The Moorings Supported Living Service

About the service

The Moorings Supported Living Service is a supported living service providing personal care to people with a physical disability, older people, younger adults, and people who may have learning disability and/or autism. At the time of the inspection 9 people were receiving personal care and lived in their own accommodation at the one location.

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

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. Staff supported people to make decisions following best practice in decision-making. Most people were able to make decisions for themselves and staff were seen to respect people’s choices.

Right Support:

People’s medicines records were not always accurate this meant we were not fully assured their medicines were managed safely. Staff supported some people to manage their own medicines independently. Staff enabled people to access routine and specialist health and social care appointments to ensure their health and wellbeing.

Some staff employed had not had all the required checks completed for working with vulnerable people before they began their employment. There were enough staff available to provide care and support to people as they needed it and in the event of an emergency.

We have made a recommendation the recruitment process used includes all of the required checks of suitability to work with vulnerable people.

People told us they were supported to be independent. People were supported by staff to pursue their hobbies and interests in their homes and in the community. People told us they enjoyed a variety of activities in the local community. One person told us, “I go out most days to do a variety of things. Today I’m going out for lunch with my relative.” Staff supported people to identify and achieve their aspirations and goals.

People had a choice about their living environment. The service gave people care and support in managing their own home, support with cleaning and choosing appropriate furnishings. One person told us they had been supported by staff to choose a new bed more suitable for their physical needs.

Right Care:

Some people's care and support plans were not always reflective of their current health needs and risks associated with their health. This meant those people were put at risk of not receiving the appropriate care, treatment, and support for their health condition. Staff had carefully identified and assessed other health conditions and risks associated with people’s health and lifestyles.

People received kind and compassionate care. One person told us, “The staff I have are so helpful.” Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs.

People were safe and protected from abuse. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. One person told us, “I definitely feel safe I can call a member of staff at anytime and they always come to check on me.”

People liked the staff who supported them. One person said, "[Staff member] is nice, they have helped me sort out my new bed." People could communicate with staff and understand information given to them because a team of regular staff supported them consistently and understood their individual communication needs.

One person who had individual ways of communicating, using body language, sounds and their own sign language. Staff had worked with them to develop this and to understand and devise their new signs.

Right Culture:

People’s concerns and complaints had not been managed in line with the company’s policies and procedures. We saw some complaints had been informally responded to by the registered manager. However, we did not see how they had been investigated and/or responded to and what if any actions had been taken. This meant we could not be sure people and those important to them had their complaints fully investigated and resolved.

Governance processes in place were not used effectively. This meant there was no meaningful oversight of the safety and quality of care and support. We could not be sure there was a clear understanding of the performance of the service and where improvements were needed to be made had been recognised.

Staff did not always receive regular support in the form of continual supervision, appraisal, and recognition of good practice. Staff could describe how their training related to the people they supported.

People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect, and inclusivity. Staff knew people well and placed their wishes, needs and rights at the heart of everything they did.

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 good (published 16 November 2018).

Why we inspected

We undertook a targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about managing specific medical health needs. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the records used to manage specific health needs, so we widened the scope of the inspection to become a comprehensive inspection which included all of the key questions.

The inspection was prompted in part by notification of a medical incident following which a person using the service died. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of specific health needs. This inspection examined those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to the records for identifying and managing health risks, the safe management of medicines, dealing with complaints and the oversight of the safety and quality of the service at this inspection.

During and immediately following the inspection the provider ensured any risks identified were addressed.

We have made a recommendation about ensuring all of the required checks of suitability are made during the recruitment of staff.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This service provides care and support to people living in a ‘supported living’ setting, 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. People using the service lived in their own individual apartments which were in one housing development near the village of Garstang. Car parking is available at the development and there is access for people who have mobility challenges.

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.

At our last inspection in August and September 2017 the service was rated as ‘Requires improvement’. We identified a breach of Regulation 12 of the Health and Social Act Care Act 2008 (Regulated Activities) 2014. We found systems were not operated effectively to ensure medicines were managed safely. We also found staff did not receive annual reviews of their performance. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. In addition, the Care Quality Commission is required to be notified of certain occurrences. We found a notification had not been provided to us in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We took regulatory action and served requirement notices for these breaches in regulation. We asked the registered provider to take action to make improvements to the areas we identified. The registered provider sent us an action plan which indicated improvements would be completed by December 2017.

At this inspection in October 2018, we found improvements had been made. Medicines were managed safely and staff received annual appraisals. We found notifications were provided to the Care Quality Commission (CQC) in a timely manner.

At the time of the inspection visit there was a manager in place who was registered with the Care Quality Commission. 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.

Recruitment checks were carried out to ensure suitable people were employed to work at the service and training was provided to enable staff to maintain and increase their skills and knowledge.

Care records contained information regarding risks and guidance for staff on how risks were to be managed. We found information in two care records required updating as further information was required regarding the needs of the people they related to. The registered manager could demonstrate the records were in the process of being updated.

The registered manager told us they did not currently provide end of life care at the service. They explained that should this be required a policy was available to guide staff.

People told us they were supported to access medical advice from external healthcare professionals and their healthcare needs were met. Documentation we viewed confirmed this. People and relatives told us they were happy with the care at support provided by The Moorings Supported Living Service.

People told us they could raise their views with staff and these were listened to. The registered manager told us they sought verbal feedback from people who used the service and meetings were held with them as a way of gaining their views. In addition, people told us they could raise comments with staff and these were appropriately responded to.

People told us they were supported to cook meals of their choice and we saw documentation which showed people were referred to dieticians if this was required.

Staff we spoke with knew the needs and wishes of people at the service. Staff spoke respectfully of the people they supported and said they cared about them and their wellbeing. We observed person centred and caring interactions between people who received support and staff. People told us they felt respected and valued.

Relatives told us they were consulted with and involved in their family members care. People we spoke with confirmed they were involved in their care planning if they wished to be and they were asked to consent to their care.

Staff we spoke with were able to describe the help and support people required to maintain their safety and promote their independence. People who received support told us they felt safe.

Staff told us they were committed to protecting people from abuse and would raise any concerns with the registered manager or the Lancashire Safeguarding Authorities so people were protected.

There was a complaints procedure available at the service. People we spoke with told us they had no complaints, but they if they did these would be raised to the registered manager or staff.

People and relatives we spoke with told us that staff were available to meet their family member’s needs. People told us they received care and support at the times they agreed and they were not rushed or hurried in any way. Staff we spoke with told us they had the time to support people in a calm and relaxed way.

People told us they were supported to maintain their hobbies and interests if this was part of their assessed and funded needs.

The registered manager demonstrated their understanding of the Mental Capacity Act 2005. People told us they were enabled to make decisions. Staff told us they would help people with decision making if this was required. People are supported to have maximum choice and control in their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The registered manager told us they were committed to improving the service they provided and they wanted people to be as independent as they could be. They told us they upheld people’s rights to live individual lives in an environment which promoted their rights as ordinary citizens.

The registered manager spoke highly of the staff and praised them for the way they supported people and worked as a team. Staff told us they felt supported by the registered manager and the registered manager worked closely with them.

Relatives we spoke with told us they could speak with the registered manager if they wished to do so and they found the registered manager and staff approachable.

The Moorings Supported Living Service is situated on a private development on the outskirts of Garstang and provides support for twelve people who require assistance due to physical or other disabilities. People who use the service live in independent apartments on the development. Care and support is provided by Leonard Cheshire Domiciliary support services.

People who use the service are facilitated to live independently through the 24 hour on site support service available to them.

There was a registered manager 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.

We last inspected The Moorings Supported Living Service in August 2014. We identified no breaches in the regulations we looked at.

During this inspection visit carried out in August and September 2017 we asked people if they felt safe. People we spoke with told us they did. However, systems were not operated effectively to ensure medicines were managed safely. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We checked to see if staff were supported in their role. Staff told us they received supervisions to enable them to discuss any concerns. They told us they did not have annual reviews of their performance and they would welcome these. This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Care Quality Commission is required to be notified of certain occurrences. We found a notification had not been provided to us in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

We looked at the auditing systems used by the service to drive improvement. We found checks on medicines, care records and the environment were carried out. We saw evidence that accidents and incidents were monitored and the registered manager could explain actions taken to minimise reoccurrence. However, the audit system in place had not identified the lack of submission of the required notification to the CQC or that staff required refresher training and competency assessments for supporting people with their medicines. We have made a recommendation regarding this.

We discussed staffing with people who used the service. They told us staff were busy and at times they had to wait for support. People also said they had noticed a lot of new staff. One person said, “There’s a lot of agency here.” Relatives we spoke with also told us they felt a lot of agency staff were used. The registered manager told us they were actively recruiting staff and looking at ways of improving staff retention. We have made a recommendation regarding this.

The registered manager provided guidance and advice by visiting the service and providing on- call support. We have made a recommendation regarding this.

We reviewed staff files and found there were processes that ensured staff were suitably recruited.

During the inspection visit we found some documentation required further information regarding people’s needs. We raised this with the registered manager. Prior to the inspection concluding we were informed documentation had been updated.

People told us they were involved in their care planning and we saw documentation in care records which confirmed this.

We checked to see if people without mental capacity were lawfully deprived of their liberty if this was necessary. We found people’s rights were protected and upheld.

People who received support told us they considered staff were caring. One person told us, “The staff really care about me. They give me really good attention.” We observed people being supported with kindness and compassion.

People told us they were able to pursue their individual interests and documentation reflected people’s preferences.

There was a complaints policy available at the service. People told us they would talk to staff if they had any concerns.

People told us their individual preferences were respected in relation to their meals. We saw documentation which evidenced that if people needed support with nutrition, this was referred to other health professionals.

People told us they were supported to see health professionals if the need arose and we found this was recorded in care documentation.

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

"I think it's fantastic here!...I get the support I need...I'm encouraged to be independent."

"Staff always knock before they come in and ask before they start to do anything...They encourage me to do things myself...Staff do what i need them to do...I'm very well supported."

We found people gave their consent before any support was delivered to them. Staff had been trained on the Mental Capacity Act 2005 and were aware of their responsibilities.

People's needs were properly assessed and person centred plans of support were drawn up following consultation with people, their families and other people involved in their care. People spoke positively about the support they received and told us their needs were being met.

Medicines were managed appropriately. The service ensured staff underwent training and assessed them to ensure that people were protected against the risks of inappropriate administration of medication.

The provider had comprehensive policies and procedures in place which we saw were followed in practice with regard to ensuring staff were suitable for the role. People felt staff were supportive and knew what they were doing.

We found there were systems in place to monitor and assess the quality of the service provided for people. These measures helped to ensure that people were safe and the service was meeting their needs. This included a comprehensive complaints policy and regular meetings with people.

There were twelve people using the agency's service at the time of the inspection. They lived in independent self contained apartments. This meant they were supported to live an independent lifestyle within the parameters of their disabilities.

Most of the people using the service were out with support workers, a number of people were receiving personal care or not available to speak with. We did however visit a service user and gained some comments about the care they received. They told us,

'I have everything I need'.

'Staff are very patient with me'.

'I like to live as independently as I can for as long as I can'.