United Response - Fylde Coast Supported Living Also known as St Annes DCA

About the service

United Response - Fylde Coast Supported Living is a supported living service providing personal care to 15 people. At the time of the inspection there were 14 people receiving support in their own homes.

Not everyone who used 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 also consider any wider social care provided.

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

Right Support:

People’s needs were assessed, and care plans were developed to promote positive risk taking. However, some people’s care documentation needed additional information or had passed their assigned review date. Staff were trained in the safe storage and administration of medicines; however, we noted some concerns that were addressed by the management team during the inspection. People’s homes and decor was personalised and reflected their personalities, showing their choices and decisions had been respected. Adjustments had been made in people’s homes to promote their independence and keep them safe. Staff were knowledgeable on what actions to take should they see any safeguarding concerns or hear any allegations of abuse. One staff member told us, “Staff are absolutely safe living here, safeguarding is our priority, keeping people safe our main role.”

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. When people lacked capacity to make specific decisions, we found the service was following the best interests principle. Relevant authorisations had been granted by the Court of Protection where people’s liberties were deprived.

Right Care:

The service had enough staff to meet people’s needs and keep them safe. Staff knew the people they were supporting well, including their health and wellbeing needs. Staff were trained and skilled to offer support and guidance to quickly lessen or minimise people’s distress. Staff and visitors were welcomed into people’s homes. Staff knew how to ensure people had the choice of eating a healthy diet.

Right Culture:

People had the choice of carrying out their daily living tasks and leisure activities in their local area. When people had chosen to opt out of certain tasks their decisions had been respected. Staff told us they could raise concerns with managers and feel safe and supported. People were comfortable and relaxed in the company of staff. People and staff had a friendly rapport and positive relationships had formed through the continuity of support. The management team worked alongside staff and with outside agencies to keep people safe and achieve their goals.

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 30 May 2018).

Why we inspected

We received concerns in relation to staffing, leadership and the management of risk and people’s care needs. As a result, we carried out a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

We have found evidence that the provider needs to make improvements. Please see the Well-led sections of this full report. The provider has taken immediate action to address the concerns found.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for United Response - Fylde Coast Supported Living on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to systems and processes to ensure documentation is accurate and reviewed in line with the providers policy.

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.

At our last inspection in October 2015, we rated the service as good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

This service provides care and support to people living in ‘supported living’ settings, so that 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.

During this inspection, people and relatives we spoke with told us they felt safe at the supported living houses. A relative commented, “It's really good for me to know [my relative’s] settled there, I don't want him to ever be moved.” Staff had safeguarding training and demonstrated a good understanding of related principles and reporting procedures.

Information contained in people’s care records guided staff to protect people from the risks of unsafe care. Furthermore, the registered manager had a system to analyse accidents and incidents to check for themes and reduce their occurrence.

Records we reviewed showed staff checked people’s decision-making skills related to medicines and administered these for them if they felt unsafe. The management team developed risk assessments with them and their representatives to ensure the safe delivery of their medication.

United Response - Fylde Coast Supported Living had robust recruitment procedures, which included in-depth induction. A relative said, “Staff are always made to shadow existing staff, and are encouraged to learn about individuals.” We saw there were sufficient staffing numbers to meet people’s needs and to safeguard them from harm. One staff member told us, “We’ve got enough staff.” People and their representatives stated staff had good levels of training and supervision.

People were 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. Records we looked at evidenced people’s general and decision-specific consent to care.

Individuals we spoke with told us about how effective support from staff assisted them with healthy eating and to reduce weight.

People and relatives told us staff worked collaboratively with them to ensure a holistic approach to care and support. They said staff were kind and patient. One person told us, “I like my staff member, she's a lovely lady.” We found staff respected people’s dignity and care plans focused upon helping people to improve. A relative said, “I feel like I’ve got a different [family member]. She is so much more confident and doing things she had never done before. It's just brilliant.”

Care records contained detailed information about each person’s preferences, wishes and day-to-day decisions. This included activity provision and we saw people were supported to engage in their chosen interests. A relative said, “On Christmas day and Boxing Day [our family member] went and stayed in a hotel. She talked about living the dream.”

Each supported living house completed quality assurance checks and acted on concerns to improve people’s wellbeing. Those who used the service and their family members said the management team sought their feedback. A relative told us, “I have a wonderful relationship with management because they will listen to what I have to say. They will always put into place things that I have had concerns about. United response I feel is very well led and I think the current managing team are doing a really good job.”

Further information is in the detailed findings below.

We saw that best interest meetings took place. Staff we spoke with had a good knowledge and understanding of their role to support people to make decisions that reflected their likes, health care needs and preferences. People were supported to be fully involved and consulted regarding their care and support. The agency had a policy and procedures in place for dealing with managing people's medication. There were contingency measures in place regarding emergency care people may require. There was an emergency on call system available for staff for advice and guidance.

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

`I am not for moving my Mum and Dad think it's brilliant`.

`If I am worried I can talk to my support worker`.

`I teach Human Rights training, I teach the police about the 15 Articles, the support workers and all the managers in United Response and outside companies`.

` A great team effort, we've worked really hard, looked at shift reports and records and we knew something wasn't right by reading this information`.

`I started in a brand new service and it was fabulous, continuity is extremely important`.