Archived: Access Community Services Limited

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

This was an Announced inspection which took place over two days on 20 and 21 August 2018. The service was supporting 45 people within supported living and 52 people in the community; 36 of the total 97 individuals received support with personal care.

We last carried out an inspection of this service in November 2017. This had been a ‘focussed’ inspection where we looked specifically at previous breaches of regulations. We found there had been overall improvements but the service still required to improve some management systems as the provider’s action plan had not been fully met and there were areas that still required development and implementation. The service was rated as ‘Requires improvement’ for the second consecutive inspection.

On this inspection we found continued improvement and more consistent and sustained service delivery. Managers had continued to develop management systems to assess and monitor the service ongoing and the remaining breach of regulations regarding the governance of the service had been met. The registered manager could evidence a series of quality assurance processes. There was a clear management hierarchy and we saw that new ideas and service improvements were effectively developed and communicated.

We rated the service as Good.

The service 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.

We visited two of the supported living houses which were staffed by the care agency. We also spoke with people who were receiving support at their own homes. The observations made and feedback we received evidenced people were getting good support. External professionals involved in peoples care also gave positive feedback which gave further evidence of a good service.

We found medicines were administered safely. Medication administration records [MARs] were completed in line with the service's policies and good practice guidance. We pointed out some anomalies in one ‘house’ we visited concerning safe storage of medications and staff knowledge regarding covert administration of medicines [medicines given without a person’s consent] and both issues where addressed by managers.

There were arrangements in place for checking the care environment to help ensure this was safe. These arrangements included regular checks and audits by house managers which were supported by health and safety audits by senior managers.

People using the service, relatives, professionals and staff told us they felt the culture of the organisation was fair and open and supported good care and support for people using the service.

People we spoke with said they felt safe with the staff from the agency and the support they received. We were told that if any issues arose they were addressed by the managers.

We saw that any risks to care provision had been assessed and there were fully developed plans in place to help ensure they were kept safe. Staff were arranged to support this depending on each person’s needs.

There were sufficient staff available to support people.

We looked at how staff were recruited and the processes in place to ensure staff were suitable to work with vulnerable people. Appropriate applications, references and security [police] checks had been carried out.

The staff we spoke with clearly described how they recognised abuse and the action they would take to ensure actual or potential harm was reported. All the staff we spoke with were clear about the need to report through any concerns they had. We reviewed past safeguarding investigations and it was established that the agency had followed procedures and liaised well with safeguarding authorities. Agreed protocols had been followed in terms of investigating and ensuring any lessons had been learnt and effective action had been taken. This rigour helped ensure people were kept safe and their rights upheld.

We saw that people's consent to care was recorded. The service worked in accordance with the Mental Capacity Act 2005.

Feedback from people and their relatives told us that staff seemed well trained and competent. Communication between relatives, people being supported, staff and senior management was effective.

Staff were supported by on-going training, supervision, appraisal and staff meetings. We found that house managers had been left out of the formal supervision process; managers said this would be reviewed and formalised. Formal qualifications in care were offered to staff as part of their development.

Local health care professionals, such as the person’s GP and the Community Mental Health Team [CMHT] were involved with people and staff from Access Community Services liaised when needed to support people. This helped ensure people received good health care support.

Staff could explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

We saw that staff respected people’s right to privacy and to be treated with dignity.

All family members and people spoken with felt confident in expressing concerns and complaints. Issues were dealt with and the service was responsive to any concerns raised. An issue raised on the inspection was dealt with appropriately with the services complaints procedure.

The registered manager and the two deputy managers could talk positively about the importance of a ‘person centred approach’ to care. Meaning care was centred on the needs of each individual, rather than the person having to fit into a set model within the service. It was clear that the service was meeting standards outlined in current good practice guidance including ‘Registering the Right Support’.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

We undertook an unannounced focused inspection of Access Community Services on 15 November 2017. This inspection was done to check that improvements to meet legal requirements planned by the provider after our last comprehensive inspection in July 2017 had been made. The team inspected the service against three of the five questions we ask about services: is the service well-led, is the service safe and is the service responsive. This is because the service was not meeting some legal requirements. No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Access Community Services Limited’ on our website at www.cqc.org.uk.

This inspection was carried out by two adult social care inspectors.

At the last inspection in July 2017 the service had been in breach of three regulations. These were with respect to safe management of medicines; people’s care not always being assessed and planned so it was personalised and reflected their current and ongoing care needs; and the overall management and governance being ineffective in identifying and managing areas of health and safety which exposed people to potential risk.

On this inspection we found improvements with medication management and with standards regarding people’s personalised care; both of these regulations had been met. We found the overall governance of the service still required improvement to help maintain consistent standards. There were also areas of the provider’s action plan from the last inspection that still needed to be implemented.

Overall, we found the service to be rated as ‘Requires improvement’. This is the second consecutive time the service has been rated Requires Improvement.

At the last inspection we had found failings in the services governance [management] arrangements needed to ensure effective monitoring of safe standards of care at the supported living establishments. We found a lack of arrangements in place for checking the care environment people were living in at one of the supported living houses. We gave urgent feedback to the registered manager who put remedial measures in place and updated us of the action taken to ensure people were safe.

We found the overarching governance systems had failed to effectively monitor standards and required review. We identified management audits and checks that required further development and regular and consistent implementation as well as the service’s admission assessment tool.

On this inspection we found there had been some improvements to the management systems but the provider’s action plan had not been fully met and there were areas that still required development and implementation. Managers had developed some audit tools and carried out audits however in some instances, there had not been any follow up. Some audits had failed to identify and monitor key safety issues and recording of in-house safety checks. We found the ‘audit cycle’ had not been developed which meant managers did not have clear dates for follow up and re auditing / review. This breach had not been met.

You can see what action we told the provider to take at the back of the full version of this report.

At the last inspection in July 2017 we visited two of the supported living houses which were staffed by the service. We found, in one house, medicines were not administered safely. Medication administration records [MARs] were not completed in line with the service’s policies and good practice guidance. It was unclear whether some medicines were given correctly.

On this inspection we visited three supported living houses and checked medicine management. We found medication records were clear and auditing of the medicines had also improved. The breach had been met.

At the last inspection the registered manager and deputy were able to talk positively about the importance of a ‘person centred approach’ to care. Meaning care was centred on the needs of each individual in line with best practice, rather than the person having to fit into a set model. We had found, however, there had been failings to properly assess a person’s personal care needs and preferences; this had resulted in the person not receiving individualised care.

On this inspection the three people we reviewed were in receipt of well-planned personalised care that addressed their care needs. There were clear support plans and documentation which highlighted how staff supported people’s personal care needs, as well as preferences and choices. The breach had been met.

The service 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.

There was a clear management hierarchy. People using the service, relatives, stakeholders such as health care professionals and staff told us they felt the culture of the organisation was fair and open. The registered manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

The service supported 94 people living in the community including 19 supported living accommodations.

This was an unannounced inspection which took place over three days between 27 June and 5 July 2017. The inspection was carried out by an adult social care inspector.

The service 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.

At the last inspection in May 2016 the service had been in breach of one regulation with respect to gaining peoples consent to care and treatment; on this inspection we found improvement and the breach had now been met. We found, however, on this inspection,three further breaches of regulations.

We visited two of the supported living houses which were staffed by the service. We found, in one house, medicines were not administered safely. Medication administration records [MARs] were not completed in line with the services policies and good practice guidance. It was unclear whether some medicines were given correctly.

The registered manager and deputy were able to talk positively about the importance of a ‘person centred approach’ to care. Meaning care was centred on the needs of each individual rather than the person having to fit into a set model within the service. We found, however, there had been failings to properly assess a person’s personal care needs and preferences and this had resulted in the person not receiving individualised care.

We found there was a lack of arrangements in place for checking the care environment. We found there were inadequate arrangements to safely monitor and ensure the health and safety of people living in one of the supported living houses. We gave urgent feedback to the registered manager who put remedial measures in place and updated us of the action taken to ensure people were safe.

We found the services governance [management] arrangements needed to ensure effective monitoring of safe standards of care at the supported living establishments. Some overarching governance systems had failed to effectively monitor standards and required review. We identified management audits and checks that required further development and regular and consistent implementation as well as the services admission assessment tool.

You can see what action we told the provider to take at the back of the full version of this report.

At the inspection in May 2016 we found the service in breach of regulation concerning the need for consent to care and treatment. This was because the service did not always work in accordance with the Mental Capacity Act 2005. At this inspection we found improvements had been made and peoples consent to care was recorded.

Prior to the inspection we received some concerns regarding the consistency of staffing at the service. People we spoke with said they felt safe with the staff and the support they received. The registered manager reported there had been issues with staffing in some areas of the service but these were being addressed. We found there were sufficient staff available to support people.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We looked at staff files and found that appropriate applications, references and security [police] checks had been carried out. This meant that there was thorough processes to help ensure staff employed were ‘fit’ to work with vulnerable people.

The staff we spoke with clearly described how they recognised abuse and the action they would take to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report any concerns they had. We reviewed safeguarding investigations during the inspection and the agency had followed procedures and liaised well with safeguarding authorities. Agreed protocols had been followed in terms of investigating and ensuring any lessons had been learnt and effective action had been taken. This helped ensure people were kept safe and their rights upheld.

There was a good level of understanding regarding how safe care was managed. Care was organised so any risks were assessed and plans put in place to maximise people’s independence whilst helping ensure they were safe.

Feedback from people told us that staff seemed well trained and competent. Staff were supported by on-going training, supervision, appraisal and staff meetings. Training for formal qualifications in care was offered to staff as part of their on-going development.

Local health care professionals, such as the peoples GP and the Community Mental Health Team (CMHT) were involved with people and staff from Access Community Services liaised when they needed to support people. This helped ensure people received good health care support.

Staff were able to explain each person’s care needs and how they communicated those needs. We saw that staff respected people’s right to privacy and to be treated with dignity.

All family members and people spoken with felt confident to express concerns and complaints. Issues were dealt with and the service was responsive to any concerns raised.

There was a clear management hierarchy. People using the service, relatives, stakeholders such as health care professionals and staff told us they felt the culture of the organisation was fair and open. The registered manager was aware of their responsibility to notify us [The CQC] of any notifiable incidents in the home.

This was an announced inspection which took place over three days between 11 and 27 May 2016. The inspection was carried out by an adult social care inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The service 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.

The service did not always work in accordance with the Mental Capacity Act 2005. Care planning did not contain enough detail regarding people’s decisions around key issues. There was a lack current evidence of people’s mental capacity being assessed.

We told the provider to take action.

Medicines were administered safely. Medication administration records [MARs] were completed in line with the services policies and good practice guidance.

We were able to speak with people at the two supported living locations we visited. They looked relaxed and had an obvious positive rapport with the staff members providing support. Those able to express an opinion said they felt safe with the support they received.

We saw that people requiring support when out in the community to ensure they were safe, had fully developed plans in place. Staff were arranged to support this depending on each person’s needs. There were sufficient staff available to support people.

We looked at how staff were recruited and the processes to ensure staff were suitable to work with vulnerable people. We looked at two staff files and found that appropriate applications, references and security [police] checks had been carried out. These checks had been made so that staff employed were ‘fit’ to work with people who might be vulnerable.

The staff we spoke with clearly described how they recognised abuse and the action they took to ensure actual or potential harm was reported. All of the staff we spoke with were clear about the need to report through any concerns they had. There had been two safeguarding referrals and investigations since our last inspection of the service. Agreed protocols had been followed in terms of investigating and ensuring any lessons had been learnt and effective action had been taken. This rigour helped ensure people were kept safe and their rights upheld.

Arrangements were in place for checking the care environments to ensure they were safe.

We observed staff provide support and the interactions we saw showed how staff communicated and supported people as individuals. Feedback from people, their relative’s and care professionals told us that staff seemed well trained and competent. Communication between relatives, people being supported, staff and senior management was effective.

Staff were supported by on-going training, supervision, appraisal and staff meetings. Formal qualifications in care were offered to staff as part of their development.

Local health care professionals, such as the person’s GP, and Community Mental Health Team were involved with people. The feedback we received from people using the services, professionals and relatives evidenced good liaison and appropriate working to ensure people received good health care support.

We discussed with staff and the people living in supported living how meals were organised. We saw that these were organised individually and people were encouraged to choose and plan their own meals.

We observed staff interacting with the people they supported. We saw how staff communicated and supported people. Staff were able to explain each person’s care needs and how they communicated these needs. People we spoke with and their relatives told us that staff had the skills and approach needed to ensure people were receiving the right care.

We saw that staff respected people’s right to privacy and to be treated with dignity.

All family members and people spoken with felt confident to express concerns and complaints. Issues were dealt with and the service was responsive to any concerns raised.

All of the managers we spoke with were able to talk positively about the importance of a ‘person centred approach’ to care. Meaning care was centred on the needs of each individual rather than the person having to fit into a set model within the service. People using the service and relatives told us they felt the culture of the organisation was fair and open.

We enquired about the quality assurance systems in place to monitor performance and to drive continuous improvement. The manager was able to evidence a series of quality assurance processes both internally and external to the service. There was a clear management hierarchy and we saw that new ideas and service improvements were effectively developed and communicated.

Internally there were other key audits carried out to monitor standards.

You can see what action we told the provider to take at the back of the full version of this report

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On this inspection we checked to see if new arrangements were in place. We found improvements had been made.

When we checked care records, we found people's support plans had been drawn up with their involvement. Care records were signed by people and if required, their relatives. Care and support plans were in place for all aspects of everyday life and we saw these were reviewed regularly.

People's medicines were safely stored in their home. Support workers were knowledgeable about medicines they helped people to take. We confirmed staff had received training on the management of medicines. We did note that medicine audits needed strengthening and explained this to the provider who told us this would be dealt with immediately.

Staff recruited were subject to thorough referencing and background checks. We were able to confirm that all staff had undergone an enhanced Criminal Records Bureau check (CRB). Before working in the community, staff had attended induction training. All staff received planned updates to training and planned supervisions were in place to check staff competency in their role. Staff we spoke with told us they felt well supported by management in the delivery of their duties.

We reviewed the complaints policy of the provider and found this was accessible to people. It was written in plain English and free from any jargon.