CSL Mablethorpe

About the service

Community support is a service providing personal care for people in their own homes or supported living accommodation in multiple locations across Lincolnshire. At the time of the inspection 49 People were receiving personal care.

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

The service supported people to have the maximum possible choice, be independent and have control over their own lives. However, staff did not always demonstrate best practice around documentation of assessment of mental capacity to show the least restrictive options had been undertaken when people were supported with decisions.

Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People were supported by staff to pursue their interests, aspirations and goals.

People living both in a supported living environment or their own homes had a choice about their living environment and how they personalised their homes.

The service made reasonable adjustments for people so they could be fully included in discussions about how they received support, including support to travel wherever they needed to go.

Staff enabled people to access specialist health and social care support in the community. Where needed people were supported with their medicines in a way that promoted their independence and achieved the best possible health outcome. They were supported to play an active role in maintaining their own health and wellbeing.

Staff communicated with people in ways that met their needs.

Right care

Although in some areas of the service people’s care plans had not been reviewed to ensure they still reflected people’s needs, most people’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

The service did not always have enough appropriately skilled staff to meet people’s needs. However, the provider had consistently worked to address the staffing issues at the service and worked proactively to recruit appropriately skilled staff.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate 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.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. this included people who had individual ways of communicating, using body language, sounds and Makaton (a form of sign language), pictures and symbols, so they could interact comfortably with staff.

People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives.

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture

The COVID 19 pandemic had a negative impact on staffing and the provider continued to work to address this. They had worked to restructure the service to ensure people were supported by staff who knew and understood them well, and were responsive, supporting people’s aspirations to live a quality life of their choosing.

Although there had been a large number of anonymous whistle blowers about the service. All the concerns were investigated by the provider and their quality monitoring team. Where necessary actions had been taken to protect people. The culture of the management team was open, and they continued to work to ensure closed cultures which could impact on people’s quality of life at the service did not develop.

We saw in some areas staff evaluated the quality of support provided to people, involving the person and those important to them, including advocates, to be involved in planning their care.

There were some areas of the service where this process required some improvement. The provider was aware of this and was working to address the issue.

People’s quality of life was enhanced by the service’s culture of improvement and inclusivity. The changes to the management team and structure of the service was beginning to show a positive impact on people’s lives.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 21 April 2021).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support Right care Right culture. The inspection was prompted in part due to concerns received about allegations of abuse, staffing and management culture. A decision was made for us to inspect and examine those risks.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner

Community Support Services is a domiciliary care agency (DCA). The service provides personal care for adults who have a learning disabilities or autistic spectrum disorder. These people lived in their own houses, flats or specialist housing in the community.

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, medicines and eating. Where they do, we also consider any wider social care provided. 36 people were receiving a regulated activity on the day of our inspection.

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

Although we found safeguarding concerns were robustly investigated, some aspects of the disciplinary policy did not give managers clear guidance, this had resulted in an incomplete disciplinary process. The provider has addressed this.

We could not be assured all medicines were safely managed as the quality monitoring tools in place for some areas of the service were not robust. The provider has addressed this.

Staff were aware of their responsibilities to keep people safe and people using the service felt safe.

Risks to people’s safety were assessed and were used to provide guidance for staff to encourage people’s independence. People were supported by adequate numbers of staff who were safely recruited and received appropriate training for their roles.

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.

People were supported by a group of staff who knew them well and were passionate about providing people with high-quality person-centred care. People were treated with dignity and respect. Staff worked with them to ensure they had choice and supported them to make independent decisions about their care.

Although we found there were some small areas requiring improvements in the quality monitoring processes, people, relatives and staff told us the service was well led. People and relatives felt the communication was good and told us the care people had received throughout the COVID-19 pandemic had been excellent. Staff told us they were well supported by their managers.

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. The ethos of the provider was continued learning, development and enabling independence for the people they supported. This was shown in the way people were supported in their living environments, the way staff worked to enable people to make their own choices and ensuring the staff supporting them understood their roles.

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 Outstanding (published 3 May 2019).

Why we inspected

The inspection was prompted in part due to Safeguarding concerns and staff culture. A decision was made for us to inspect and examine those risks.

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.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and autism to live meaningful lives that include control, choice and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service: People were at the heart of their care and involved in the planning of their support. Their preferences were always considered and each person was treated as an individual. Their physical, social, emotional and spiritual needs were always valued and respected by staff.

Strong community links were established. Staff worked with people to promote inclusion with community groups with the goal of achieving the best possible outcomes for people. Their choices and wishes were recognised and people were actively encouraged to share their views and give feedback regarding their support.

People and their relatives consistently told us staff were caring and always showed kindness and compassion.

People were truly placed at the centre of the service and were consulted on every level. Staff worked in respectful ways to maintain people’s privacy and dignity. Staff were motivated and demonstrated a clear commitment to providing dignified and compassionate support.

People using the service received exceptional care from a well-led service. There was a truly holistic approach to assessing and delivering care and support. Support plans were personalised and recorded specific information about what was important to each individual.

The registered manager demonstrated a strong and supportive leadership style. They led by example and promoted a culture of team work and inclusion for all. Staff felt valued and demonstrated the provider’s values.

The service was outstanding in supporting people to ensure they were safe within their own homes.

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.

More information is contained in the detailed findings below.

Rating at last inspection: At the last inspection in July 2016 the service was rated good.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

We carried out this announced inspection on 20 and 21 July 2016. At the time of our inspection 54 people received care under the regulated activity of personal care.

There was an established registered manager in post. 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.

People were involved in making decisions about how they wanted to be supported and how they spent their time. Staff were caring, compassionate and positive working relationships had been developed between staff and the people who used the service. These relationships were being consistently maintained and people were treated with kindness, compassion and respect.

New staff were recruited safely and staff had all of the knowledge and skills they needed in order to care for people in the right way. The registered persons had consistently provided staff with the guidance and training they needed and there were enough staff available who were deployed in the right way to meet people’s care needs.

Staff had a good understanding of how to manage risks and protect people from avoidable harm. They also knew how they would report and follow up on any concerns they identified regarding people’s safety.

The registered manager had ensured there were clear arrangements in place for ordering, storing, administering and disposing of the medication people needed. Staff’s competency to safely support people to take their medicines was regularly checked.

People had been consulted about the care they wanted to receive. In addition, care was

always assessed, planned and delivered in a consistent way.

The registered persons and staff were following the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people's best interests.

People were supported to share their views and opinions and were involved in planning and reviewing the arrangements for the care they received. People and their relatives also understood how to raise any complaints or issues they had and were confident the right actions would be taken to resolve them.

Arrangements were also in place to enable staff to share any ideas they had regarding the development of the service and to raise any concerns they had direct with the provider so these could be responded to in the right way.

The provider had completed regular quality checks together with the registered manager to make sure that people received the care they needed in a consistent way. These checks included a range of effective audit systems which ensured the service was continually monitored. This was so that any changes or improvements needed could be identified quickly and acted upon in order to keep improving the quality of the services they provided.

People had been given information about the support they could receive and they had been assisted to make decisions about things that were important to them.

People said that they had received all of the support they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

People had been supported to safely manage their medication.

The provider employed enough staff to give it the capacity it needed to consistently meet people's needs for support.

We saw that a range of quality checks had been completed to help ensure that people reliably received the help they needed.

People told us their care was personalised to their needs. People's preferred names were used even when there were changes in staff. People were happy that staff adapted well when care changes were made. One person told us, "I appreciate it when staff adapt to my wishes."

People felt staff were well trained and understood their needs. People told us they felt safe and if they had concerns they would speak with any staff member. One person told us, "I feel I can approach any member of staff to talk to."