The agency Integrate Preston is managed from well equipped offices located in Ashton in central Preston. The agency provides personal care to adults with learning disabilities and mental health needs. Services are provided to support people to live independently in the community.
The inspection of this service took place across three dates; 20 & 21 October and 1 November 2016. A follow up desk top review of further evidence was completed 23 November 2016. This was completed following a meeting with the two registered managers for the service, the inspector and an inspection manager. This was the first time the service had been inspected under the comprehensive methodology. The service was given 24 hours’ notice prior to the inspection so that we could be sure someone would be available to provide us with the information we required.
The service has two registered managers, and one of the registered managers of the service was present throughout our inspection. 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 found a lack of consistency in the way people's risk had been assessed and managed. The risks to people were not always sufficiently managed to avoid harm. In addition, there was not always information on how to mitigate risks and there was missing information to help guide staff if the said risk occurred.
We found that the service had policies and procedures in place to protect people from bullying, harassment, avoidable harm and abuse. We spoke with staff who told us they were aware of the procedure. However, these were not always being followed.
A central register of accidents and incidents was held by the registered manager in order for these to be monitored. The file contained an extensive list of accidents and incidents with clear guidance for reporting. However, we found a lack of consistency in reporting across the service.
We looked at how the service managed people’s medicines and found that medicine administration was being completed outside of Integrate policies and procedures.
We found that the providers disciplinary procedures were not always correctly adhered to and robust. We did find that recruitment within the service was safe.
A range of checks were carried out on a regular basis to help ensure the safety of the properties and equipment was maintained.
We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). We found that the principles of the MCA were not consistently embedded in practice. The service provided care for people who may have an impairment of the mind or brain, such as learning disabilities. We found that people's capacity to consent to care and treatment had not always been assessed.
We found supervision for staff working within the service was not consistent. We saw the service had a detailed induction programme in place for all new staff and that staff were required to complete an induction prior to working unsupervised. We found that the service promoted staff development and had a rolling programme to ensure that staff received training appropriate to their role and responsibilities.
People’s care records told us about their likes and dislikes in relation to food and drink. We saw that people had a choice of what they wanted to eat and staff were aware of people’s needs in this area. During the inspection, we observed staff supporting people to make meals for themselves.
The staff approached people in a caring, kind and friendly manner. We observed positive interactions throughout the inspection. Staff appeared to understand the needs of people they supported and it was apparent that trusting relationships had been created.
People were supported by staff to access the community and minimise the risk of becoming socially isolated. Staff understood how to respect people's privacy, dignity and rights, and received training in this area.
There was a lack of consistency in care planning across the service. We viewed some really good in depth information that was clear concise and up to date. However, there were also care plans that were out of date, vague or that had not been considered at all.
We saw that people were supported to be independent and their views and wishes respected. People were supported and encouraged to take part in activities of their choice.
We found there was a clear assessment process in place, which helped to ensure staff had a good understanding of people's needs before they started to support them. We saw multiple examples across the care records we looked at of people being referred for external health and social care support and professional advice being followed.
The service had a complaints procedure and people and everyone we spoke with said they felt confident that any complaint would be taken seriously and fully investigated. A system for recording and managing complaints and informal concerns was in place.
Evidence we found showed there was a lack of management oversight. Although systems were established and in place to allow for oversight of accidents and incidents these were not always operated effectively.
We found the management team receptive to feedback and keen to improve the service. The managers worked with us in a positive manner and provided all the information we requested.
The service regularly, support people who use the service to be more involved in external meetings and consultations regarding the wider disability agenda. People who use the service are actively involved in recruitment. People are trained in interviewing techniques and sit as equal members on the interview panels.
We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment, consent, safeguarding, staffing and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.