Background to this inspection
Updated
1 July 2023
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
This was a focused inspection to check whether the provider had met the requirements of the Warning Notice in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Inspection team
The inspection was carried out by 2 inspectors on the first day of the inspection, and 1 inspector on subsequent days.
Service and service type
This service provides care and support to people living in 4 ‘supported living’ settings, 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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.
Inspection activity started on 1 June 2023 and ended on 21 June 2023. Visits to 2 of the supported living houses were made on 5 June 2023 and 8 June 2023. We visited the location’s registered office on 12 June 2023.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
We contacted staff by email, to invite feedback.
During the inspection
We met and had discussions with a quality manager, the manager, and an operations manager. We also spoke with a team leader and care worker.
We met with people when we visited the 2 supported living premises.
We looked at all or part of 5 people's care plans, risk assessments and a sample of medicine administration records. We checked records of audits and monitoring carried out by the provider. Other records we read included accident and incident logs, staff training records, recruitment and staff development files.
After the inspection
We requested and received additional records and evidence after the site visits and continued to review these until 21 June 2023.
Updated
1 July 2023
About the service
Aylesbury Supported Living Service provides support for 28 adults with learning and physical disabilities across 4 sites in the Aylesbury and surrounding areas. Each property blends in with other housing in the area and is indistinguishable as a care setting. At 1 of the sites, night time support is provided by another service which is separate to The Fremantle Trust. This is a contractual arrangement with Buckinghamshire Council. People are supported in individual flats and shared houses which are owned by a housing association. People's care and housing are provided under separate contractual agreements.
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
People’s experience of using this service and what we found
Right Support:
Staff did not always follow best practice where people lacked capacity to make their own decisions.
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.
People were supported to be independent and pursue their interests.
Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.
People were supported with their medicines in a way which promoted their independence.
Right Care:
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.
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.
The service had enough appropriately skilled staff to meet people’s needs and keep them safe.
People’s care and support plans reflected their range of needs and this promoted their well-being.
Right Culture:
People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. There had been many improvements since the last inspection and these needed to be sustained.
People led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of managers and staff.
Staff knew and understood people well and were responsive, supporting their aspirations and choices.
People received support based on transparency, respect and inclusivity which minimised the risks of a closed culture.
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 inadequate (report published 8 February 2023).
The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection we found the provider remained in breach of 1 regulation.
At our last inspection we recommended that environmental checks were routinely carried out to ensure standards of hygiene were met. At this inspection we found improvements had been made.
This service has been in Special Measures since 8 February 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
Why we inspected
We carried out an announced focused inspection of this service on 8, 9 and 19 December 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, meeting regulatory requirements, duty of candour, need for consent and good governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. 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 inadequate to requires improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Aylesbury Supported Living Service on our website at www.cqc.org.uk
We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
Enforcement and Recommendations
We have identified a continuing breach in relation to need for consent. We have made a recommendation about management of people’s medicines.
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.