Archived: Community Living Project

Community Living Project is a residential care home. This service supports people with learning disabilities and autism. The service is registered to care for nine people; there were eight people living at the service at the time of the inspection.

The service has 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/or 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.

The service was a large home, bigger than most domestic style properties. It was registered for the support of up to nine people. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff did not wear uniforms that would suggest they were care staff when coming and going with people.

We saw many examples where staff had supported people to become more independent, make choices and increase their physical and emotional wellbeing. With staff support and by increasing their understanding, personalised daily routines were established, reflecting people's preferences and healthy eating was promoted.

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

People were supported to stay safe. Risks associated with the premises were identified but not always responded to in a timely manner. Improvements were needed to the administration, storage and recording of medicines to ensure these were consistently safe. There was a system in place to report any incidents, including safeguarding concerns, which were analysed for any themes or trends. Peoples' staffing requirements were assessed and met. People were supported by enough staff who knew them well and had been safely recruited. The environment was clean and good infection control procedures were followed.

Staff were supported to provide good support through effective training and induction to the service. People were supported by staff who understood the importance of utilising positive behavioural support and this was used in line with best practice guidance. Staff also worked with health and social care professionals to ensure the support provided met people's needs. People were supported to maintain their health and well-being and were protected from the risks of poor nutrition or hydration. The environment had been adapted. as far as possible, to meet the current needs of the people using the service. People were able to personalise their rooms. 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.

Staff were caring and kind to people. They were skilled in communicating and supporting people to make choices and decisions about their care. It was clear bonds had been formed and people told us the staff were good and listened to them. A relative spoke highly of the good work the staff team had done to ensure their family member remained well cared for and safe. People were given choices and encouraged to reach personal goals. Staff could describe how to support people and were aware of people's routines.

Care plans were detailed and regularly reviewed. Care plans were developed with people, their relatives and staff and contained people's likes, dislikes, preferences and aspirations. People were supported to attend many activities in and away from the service. The registered provider and staff were open to receiving concerns and complaints and there was easy read information available to enable people to understand the process. Plans were in place to support people's wishes for end of life care where they were able to discuss this.

The leadership of the service promoted a positive culture that was person-centred and inclusive. The registered provider supported staff to be able to do their job effectively. The provider's quality assurance processes had been developed and resulted in improvements to the service.The registered provider and the staff team showed a desire to improve on the service provided and in turn the quality of life experiences for the people at community Living Project.

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 a comprehensive inspection of this service was Requires Improvement (published 14 November 2018).

The last rating for a focussed inspection of this service was Good (published 5 April 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Why we inspected: At our inspection carried out in July 2017, we found the provider's systems and processes to monitor and respond to incidents had not always been sufficiently embedded and followed. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance. We inspected again in September 2018 when we identified a continued breach of Regulation 17: Good Governance. The service was rated Requires Improvement in all domains and overall. A warning notice was served and the provider was given a compliance date of 31 December 2018. Following our inspection, the provider informed us what they would do to meet the regulations.

We carried out this focussed inspection to check the providers progress against the warning notice served, and to check they now met the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Our visit was unannounced. This meant the staff and the provider did not know we would be visiting. During this inspection we found the provider had implemented the necessary improvements and were no longer in breach of Regulation 17: Good Governance.

People’s experience of using this service:

•The provider/registered manager had developed a system for the regular monitoring of the service provided.

•Regular audits had been carried out to identify any shortfalls within the service.

•A dependency tool had been used to identify the levels of staffing required to support people appropriately.

•Staffing levels enabled people to be involved in activities of their choice.

•Improvements to the environment ensured people were provided with a safe and comfortable place to live. The cleanliness of the service was being monitored.

•People’s views of the service were sought through meetings and the use of surveys.

•A business continuity and improvement plan had been developed to ensure the service continued to improve in the future.

•The provider/registered manager and the staff team were committed to providing person-centred, high quality care.

Rating at last inspection: Requires Improvement - (last report published 13 November 2018)

Follow up: We will continue to monitor the service in line with our regulatory powers and our re-inspection schedule for those services rated Requires Improvement.

More information is in the detailed findings below.

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

We inspected the service on 27 and 28 September 2018. The inspection was unannounced. Community living project is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates nine people.

On the day of our inspection nine people were using the service.

The care service had not originally 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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. However, people were given choices and participation within the local community was encouraged.

At the last inspection we carried out in July 2017 we found that the provider's systems and processes to monitor and respond to incidents had not always been sufficiently embedded and followed. This was a breach of Regulation 17: Good governance the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider was still in breach of this regulation because systems and processes for monitoring the quality of service provision were not always effective.

An incident had not been reported to the local authority or CQC. Staffing numbers were not planned and reviewed with consideration to people’s needs and dependency levels. This meant people did not always have their needs met in a safe way. Staff recruitment procedures were safe because checks were carried out on the suitability of the staff member before they were offered employment. People received their medicines in a safe way and at the right time. Risk was assessed and staff knew what action to take in the event of an emergency.

The decoration and maintenance of the premises did not meet people’s needs in some areas. Some people’s rooms were untidy and were not personalised. Staff received training but did not have all the training they required to meet people’s needs. People were supported to eat and drink enough and to have a balanced diet. People had access to the healthcare professionals they required. Staff obtained people’s consent before offering care or support and were following the principles of the Mental Capacity Act. People had positive relationships with staff and they knew how to comfort people when they were distressed.

Some language used in care records was not respectful. Staff did not always have time to spend with people and people were not fully supported to express their views.

People’s needs were assessed but these were not always planned for. People had access to a range of activities but there was little opportunity for activities that people could have an active involvement in opportunity for work and education. There was a complaint procedure which was also available in an easy read format. The Accessible Information Standard was not being met and people were not always supported to communicate or provided with additional tools for communication. People’s preferences and choices for their end of life care were recorded in their care plan.

People and relatives had limited opportunity to be involved in developing the service and were not involved in reviewing care and support plans. Staff were not always actively involved in developing the service.

Further information is in the detailed findings below.

Community Living Project is a registered care service providing care and support for up to eight people who have a learning disability or autism. There were eight people using the service when we visited.

The service does not require a registered manager. The nominated individual was managing the service alongside a manager who had been employed to run the service on a day-to-day basis.

At the last inspection we carried out on 27 June 2016 we found that where people lacked the capacity to consent to their care and treatment, the provider had failed to act in accordance with the provisions of the Mental Capacity Act 2005. We also found that staff did not always understand their requirements under the Act. At this inspection we found the provider had made the required improvements.

The provider had not always taken all of the appropriate action following incidents that had occurred. Staff knew their responsibilities for helping people to remain safe. Risks to people’s health and well-being were assessed and staff had the guidance they required. The provider had arrangements in place to check the environment and the equipment within it to protect people from risks. Emergency plans were in place to help people to remain safe during unforeseen events.

The provider had safely recruited a suitable number of staff to offer support to people.

People mainly received their medicines when they required them. Staff received training and guidance on how to handle medicines safely.

Staff received guidance and training so that they could provide good support to people. They had the skills and knowledge they required to support people living at the Community Living Project.

People were asked for their consent before support was undertaken. Where the provider had concerns about a person’s ability to make a decision, they completed assessments and made decisions in people’s best interest where this was required. They did this in ways that protected people’s freedom and liberties.

People chose what they wanted to eat and drink. People could choose where they ate their meals. Where there were concerns about a person’s eating or drinking this was monitored by staff. This was so that they could be sure people were having enough to eat and drink. People had access to a range of health care services to maintain their health.

Staff offered their support in kind ways. They made sure that people’s dignity and privacy was respected. Staff had developed good relationships with people and knew how each person communicated so that they could support them well. People were involved in decisions about their support. Additional support had been made available to people to make decisions where this was required. Staff supported people to retain their skills and independence.

People received support that was based on things that mattered to them. They had opportunities to take part in activities that they were interested in and enjoyed. Staff had guidance available to them within support plans that detailed people’s specific support requirements. Staff followed this guidance when supporting people. People contributed to the review of their support where they were able to.

The provider had made information on making a complaint available within the home. The provider was following their complaints procedure where a complaint had been received.

People and their relatives had opportunities to comment on the quality of the service. Where suggestions were made, the provider took action.

Staff received good support from the manager and knew their responsibilities.

The manager and nominated individual were aware of their responsibilities. However, the provider’s checks on accidents and incidents that had occurred were not always sufficient. As a result the provider had not always taken the required action. Other checks on the quality of the service took place and the provider took action to drive improvement.

We found a breach of the Health and Social Care Act (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The Community Living Project is a registered care service providing care and support for up to eight people who have a learning disability. At the time of our inspection six people were using the service. The accommodation is offered over two floors. There is a communal lounge and dining room on the ground floor along with some of the bedrooms, and the remaining bedrooms are on the first floor. There is an accessible garden for people to use should they wish to.

The service does not require a registered manager. There was a manager in place who was spending less time working at the home. They had made arrangements for an acting manager to run the service on a day-to-day basis. The manager told us that the acting manager would be submitting an application to become the registered manager.

Relatives had no concerns about their family members’ safety. Staff knew how to protect people from abuse and avoidable harm. The provider did not always have robust records where incidents had occurred. The provider was not always routinely checking the equipment and the premises to keep people safe.

The provider had managed risks to people that they were vulnerable to. For example, where people used the kitchen to make drinks and snacks there were clear instructions for staff about how to support people to stay safe.

We found that staffing levels were adequate to meet people’s safety needs. The provider recruited staff safely.

People’s medicines were stored safely but not always stored correctly. For example, one person’s medicines were not stored at the correct temperature. Staff received regular guidance on how to administer people’s medicines and were trained.

We identified a breach of the regulation where the service had failed to act in accordance with the provisions of the Mental Capacity Act (MCA) 2005. Staff did not always understand the requirements of the MCA and people’s consent to care and support had not always been recorded. Where people may have lacked the capacity to make their own decisions, the provider had not followed the requirements of the MCA. For example, mental capacity assessments were not in place.

People were supported by staff that had received regular training and support. For example, staff had received training in supporting people with epilepsy.

People were satisfied with the food offered to them. Where there were concerns about people’s health and well-being the provider had sought additional support.

People said that staff were kind and we saw staff supporting people in a caring manner. People’s dignity was not always upheld. This was because some terminology in records could have been seen as not showing respect for people.

The provider had not documented how people had been involved and contributed to the planning and reviewing of their care and support. Information on independent advocacy services had not been made available to people to support them to speak up if they had required this.

Staff knew about people’s preferences and what was important to them. For example, staff knew how people communicated. People were supported to maintain relationships that were important to them.

The service was responsive to people’s needs and preferences. For example, the provider was installing a new bath for a person whose needs were changing.

People’s support plans contained person-centred information and focused on them as individuals. We saw that staff worked in a person-centred way with people.

People had access to activities and interests that were important to them. For example, we saw that some people accessed a local day centre and some people had enjoyed a recent trip to a local zoo.

The complaints procedure was available to people and relatives knew how to make a complaint should they have needed to.

People and their relatives had opportunities to give feedback about the quality of the service. For example, people attended residents meetings to give suggestions to the provider about activities.

Relatives described the service as well-led. There was a shared vision of the service by the managers and staff members. This included promoting people’s independence.

The manager was mainly aware of their responsibilities. However, the required notifications to CQC had not always been submitted. The provider had some quality checks of the service in place. However, these had not been effective in identifying some of the concerns we raised during our visit. For example, the medicines check had not identified that one person’s medicines were stored incorrectly.

Staff told us that they were supported and we saw that the provider had processes in place to make sure that this occurred. Staff understood their responsibilities including reporting the poor practice of their colleagues should they have needed to.

People using the service told us they were happy with the care and support they received and were treated with respect. One person told us they made their own decisions. Another person said, 'The staff are alright, I've been here some time so they know me.' When we asked a third person for their view, they smiled and showed us the 'thumbs up' sign to indicate they were happy with the care and support they received.

There were menus available in formats that were suitable for people to understand. People were provided with a choice of meals to meet their needs and preferences. One person told us there was always an alternative and on that day they chose to have soup instead of the main meal.

People said they received their medicines on time. Records showed medicines were administered correctly. Appropriate arrangements were in place to store medicines safely.

People were supported by staff that understood their needs and promoted their wellbeing. There were enough qualified and experienced staff employed by the service.

People's care records, risk assessments and daily reports were detailed, kept up to date and stored securely. Staff were aware of their responsibilities to maintain confidentiality and accurate records.

Everyone spoken with told us that they were happy living at Community Living Project and happy with the care and support they received. One person told us: 'It's alright; I can come and go as I please.' Another told us: 'They [the staff] are good to me.'

Throughout our visit, people were supported to be as independent as possible and were encouraged to do as much for themselves as they could. When help and support was needed, we saw the staff providing this, in a friendly and relaxed manner.

People were encouraged and supported to be involved in community activities. On the day of our visit four people were supported to attend a local day centre, one person was meeting a relative for lunch and another person told us that they were going to the shops.

Care plans and person centred plans had been developed for everyone living at the service. Those seen on the day of our visit were comprehensive and gave the reader a really good picture of the individual, their strengths and abilities, their likes and dislikes and their aspirations and goals.