Caritas Care Limited - 218 Tulketh Road

Caritas Care Limited - 218 Tulketh Road (Caritas Care) is a supported living and domiciliary care service. At the time of our inspection, the service supported 24 adults. However, 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 receive support with personal care, we also consider any wider social care provided. At the time of the inspection there were twelve people in receipt of personal care.

Some people lived in their own homes with family, whilst others lived in supported living houses with other people, who also used the service. The service supports people of all ages whose needs range from mild, moderate or complex learning disabilities and associated medical conditions. The agency is situated in Ashton on the outskirts of Preston city centre.

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

Assessments were conducted, which identified potential risks to people's safety. However the personal risk assessments and associated care plans could have provided staff with more personalised information about people.

We have made a recommendation about including more personalised details within the risk assessments and plans of care.

We noted a few areas where the recording of medicines could have been improved. The registered manager was receptive to our discussion around this area and confirmed this would be addressed without delay.

We have made a recommendation about the clearer recording of medicines.

Systems had been implemented, which helped to protect people from the risk of abuse and relevant policies and procedures were in place. People who used the service told us they felt safe and relatives we spoke with felt their loved ones' health and safety were protected. Staff we spoke with were fully aware of people's needs and how best to support them.

The provider had a staff training programme in place and competence assessments had been conducted to ensure the staff team were able to deliver the care and support required by those who used the service. Recruitment practices adopted by the service were robust and these therefore helped to ensure the staff team were fit to work with vulnerable people. People told us the staff team were consistent and records we saw confirmed this to be accurate.

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.

A range of community professionals were involved in the health and social care of those who used the service and feedback from those we contacted was positive. Systems were in place within a management framework for the assessing and monitoring of the service provided, which helped to ensure good standards were maintained. There were clear lines of accountability within the service. People who used the service and their relatives told us they were in regular contact with the management team and were able to voice their concerns, if needed.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right support:

People were supported to make choices, take control and maintain independence.

Right care:

Care was person-centred and promoted people’s dignity, privacy and human rights.

Right culture:

The ethos, visions, values, attitudes and behaviours of leaders and care staff ensured people who used the service lead confident, inclusive and empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (published 30 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the care and support provided to a named service user. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We found no evidence during this inspection to demonstrate that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Caritas Care Limited - 218 Tulketh Road on our website at www.cqc.org.uk

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.

At our last inspection in March 2016, we rated the service as good overall. Under safe and effective we rated the service as requires improvement because we found breaches of legal requirements. This was because the provider had not fully ensured staff were aware of procedures to report safeguarding concerns. The contact details of the appropriate agencies were not up-to-date and we could not determine if restrictive practice procedures had been followed lawfully. Additionally, there was limited evidence to show why people did or did not consent with their full understanding. After the comprehensive inspection in March 2016, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

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. The provider also demonstrated they had implemented and embedded good practice and were meeting the requirements of the regulations. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

During this inspection, we found the provider had updated safeguarding and other relevant policies and the contact details of responsible authorities. Staff had relevant training and we found the management team reviewed any lessons learnt to maintain everyone’s safety and welfare.

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. We found the management team had obtained each person’s consent to care, or their representatives where this was applicable. A relative of a person who lived at one of the supported living houses told us, “It’s a democratic house where the staff help people to make decisions. They act as their advocates, which is very important to me.”

People who received support in their own homes or a supported living house told us they felt safe using Caritas Care. A relative said, “My [relative] is very safe.” The registered manager reinforced this by guiding staff to support each person safely when they used the service. We also saw good systems to manage, review and mitigate accidents and incidents within the service.

The management team had implemented and completed audits to improve the quality and safety of their medicines procedures. We observed staff administered medication with a safe and patient approach. People told us they received their medicines on time and as required.

The registered manager followed safe recruitment procedures to reduce the risk of employing unsuitable personnel. Staff told us teams they worked in were sufficient to meet people’s needs with a timely approach. A relative commented, “There is excellent continuity of care. Having the same carers and being able to build up that trust in familiarity is a huge thing.” The registered manager had a training programme staff were required to complete and refresh themselves with.

Where applicable, we saw care plans evidenced staff worked with people to develop a healthy lifestyle. They were supported with their cooking skills by helping to make meals of their choice.

We observed staff and the management team had a kind and caring approach to people they supported. A relative stated, “It’s been a very tough time recently, but [the registered manager] and staff really care and are looking after us all as a family.” Relatives told us they and their family members worked collaboratively with staff in the planning and implementation of their care.

Care plan information focused on a person-centred method of supporting people. When we discussed staff responsiveness to people’s needs, a relative told us, “The service they provide for [my relative] to go out has been a Godsend. In the time Caritas have been working with him he has started going out, so that’s been a great change.”

People and their relatives talked positively about the service leadership and management of their care packages. Staff said they had access to the management team at any time and felt they were supportive. The registered manager addressed identified concerns and implemented change to improve the quality of service delivery.

Further information is in the detailed findings below.

The service was last inspected In July 2013 where it was found complaint with the regulations inspected. This is the first inspection under the new methodology, where the service has been provided with a rating under the Health and social Care Act 2008 (Regulated Activities) Regulations 2014.

This report is for the inspection of the supported living service. The service supports 35 people living with learning disabilities in the community. Some people live in their own homes and some live with their families. The service supports people living in Lancashire.

The provider operates a number of other services including services accessible to people supported by the supported living team. These include day centres, self- advocacy services, befriending services and social and educational projects.

The provider has a manager who is registered with the 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.

We found risk assessments were completed as required on both the properties where people lived and for specific risks to people using the service. We saw the provider had a good set of policies and procedures to protect people and staff as the service was delivered.

However we found the safeguarding policy needed updating to include key contact information and staff needed further information on who to inform in the event of a suspected act of abuse including notification to the Care Quality Commission. We found the service in breach of the regulation associated with ensuring that people were safeguarded against potential acts of abuse.

The service had recently reviewed a number of policies including those associated with medicines and infection control. We discussed these with the provider and registered manager who acknowledged work was ongoing to ensure their full implementation.

Recruitment was undertaken equitably and safely with potential staff. People using the service were involved in the selection of future staff where appropriate. Suitable checks were undertaken to ensure people were suitable for the role they were applying for.

We were told by staff that the induction to the role was good and ongoing training was provided. A new suite of training had recently been commissioned which staff were looking forward to attending. Staff undertaking clinical tasks were to complete competency tests shortly after the inspection to ensure they were competent in supporting those people with more complex needs.

We found some concerns around how the service acquired consent from people. Consents had been acquired before people had been assessed to determine if they could safely give their consent. We discussed this at length with the provider and registered manager who were to implement the guidelines with the Mental Capacity Act 2005 as a matter of urgency. We found the provider in breach of this regulation but were given assurances work had begun to address these concerns.

We spoke with four people who used the service in their homes and saw four others whilst participating in planned activities. We saw relationships between staff and people using the service were well developed. Staff were knowledgeable about people’s likes and dislikes and understood triggers that could result in changes in behaviour or health care needs. We saw staff reacting appropriately in all the situations we observed and people being supported were very happy.

People we spoke with spoke about their support workers in a high regard and staff spoke about the people they supported with admired warmth. People’s dignity was upheld at all times and the service and its entire staff did everything within their power to make people’s lives easier. This included liaison with professional teams to ensure family members received appropriate support and equipment to meet the needs of people using the service.

When people were first referred to the provider the service completed a comprehensive pre assessment including all available information. The service liaised with all involved professionals and relevant family members. We saw this information was then used to inform the care plans for staff to have the key information they needed to support people.

We saw the service worked with people’s likes and dislikes and ensured people had access to services and activities to best meet their needs. We noted the provider had a number of key services to better support the people using the supported living service and access to these was available if appropriate. We also saw the provider had set up additional services based on the needs of people using the service. The provider had determined that people using the supported living service held full lives during the week when services were predominantly open. Good friendships were formed at this time and people requested a safe environment to develop and maintain these friendships without the structure of the groups or day centres. Caritas care consequently accessed and secured funding for the Saturday maintaining and developing friendships group that many of the people using the supporting living service attend on a Saturday.

Good information was given to people when they first started using the service including information about the service and available activities and projects. Key themes were explored, including, dignity and safety and information was provided on what people should do if they were not happy with something. This included information on how to complain.

The provider had recently set up a comprehensive system of business monitoring and improvement. The results of monitoring, actions from meetings and performance against targets were all collated and delivered to the management team by way of a Balanced Score Card (BSC). The BSC was shared with management and further actions were agreed for improvement and development.

The new staff newsletter shared the results of the BSC with the wider staff team and enabled staff to understand the quality assurance methods used by the provider. Staff we spoke with were beginning to understand the process and knew how the results of pieces of work they completed, were included within the monitoring.

Staff we spoke with were happy in their role and enjoyed working with the people they supported.

We were told they were well supported by both their peers and management. Feedback was acquired from the staff team by way of a staff survey, newly implemented feedback boxes in all the provider offices and through supervision and appraisals.

The Provider and service were proactive in addressing any concerns raised during feedback after the inspection and we received an action plan with three days.

We looked at outcomes 4, 8, 13, 16 and 21 and found compliance with all these outcomes.

People that used the agency, a relative and professional involved in the care of a person told us that people's health care needs were very well managed. Words such as professional and responsive were used to describe the agency.

People told us that they received support to keep themselves healthy and well by having guidance and support about good personal hygiene and food preparation available to them. They told us that the agency supplied them with soap and towels in their kitchen, bathroom and toilet so they could wash their hands when needed.

People told us they had support from the same staff team and that the support they had was flexible to meet their needs and support them to pursue social and leisure interests.

People told us that they were asked about the service they received and that they could contribute toward the agency's development or ask for their care to be changed to their liking. One person said, 'When '. moved jobs and not my team leader I asked what would happen as she knows me. The lady replacing her wasn't starting straight away so they agreed until she did and the new lady got to know me that '. would still be my team leader. That's great'.

'I have been fully involved in my daughters care from day one. I am consulted about her care needs on a daily basis and agree with the staff what support they should be providing. The agency is very professional in everything they do'.

'I have been with several other agencies and very disappointed with the service provided. I have been very impressed with this agency'.

'My daughter has really complex care needs. They understand her moods so well and are always relaxed and professional when delivering her care. They make my daughter very happy and that makes me happy'.

Information received from Lancashire councils contracts monitoring team confirmed they currently had no concerns with the service being provided by the agency.