Archived: Craegmoor Supporting you in Kent

Updated 30 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection. We re-inspect services that have been rated as ‘Inadequate’ within 6 months of the last reports publication date.

The inspection took place on 06 and 07 February 2018 and 12 and 13 February 2018 and was announced. The inspection was carried out by one inspector and an expert by experience. The expert-by-experience had a background in social care and learning disability services. We gave the service 48 hours’ notice of the inspection site visit because we needed the regional manager and some staff to be available to interview at the office. We also needed to gather some pre inspection information to confirm which people or their relatives had consented to speaking to the expert by experience or the inspector during the inspection.

We reviewed the information we held about the service. Before the inspection, we looked at previous inspection reports, the provider’s improvement action plan and notifications about important events that had taken place in the service, which the provider is required to tell us by law. We used all this information to plan our inspection.

We visited all five of the supported living services. Fourteen people and three relatives told us about their experience of the service. We spoke with ten staff including the regional manager, senior quality improvement manager, the deputy manager, two managers called locality coordinators, one shift leader, and four care workers. We received written feedback from one relative. We contacted three health and social care professionals for feedback about the service and received feedback from a commissioner at Kent County Council and a care manager.

We looked at records held by the provider and care records held in the office at in people’s homes. This included nine people’s care plans and the recruitment records of five staff employed at the service and the staff training programme. We viewed a range of policies including; medicines management; complaints and compliments; meetings minutes; health and safety assessments and quality audits. We looked at what actions the provider had taken to improve the quality of the service.

Updated 30 March 2018

This announced inspection took place on 06 and 07 February 2018 and 12 and 13 February 2018.

This service provides personal care and support to adults living in ‘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 only looked at people’s personal care. This supported living service meets the needs of people with learning disabilities, autism or people with more complex health needs such as epilepsy. At the time of this inspection there were 24 people receiving personal care. The service is run from an office in New Romney.

A registered manager was not employed at the service. However, the provider’s regional manager had applied to register as the manager and was available to support the inspection process. 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.

Craegmoor Supporting You in the South East Services was placed in special measures in December 2016. [Services that are in special measures are kept under review and inspected again within six months.] We expect services to make significant improvements within this timeframe. The last inspection report for Craegmoor Supporting You in the South East was published on 05 September 2017, with an 'Inadequate' rating following a comprehensive inspection, which took place on 28, 29 and 30 June 2017 and 03 July 2017. At that inspection, although we found improvements, we found six breaches of the legal requirements set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to Regulation 9, Person centred care; Regulation 12, Safe care and treatment; Regulation 13, Safeguarding service users; Regulation 16, Receiving and acting on complaints; Regulation 17, Good governance; Regulation 18, Staffing. Due to these breaches we used our regulatory powers by imposing conditions on the provider’s registration and this service remained in special measures.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The provider had restructured the management of this supported living service from a centralised model to a localised model. This had facilitated improved operational and quality management oversight by the deployment of an experienced regional manager to take day-to-day charge of this service. The regional manager had been supported to make significant improvements in the last six months by an experienced senior quality improvement manager. These changes had assisted the provider to meet the Regulations set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The regional manager and the provider had demonstrated a desire to improve the quality of the service for people with a learning disability by listening to feedback, asking people their views and improving how the service was delivered. People, their relatives and staff felt that the service was now well led. They told us that the management understood people’s needs, were approachable and listened to their views. The service commissioners told us that the service had improved. The provider and regional manager continued to develop business plans to further improve the quality of the service.

The regional manager had involved people in planning their care by re-assessing their needs based on a person centred approach. Care management reviews had taken place and in some cases, people were now receiving higher levels of staff support. For others, the regional manager was working with other agencies to find placements better suited to people’s needs and choices.

New systems were now in use to monitor people’s one-to-one hours and shared hours. Systems were audited on a weekly basis to check for effectiveness and quality.

More robust processes were now in place to manage medicines safely. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. Staffs continued competence in this area was checked at least annually.

An open and honest culture had been developed within staff teams. People could involve relatives or others who were important to them when they chose the care they wanted. The care plans had been developed to assist staff to meet people’s needs, told people’s life story, recorded who the important relatives and friends were in people’s lives and explained what lifestyle choices people had made. Care planning told staff what people could do independently, what skills people wanted to develop and what staff needed to help people to do.

The regional manager had delivered training about the principals of supported living to all staff. This training was based on nationally recognised practice. This had given staff a better understanding of how they assessed and treated people as individuals so that they understood how they planned and delivered people’s care to maintain their safety, health and wellbeing and personal choices. Risks were assessed within the service, both to individual people and for the wider risk from the environment people lived in. Actions to minimise risks were recorded. Staff understood the steps they should take to minimise risks when they were identified.

People’s care was being reviewed in line with the requirements of the Mental Capacity Act 2005 (MCA 2005). The regional manager understood their responsibility to comply with the MCA 2005, to assess people’s capacity and work in people’s best interest. Staff received training about this.

The provider’s health and safety policies and management plans were implemented by staff to protect people from harm. The provider trained staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have.

Incidents and accidents were recorded and checked or investigated by the regional manager to see what steps could be taken to prevent these happening again. Staff followed the provider’s policy for recording and responding to safeguarding incidents. When required these had been reported to the local authority for further investigation and notifications had been sent to the commission.

People were often asked if they were happy with the care they received. The provider offered an inclusive service. They had policies about Equality, Diversity and Human Rights. People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face, by telephone, or by using formal feedback forms. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The provider recruited staff with relevant experience and the right attitude to work with people who had learning disabilities.

New staff and existing staff were given an induction and on-going training which included information specific to the people’s needs in the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

Staff received supervision and attended meetings that assisted them in maintaining their skills and knowledge of social care. Staff consistently fed back to us that the culture and attitude to the quality of care in the services had been changing for the better. Staff had a better understanding of the balance between positive risk taking and safety. People were supported to maintain their health by healthy lifestyle planning and advice. Dietary support had been provided through healthy eating plans put in place by dieticians. Staff supported people to maintain a balanced diet and monitor their nutritional health. People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health.

The quality outcomes promoted in the providers policies and procedures were monitored by the management in the service. Audits undertaken were based on cause and effect learning analysis, to improve quality. All staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice.

Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and accessed personal protective equipment like disposable gloves and apron’s.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

The provider met their legal obligations by displaying their last inspection rating in their offices and on their website. The provider had been meeting the five additional conditions of their registration we placed on the service in October 2017.