

The supported living settings varied between individual flats with sole occupancy to houses with shared living areas, kitchens and individual bedrooms.

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 some of the underpinning principles of Right support, right care, right culture.

Right support:

People and relatives told us how they or their family member could choose how they wanted to live and had the support they needed to do this. Staff encouraged people’s choice and independence. 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:

Care and support was not always provided according to people’s individual needs and wishes. There had been some instances where staff had not always respected people’s privacy and dignity. The provider had taken corrective action to prevent such instances re-occurring.

Right culture:

The service had been through a period of major staff changes at both a managerial level and with care staff, which had had a detrimental effect on the culture. Ensuring appropriately trained and experienced staff had been a challenge because of the COVID-19 pandemic. The provider had taken additional steps and put a plan in place to manage and support the service through this challenging time. The service had an ethos of providing person-centred care to encourage people to lead independent, inclusive lives.

Improvements were needed regarding staffing within the service. Some people told us they felt comfortable with staff and enjoyed their company. However, other people told us they did not like being supported by agency staff as they felt they did not support them as they preferred. The service was reliant on using agency staff to ensure people received their appropriate levels of care and support. Problems had arisen when new agency staff had been employed and people told us the new agency staff did not know how to support them how they wished.

We found inconsistencies in the risk assessment processes. Some people’s risk assessments did not always inform staff how to care for people in the ways they wished. Some risks had not been identified and plans had not been put in place to manage them.

Improvements were needed to the providers governance systems. The systems in place for monitoring and checking the service was operating safely were not effective. The provider had a range of quality assurance processes in place; however, these had failed to identify the shortfalls we highlighted during our inspection.

We have made a recommendation regarding the providers complaint process.

Following the inspection, the provider confirmed they would review their quality assurance processes to ensure any future shortfalls would be captured and actioned appropriately.

Staff understood how to identify and report abuse and were well supported in their roles. Staff received regular team meetings, supervisions and appraisals and completed a variety of training courses to enable them to carry out their roles competently.

The provider had an ongoing recruitment process in place and staff were recruited safely with recruitment processes for staff being well managed.

Medicines were managed, stored and administered safely. People were supported to take their medicines safely by staff who had received the appropriate levels of training and had their competency checked.

Cleaning and infection control procedures followed the relevant COVID-19 guidance to help protect people, visitors and staff from the risks of infection. Government guidance regarding testing for COVID-19 testing for staff and visitors was being followed.

People’s dietary needs were assessed and reviewed regularly. People received meals of their choice. Some people enjoyed planning and cooking for themselves with appropriate support from staff.

People had the support they needed with communicating. They were supported to keep in contact with their families, to develop friendships and to get involved in events that were important to them such as sport, work and hobbies.

People, staff and relatives expressed confidence in the service leadership. Relatives and staff told us it was an improving service and told us the management team were approachable and operated an open-door policy. Staff felt well supported and spoke of the open, friendly and supportive approach of the service leader.

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

This service was registered with us on 24 August 2021 and this is the first inspection.

Why we inspected

This inspection was prompted in part due to concerns received about the lack of consistent, experienced staff and the disrespectful attitude of some staff. A decision was made for us to inspect and examine those risks.

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 action to mitigate the risks highlighted during this inspection.

Enforcement

We are mindful of the impact of theCOVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safe care and treatment of people, the governance of the service and staffing.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.