Archived: One Fylde (Church Road)

Fylde Community Link Supported Living and Domiciliary Service provides support to adults with a learning disability across the Fylde, Blackpool, and Wyre areas of Lancashire. People's support is based on their individual needs and can range from 24 hour care within a supported living environment to a set number of visits each week from the domiciliary service.

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. The aim of the guidance is to help services ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This service provides personal care and support to 81 people living in ‘supported living’ settings, so they can live in their own home 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.

They also provide domiciliary care to 34 adults with a learning disability. The service provides personal care to people living in their own houses and flats.

There were three registered managers in place. 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 last inspection the service was rated Requires Improvement. At this inspection we found the service had improved and was rated Good.

Although a number of people had limited verbal communication and were unable to converse with us, we were able to speak with 19 people who received support. They gave us positive feedback about the service they received and told us they were cared for by staff who met their needs and treated them well.

Relatives told us staff were caring, well-trained and attentive to the needs of their loved ones. They told us they were happy with the care provided and gave positive feedback about how the service was provided.

People we spoke with and staff told us there were always enough staff to provide the support people required. Staff we spoke with knew people they supported very well. They were able to share important information about people’s care needs and how they preferred to be supported.

The service had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents to the commission when required.

Risk assessments were completed to assess the potential risk of harm to people while receiving care and support. Staff drew up plans of support to lessen these risks. Risk assessments and associated plans of support were kept under regular review.

Staff had been recruited safely, appropriately trained and were well-supported. They had the skills, knowledge and experience required to support people with their care and support needs.

The provider had implemented a new risk assessment for medicines administration, which had helped to improve the level of independence people had with their medicines. Systems were in place which helped to ensure medicines were managed properly and safely, in line with best practice guidance.

People were treated as unique individuals by staff who supported them. Through conversations with people who used the service and staff, we found the service focussed on delivering personalised support which empowered people to make their own choices and retain their independence.

People had been 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. Policies the service had took into account people’s human rights and protected characteristics. This helped to prevent any discrimination.

People told us staff knew them well, including their support needs and preferences. We saw written plans of care and support were detailed and informative. Clear records were kept of the care and support each person received.

People were supported to maintain their health and to eat a balanced diet. Staff had information about people’s dietary needs and these were being met. People had access to healthcare professionals and their healthcare needs had been met.

People we spoke with and their relatives told us they were supported to participate in a variety of activities. The service had also supported people to gain employment and set up a gardening group, which was run by people who used the service, with staff support.

People described staff as caring. Relatives we spoke with gave us consistently positive feedback about the approach of staff. Staff had received training around dignity and respect and put this into practice when delivering care and support.

The service had a complaints procedure. This was available in an easier to read format and was given to people who used the service. People we spoke with and their relatives told us they had no cause for complaint but knew they would be listened to if they wanted to raise concerns.

Staff at the service carried out regular checks and audits on various aspects of the service delivered. People and their relatives were invited and encouraged to give feedback about their experiences of the service they had received. Regular management meetings were held where concerns or areas for improvements were discussed. This showed the provider had systems to assess, monitor and improve the quality of the service provided.

Further information is in the detailed findings below.

We last inspected this service in June 2014. At that inspection we found the service was meeting the legal requirements in place at the time.

Fylde Community Link Supported Living and Domiciliary Support is a community based, non-profit making agency that offers support services for adults with learning disabilities within Blackpool, Fylde and Wyre. The agency can also provide a service for people who have physical disabilities and/or sensory impairments. The agency provides personal care and support to people in their own home and to people living in supported living services.

At the time of our inspection, Fylde Community Link Supported Living and Domiciliary Support provided services to 120 people. 69 of these people were in supported living. They shared 18 properties. 51 people received support in their own homes.

There were three registered managers for this service. Two registered managers were present throughout our inspection and the third registered manager was present on the first day only. 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.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely.

We looked at assessments undertaken for eight people. Risk assessments had been undertaken. We found care plans identified risk management in a person centred way. A significant number of incidents had been acted on appropriately.

Reviews had been carried out for people when significant incidents had happened. People were protected from bullying, harassment, avoidable harm and abuse because staff had responded to concerns of bullying and harassment when they noticed them. We found that the service had not consistently followed safeguarding reporting systems, as outlined in its policies and procedures and within the local safeguarding body arrangements. We made a recommendation about this.

The service promoted staff development; staff received training appropriate to their roles and responsibilities. Staff told us they felt well supported by management and we saw evidence that regular supervisions had been undertaken.

The service had gained people’s consent to care and treatment in line with the Mental Capacity Act (MCA). We looked at people's care records and found mental capacity assessments, with supporting best interests’ decisions records. The Local Authority had been informed of people whose care involved restrictive practice. However, we found this had not been consistent. We found a significant number of people that had not been referred to the local authority to be considered for deprivation of liberties authorisation.

Care records held details of joint working with health and social care professionals involved with people, who accessed the service.

We received consistently positive feedback about the staff and the care people received. Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights. People and their relatives told us they had developed positive relationships with care staff. We saw evidence of this during the inspection.

We found people's needs were being met in a person centred manner and reflected their personal preferences. There were clear assessment processes in place, which helped to ensure staff had a good understanding of people's needs before they started to support them. People’s care was delivered in a way that took account of their needs and the support they required to live independently in the community. Staff prompted people’s independence.

Feedback from staff was mixed. Majority of the staff and people who used the service told us that the management team were approachable. However, two care staff had raised concerns and felt their views were not taken into consideration. Grievance and whistleblowing policies were available to all staff. The registered managers were familiar with people who used the service and their needs. When we discussed people's needs, the managers showed good knowledge about the people in their care.

There were systems in place to ensure people’s views were sought. We saw evidence the organisation carried out surveys and spot checks to gather people’s views about the services they received. Advocacy services were available for people who needed someone to speak up for them.

People’s care had been reviewed and modern technology had been introduced to assist interaction with people who had communication difficulties. We saw evidence of working together with local schools to develop communication tools to help develop communication strategies for staff and people.

Minutes of meetings showed staff were involved in discussions about improving the service. Management encouraged the staff team to provide good standards of care and support.

The service had a complaints procedure which was made available to people they supported. People we spoke with told us they knew how to make a complaint if they had any concerns and the service had provided people with details on how to make a complaint. The registered managers used a variety of methods to assess and monitor the quality of the service. These included meetings with people, satisfaction surveys, audits, and care reviews. However, there were no audits for medicines within the domiciliary care part of the service. Care plans that we looked at had not been audited. We found things that should have been picked up by audits. We have made a recommendation about this.

The service had complied with some of the registration requirements. However, the service had not sent statutory notifications on some of the notifiable incidents to the Care Quality Commission (CQC) to ensure CQC can undertake its regulatory activities timely and effectively. We have made a recommendation about this.

We found people were satisfied with the service they received. We found the registered managers receptive to feedback and keen to improve the service. They worked with us in a positive manner providing all the information we requested.

We found a breach of regulation 18 CQC Registration Regulations 2009.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

We observed people being supported by staff in a safe, caring and respectful manner. People told us they felt safe and comfortable when they received support from Fylde Community Link. On person told us, 'The staff are very kind and helpful. I am very confident that they will support me in the way I need them to'.

We saw evidence that people were supported with their medication appropriately. Medication practices undertaken by staff followed the service's policy and we observed staff were trained in related principals. This meant people were protected against the risks of unsafe management of medicines because appropriate protocols were in place. One person told us, 'I'm completely confident that the staff know what they're doing with medication. I trust them to do this properly'.

Is the service effective?

We observed that staff respected people and enabled them to make basic, day-to-day decisions. The service held people's recorded consent to care and staff were able to demonstrate a good understanding of related principals. One person told us, 'The staff never take over and help me to make my basic decisions. That way I still feel in control'.

People's social, health and support needs were assessed and regularly reviewed. Support plans were individualised and risk assessments were in place. This meant people were protected against ineffective care provision because people's changing needs were monitored.

Is the service caring?

We spoke with seven people to gain an understanding of their experiences of the support they received. Their response was very positive. One person told us, 'The staff are really helpful. They don't talk down to me and really help me'. Another person said, 'My worker is brilliant, he really looks after me'.

Staff explained that they worked in a caring and friendly manner. They described being respectful to and working with people to understand their needs. One staff member told us, 'A consistent approach is key in the work we do. It's about taking small steps, which often leads to better care for people'. This meant people were safeguarded against inappropriate care provision because staff understood people's individual needs.

Is the service responsive?

People's needs were properly assessed, monitored and reviewed. This meant the provider had continuously assessed whether the service was able to maintain people's care levels. One person told us, 'If I feel panicky about anything I ring up the office and they are great. They help me to calm down and to understand what is going on'.

We saw that the service responded appropriately to complaints received. This followed Fylde Community Link's complaints policy. Responses to issues raised and actions undertaken were recorded. This meant the provider had minimised the risks of unsafe care because complaints had been acted upon.

Is the service well-led?

Fylde Community Link had a range of quality audits in place. Other regular processes underpinned this, such as staff supervision and team meetings. People who accessed the service were given the opportunity to feedback about the service. This meant people were protected against inappropriate care because the manager had systems to check the quality of care.

Managers and staff had a good understanding of the appropriate handling of complaints. We were shown evidence of complaints that had been handled correctly and in a timely fashion. This meant the service was well-led because people were enabled to make complaints, which managers acted upon.

People who used the service told us they were happy with the support they received. One person said, 'Before I came here I couldn't read, write or cook. Now I can manage my own personal care." Another person told us, 'I haven't been here long but I am really happy. They are good at getting me to do things.' People told us their needs had been discussed and they had agreed to the support to be provided. They told us their carers provided sensitive and flexible personal care support and they felt well cared for.

We looked at how the service was being staffed and reviewed staff training and supervision records. We saw there were sufficient staff with a range of skills and experience. Staff told us they felt supported, had regular meetings with the provider and their training was kept up to date.

There were a range of audits and systems in place to monitor the quality of the service being provided.

People who use the service told us they were happy with the support they received. One person said, "I am very happy with my carers." People told us their needs had been discussed and they had agreed to the support to be provided. They told us their carers provided sensitive and flexible personal care support and they felt well cared for.

We visited one of the houses where the agency provided a supported living service. This helped us to observe the daily routines and gain an insight into how people's care and support was being managed. We observed staff treated people with respect and dignity.