Aylesbury Supported Living 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.

Aylesbury Supported Living Service provides support for 27 adults with learning and physical disabilities across four 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 one 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.

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

People were not always protected from avoidable harm. Specialist advice was not always followed to prevent choking. A risk assessment had not been put in place for someone who was at risk of choking and for another person who was on anticoagulant therapy. Anticoagulants are used to thin the blood.

People did not always receive their medicines as directed by the prescriber. In one case, staff were giving medicines on an ‘as required’ dose rather than the regular dose the doctor had prescribed. The medicines were to treat constipation. Staff had stopped recording bowel movements for the person and although they had noted they had a swollen and distended stomach they did not seek medical advice until requested by inspectors to do so.

People’s consent to their care and treatment was not always sought. In 1 of the supported living properties, people contributed to a household fund. Some of the people lacked mental capacity to agree to this. Best interest meetings had not been held with their next of kin or other relevant persons to agree to the contributions. People had been paying higher contributors to the fund previously and it was identified by the provider in July 2022 a refund was due to them. No refund had been made at the time of the inspection. One person received a contraceptive injection on a regular basis. The provider was unable to tell us if the person could give informed consent for this.

We had not always been informed about significant events the provider was required to tell us about, although we could see appropriate actions had been taken at the time these occurred.

Governance systems were in place and there had been regular monitoring of the service by the provider. However, these were not effective in ensuring improvements were achieved in all required areas. There was inconsistency of care and record keeping between the different supported living properties and a lack of management oversight to ensure systems were used effectively. The provider was not meeting the duty of candour requirement, which requires providers to act in an open and transparent way when things go wrong.

Improvements had been made to infection prevention and control practice. Standards of cleanliness had improved overall. Some minor issues in a shared bathroom and laundry were brought to the provider’s attention and action was taken. We have made a recommendation to ensure standards of cleanliness are maintained.

Improvements had been made to protecting people from the risk of abuse. There were procedures in place to respond to allegations of abuse and staff received safeguarding training. The provider made appropriate referrals to the local authority about people’s welfare and co-operated with any investigations. Recording of accidents and incidents had improved.

People were supported by workers who had been robustly recruited. The provider was trying to fill vacant posts and in the meantime used agency staff to cover gaps in the rotas.

Feedback from people was positive about standards of care. Typical comments included “We have had such good support from them, kind respectful and dignified,” “There have been some changes in the last year but on the whole the staff are brilliant,” "They are kindly and respectful to her every time that I have seen them, she's always very happy being there.” Another relative told us “They really are lovely staff. They've got him to come out with others and take part more in the community.” Some relatives commented communication could be improved and they had concerns about staff turnover and agency worker use. This was more in context of consistency of familiar faces rather than concerns that people did not receive the care they needed.

The provider was not able to demonstrate how they were meeting all of the underpinning principles of Right support, Right care, Right culture.

Right support

Staff did not always follow or act in accordance with the Mental Capacity Act 2005, as consent was not always sought. Staff did not always support people with their medicines in a way that effectively managed health conditions.

Right care

People received kind and compassionate care and staff protected and respected their privacy and dignity. However, there were some instances of institutional care in how one of the supported living settings was run.

Right culture

People’s quality of life was not enhanced by a culture of improvement. Managers did not have effective oversight of practices in all of the supported living settings, leading to inconsistencies in care.

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

Rating at last inspection

This service was registered with us on 17 February 2022 and this is the first inspection after the location moved to new office premises.

The last rating for the service was Requires Improvement, report published on 10 February 2022.

Why we inspected

We carried out an announced focused inspection of this service on 5 and 17 January 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, safeguarding people from abuse, meeting regulatory requirements 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 Requires Improvement to Inadequate. 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.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led key questions of this full report.

Enforcement and Recommendations

We have identified breaches in relation to medicines practice, managing risks to people’s health and safety, consent to care and treatment, governance, acting in an open and transparent way and reporting incidents at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.