Archived: Nugent Community Choices (Sefton)

At the last inspection the service was rated Good. At this inspection we found the service remained Good.

The service did not have a registered manager as they had left the service on the 25 May 2018. There were two acting managers in post who we spent time with discussing the service provision.

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 service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. We saw that people with learning disabilities and autism who used the service were able to live as ordinary a life as any citizen.

We spoke with three of the twelve people who were receiving care and support and four relatives who all gave positive feedback about the service and the staff who worked in it. We saw that people were supported by a willing staff team who were encouraging, supportive and respectful.

People were encouraged and participated in various daily activities of their choice. Care plans were person centred and driven by the people who were being supported in their own homes. They detailed how people wished and needed to be cared for. They were regularly reviewed and updated as required.

Staff spoken with and records seen confirmed training had been provided to enable them to support the people with their specific needs. We found staff were knowledgeable about the support needs of people in their care. We observed staff providing support to people throughout the second day of our inspection visit when we went to one of the supported living homes. We saw they had positive relationships with the people being supported. There was a happy, warm atmosphere in their home. We saw that people communicated in specific ways and the staff were confident and competent at successfully communicating in the person’s preferred method of communication.

The acting manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions. We saw that people were supported to make their own decisions and their choices were respected and at all times the least restrictive option was taken. Assistive technology was in place to maximise people’s independence and ensure that their privacy and dignity was respected.

The acting managers used a variety of methods to assess and monitor the quality of the service. These included regular audits of the service and staff meetings to seek the views of staff about the service. The acting managers worked closely to support staff and people in the four supported living homes and provide quality support to staff to enable them to provide proactive, individualised care and support.

The manager was registered with the Care Quality 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 and associated Regulations about how the service is run.

We looked at the medication records for two people. The medication procedure for staff was to prompt people or to administer their medication. Records stated that support staff would record all medication on the provider’s medication record sheets. In relation to the services covert medication practice we were told that there were no people receiving this support. We discussed this practice with the register manager.

We looked at records relating to the safety of the office premises and its equipment, which were correctly recorded. We were shown where confidential records were stored in lockable filling cabinets and password protected on the computers.

People received sufficient quantities of food and drink and had a choice in the meals that they received if this was part of their person centred care plans (PCCP). Their satisfaction with the dietary options provided had been checked. Where people’s weight changed this was recognised, with appropriate action taken to meet the person’s nutritional needs.

The provider had complied with the Mental Capacity Act 2005 and its associated codes of practice in the delivery of care. We found that the staff had followed the requirements and principles of the Mental Capacity Act 2005 (MCA). Staff we spoke with had an understanding of what their role was and what their obligations where in order to maintain people’s rights.

We found that the person centred care plans and risk assessment monthly review records were all up to date in the two files looked at. There was updated information that reflected the changes of people’s health.

People told us they felt safe with staff. The registered manager had a good understanding of safeguarding. The registered manager had responded appropriately to allegations of abuse and had ensured reporting to the relevant local authorities and the CQC as required.

Accidents and incidents were recorded and monitored to ensure that appropriate action was taken to prevent further incidences. Staff knew what to do if any difficulties arose whilst supporting somebody, or if an accident happened.

The staffing levels were seen to be sufficient at all times to support people and meet their needs and everyone we spoke with considered there was adequate staff on duty.

The service used safe systems for recruiting new staff. These included using Disclosure and Barring Service (DBS) checks and annual self-disclosure checks made with the manager. The staff files did include a photograph of the staff. They had an induction programme in place that included training staff to ensure they were competent in the role they were doing at Nugent Community Choices (Sefton). Staff told us they did feel supported by the registered manager and team leaders.

The two person centred care plans we looked at gave details of people’s medical history and medication and information about the person’s life and their preferences. People were all registered with a local GP and records showed that people were supported to see a GP, dentist, optician, and chiropodist as needed.

We observed the care that staff provided to people. There were enough staff to support people in the way they wanted. People were given choices about rising and retiring times and about the activities they wanted to be involved in.

Staff supported people to shop for groceries. They were also involved in preparing meals and snacks where they were able. Where people needed assistance to eat this was provided.

Person centred care records were in place, providing informative up to date information about people.

Equipment used by people was maintained safely. Where repairs were needed these were carried out quickly.

Systems were in place for monitoring the quality of the service people received. People living in the supported houses and relatives told us that they were well supported by the staff team.