Archived: EMH Supported Living

EMH Supported Living provides personal care to people with a learning disability or autistic spectrum disorder, who may also be living with physical disability. People received care in their own private single or multi-occupancy living accommodation via individual private tenancy agreements. At the time of our inspection there were 171 people using the service.

Not everyone who uses the service received 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 consider any wider social care provided.

The service is developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

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

People’s care was not always personalised. People’s choice, control, independence and inclusion was often ensured in a way that enabled opportunities for them to gain new skills and become independent. Targeted management and staffing measures were in progress to fully ensure this, following transition of some people’s care from a care home setting to the provider’s supported living service. This helped to fully ensure the principles and values of Registering the Right Support for people’s care but was not yet fully embedded in practice.

The service continued to be safe. The provider’s arrangements for people’s care helped to protect them from the risk of harm or abuse. Staff were safely recruited and deployed to provide people’s care. Risks associated with people’s health condition and any care equipment were effectively accounted for. People were supported to take their medicines safely when needed. The provider acted when things went wrong at the service following a specific incident resulting in a person’s serious injury, to help prevent any reoccurrence. The incident is subject to a criminal investigation by the local police authority. As a result, this inspection did not examine the circumstances of the incident.

The service was now effective. Staff mostly supported people in the least restrictive way possible and in their best interests. Management remedial action was taken when this had not occurred without a delay, to prevent any reoccurrence. The provider’s policies and systems in the service supported least restrictive care principles. People’s care needs were effectively accounted for through regular consultation with them. Staff supported people to maintain or improve their health and nutrition when needed. This included to ensure consistent, timely support if they needed to move between services for any care and treatment.

People continued to receive care from kind, caring staff. The provider promoted an inclusive culture of shared care values to help ensure people’s equality and rights in their care. Staff knew people well, what was important to them for their care. People were informed, involved and supported to understand, agree and make ongoing decisions about their care.

The service was now well led. Revised governance, operational management and a comprehensive engagement strategy, helped to inform and ensure the quality and safety of people’s care and targeted service improvement when needed. Effective staff support, communication and record keeping systems also helped to ensure this. Staff understood their role and responsibilities for people’s care. Relevant partnership working with external educational, health and social care agencies and authorities, helped to inform and optimise people’s care experience. The provider met with the legal requirements of their registration with us.

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 (report published April 2018)

Why we inspected

This was a planned inspection based on the previous rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

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

The service is run from an office in the village of Holmewood, north east from Chesterfield town centre. We carried out this inspection on the 12, 13 and 14 February 2018. We visited the provider’s office on the 14 February 2018. The provider was given four working days’ notice of our inspection to arrange and seek people’s permission for us to speak with them in their own homes on 12 February and to speak with some people’s relatives by telephone on 13 February 2018.

There was a registered manager for the service. 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 personal have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection in October 2016, people who used the service were not protected from risks associated with ineffective monitoring and evaluation of the service. We asked the provider to complete an action plan to show what they would do and by when to improve the service. This was because the provider needed to improve the key question about how they ensure the service is well led in relation to its management, governance and oversight; to at least good. This is the second time the service has been rated as Requires Improvement.

Required care and service improvements had not always been proactive, timely or sustained. Revised service planning, management, communication and quality monitoring systems were introduced to reduce any related risks to people from this. Further improvement was required to fully ensure people received consistent and effective care with timely and sustained improvement when required.

Action was taken by the provider in consultation with the local authority to address recent safeguarding concerns relating to the safety and effectiveness of people’s care, medicines and monies at the services. Subsequent improvements to related safety and staffing systems showed lessons learned learnt from this to ensure people’s safety.

People felt safe at the service and relatives felt they now received safe care. Recognised staff recruitment procedures were followed for people’s safety.

Staff understood risks to people’s safety from their health conditions, equipment or environment and their related care requirements. Revised care planning, incident reporting and related management monitoring and analysis helped to further ensure people received safe, consistent and least restrictive care.

People were protected from harm and abuse; both they and their relatives were informed and confident to report any concerns if they needed to. Staff knew how to recognise and report the suspected or witnessed abuse of any person receiving care at the service.

Safe working systems were monitored and ensured for the prevention and control of infection, any equipment used for people’s care and for emergency contingency planning.

Staff had not always obtained people’s consent or appropriate authorisation for their care and people had not always received consistent care in their best interests. Management improvement actions were in progress to address this where required.

Overall, people were supported to maintain their health and nutrition and to obtain and use any care equipment they needed. This was done in consultation with relevant external health professionals when required.

Staff training, supervision and competency measures had not always been timely or consistent to accurately inform people’s care. Management action was in progress helped to fully ensure this.

Staff were kind, caring and respectful. The provider’s recent introduction of nationally recognised voluntary care standards associated with supported living, helped staff to further understand and promote people’s choice and rights to live they life they choose.

People and relatives were regularly consulted and informed about the care they could expect to receive from the service. People were provided with a range of service information and for their shared care when required. This included a range of suitable methods and information formats to help people understand and as agreed with them.

People received timely, individualised care from staff who knew how to communicate with them. People were regularly supported to engage with friends, family and in occupational and leisure activities they chose.

People and relatives were informed and confident to make a complaint or raise any concerns they may have about their care. These were accounted for and used to help inform any care and service improvements needed.

People, relatives and staff were more confident in the management of the service. The registered manager and senior management were visible, approachable and listened to their views.

Staff understood their role and responsibilities for people’s care and they were confident, supported and knew how to raise any related concerns. Comprehensive and regularly reviewed operational care, safety and staff policy measures helped to support and inform this. The provider had usually notified us of important events that happened at the service when required. They acted to fully ensure this when we asked them to following one notification oversight on their part.

The provider ensured safe, lawful information handling and data management systems concerned with people’s personal information and also for staff employed. Introduction of a comprehensive electronic record keeping and staff communication system was in progress to ensure timely, secure and consistent access to relevant care and management information sharing across the service.

A range of mechanisms were regularly used to consult with, inform and engage people, relatives, staff and external professionals with an interest in people’s care at the service to help inform and drive service changes and improvements.

The service did not have a registered manager at the time of our inspection visit. 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 provider had not addressed issues requiring improvement at our last inspection in July 2015. Some people’s risk assessments and care records had not been updated. There were systems in place to monitor and improve the service but these were not always effective as they had not acted on issues in people’s care records or established trends and reasons for incidents.

At our last inspection in July 2015 we found people’s capacity to make decisions was not always assessed and decisions were not always made in people’s best interests. We found this had improved. The principles and requirements of the Mental Capacity Act (2005) were being met. When required, best interest decisions and capacity assessments had been completed. People were supported by staff who knew them well. Staff were aware of promoting people’s safety, whilst providing information to support people to make day-to-day decisions.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure. The provider's arrangements for staff recruitment and deployment helped to make sure there were sufficient staff who were fit to work at the service to provide people’s care.

Staff understood their roles and responsibilities for people's care and safety needs and for reporting any related concerns. The provider's arrangements for staff training and their operational procedures supported this.

People received appropriate support to manage their meals and nutrition when required. This was done in a way that met with their needs and choices. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the care staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. People and their relatives were involved in the planning of their care and support.

People were supported to maintain their independence and participate in a range of leisure pursuits that met their individual needs and preferences.

Complaints were well managed. The provider had obtained feedback about the quality of the service from people, their relatives and staff.

We identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People said that staff talked things over with them before carrying out their care. From reading people's care records, we found that where people were unable to make informed choices about important life decisions their best interests were being fully considered.

People told us they had been involved in drawing up their care plans and they felt that their needs were well understood by their support workers. One relative told us, 'I'm sure they do. [Our relative] would rebel if not and we'd notice if things were wrong, by [our relative's] behaviour.' People confirmed that staff were reliable and supportive and they respected their personal preferences. People were provided with a range of activities that were appreciated by them.

People were asked for their views. One relative told us, 'Our [relative] is not able to communicate well but does let staff know in other ways how they feel.'

People told us they felt safe being supported by Enable's support workers. They also felt well treated by staff, who listened to them. One person said they had told the agency's team leader that one support worker was, 'not approachable' and added, 'that staff [member] did not come back.' Support workers had received training that kept people safe and the people we spoke with felt that staff were well trained to meet their needs. One person told us, 'It's the best company I've ever met.'

People felt that staff were recruited safely and, where possible, people or their relatives were personally involved in selecting the staff who supported them.