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Community Supported living-St Pauls Good

Reports


Inspection carried out on 1 March 2017

During a routine inspection

This inspection took place on the 01 March 2017 and was unannounced. St Pauls is registered to provide personal care and support to people with a range of needs which include learning disabilities or an autistic spectrum disorder. People live in their own flats within a supported living complex. At the time of our inspection seven people were being supported by the service.

There was a registered manager in post and she was present during our inspection. 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.

At our last inspection in July 2015 we found that the provider was meeting the regulations of the Health and Social Care Act 2008.

People received their medicines safely and we saw that improvements had been made to ensure procedures were in place to guide staff when administering ‘as required medicines’. We found that recruitment checks were undertaken to ensure only suitable people were employed. We did identify some shortfalls in relation to some small gaps in staff member’s employment history. The provider confirmed to us that they had rectified this following our inspection.

People showed us that they felt safe in the company of staff and relatives told us they thought their family members were safe and protected from harm by the staff and the systems that were in place. Staff were aware of their responsibilities to report any concerns about people’s safety, and they confirmed they had received training in relation to safeguarding people from abuse. People were supported by a consistent staff team who knew them well.

People were supported to take part in everyday living tasks and to do the things that they enjoyed. The risks associated with these activities were well managed so that people could undertake these safely and without any restrictions. Staff told us their training was up to date and that they had the support that enabled them to deliver care safely. We saw staff understood people's needs and helped them to follow their chosen lifestyles and achieve their goals.

People’s human rights were respected by staff because staff applied the principles of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards in their work practice

People were treated with kindness, and respect and staff promoted people’s independence and right to privacy. People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health or well-being. People were supported to eat and drink in accordance with their preferences and dietary requirements.

There was a complaints policy in place and staff were aware of the signs to look out for which may indicate people were unhappy. Relatives we spoke with knew how to raise any concerns they may have, and they had confidence that any issues would be addressed.

Relatives and staff told us the service was managed well and in people’s best interests. Systems were in place to gain feedback from these people to enable the service to make any required improvements. Audits were undertaken regularly to monitor the quality of the service provided.

Inspection carried out on 23 & 27 July 2015

During a routine inspection

St Paul’s is registered to provide accommodation for persons who require nursing or personal care for up to eight people. At the time of our inspection seven people were using the service. People who use the service may have a range of needs which include learning disabilities or an autistic spectrum disorder.

This announced inspection took place on 23 and 27 July 2015. The provider had a short amount of notice that an inspection would take place in order to ensure people using the service would be available for us to speak with.

At our last inspection in October 2014 the provider was not meeting the regulations which related to safeguarding people and assessing and monitoring the quality of the service. Evidence that we gathered during this, our most recent inspection, showed that the improvements had been made.

The manager was registered with us as is required by law. 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. On the day of our inspection the registered manager was not at work. The provider had a cover/acting manager in place who familiar with the operation of the service as they were the Head of Outreach and Supported Living for the provider.

Staff had been provided with training and were knowledgeable about how to protect people from harm. We saw that medicines management within the service was on the whole effective with some improvements required in the guidance available for staff in relation to ‘as required’ medicines.

There were a suitable amount of staff on duty with the skills, experience and training required in order to meet people’s needs. People and their relatives told us they felt confident that the service provided to them was safe and protected them from harm.

People were supported to access a range of health and social care professionals to meet their health needs and maintain their well-being.

Staff were responsive in supporting people and interacted with them in a positive manner, using encouraging language whilst maintaining their privacy and dignity. People were encouraged to remain as independent as possible.

A variety of communication methods were adopted in order to maximise people’s level of understanding. Staff were knowledgeable about how to access independent advice for people.

It was evident that the registered manager promoted a culture in the service of putting people’s needs at the centre of decision making and shaped the service accordingly. People and their relatives were consulted about all aspects of the planning of their care and in relation to the activities they were involved in.

People were involved in a range of activities of their choosing, both within the service and in the community. During our visit we saw that people were in good spirits and meaningfully occupied.

Feedback was routinely sought from people, their relatives and stakeholders as part of the provider’s quality assurance system.

People and their relatives spoke positively about the approachable nature and leadership skills of the registered manager. Structures for involving staff in their own and the services development were evident.

Quality assurance systems and assessments to identify issues that may put people using the service at risk, were in place. The acting manager was able to demonstrate analysis of learning and changes to practice from incidents and accidents that had occurred within the service.

Inspection carried out on 29 July & 7August 2014

During a routine inspection

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, and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service. 

This inspection was announced; this meant we gave the service short notice so they knew we were visiting.  No breaches in regulations were identified at our last inspection on 02 July 2013

St Paul's is a complex of flats where eight people who have autism spectrum disorders are supported by staff to live in their own flat. A registered manager is required to manage this service.  A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of this inspection there was no registered manager at the service. Although this is a breach of the provider’s conditions of registration reasonable steps were being taken to recruit a manager to fulfil this role.

We saw that people were not always safe and protected from harm because where possible abuse were indicated, the appropriate action was not always taken to ensure that people were safe. We also saw that restrictions were placed on people without the proper processes being in place to protect those rights in line with the Deprivation of Liberty Safeguards (DoLS) and the recent judgment by the Supreme Court. This meant that the provider was breaking the law in relation to ensuring that people were properly safe from harm or unnecessary restrictions. You can see what action we told the provider to take at the back of the full version of the report.

All the people we spoke with said they were receiving a safe service. Procedures were in place to assess and manage risks to people and staff supporting people were clear about the procedures for reporting risks. However, we found that where risks were reported in line with the procedures, appropriate action was not always taken to ensure people were safe. This included acting on incidents that were potentially safeguarding matters.  The provider had procedures in place to ensure that there were sufficient staff who were suitably recruited to meet the needs of people and keep them safe.

Most people we spoke with felt that staff had the skills and knowledge to meet their needs. All staff received training to ensure they were competent to undertake their role. The majority of staff told us they received supervision and support to ensure they undertook their role well.

Everyone spoken with said they were able to choose their own foods and drinks based on foods that they liked, this was with guidance from staff on maintaining good nutrition.

We saw and people told us they were supported to maintain good health. Each person had a health plan, showing when people had access to health care professionals.

All the people spoken with told us they were treated well by staff and we saw positive and caring interactions between staff and people. We saw that people were able to express their views and were actively involved in how they were supported. We saw that where people needed support with making decisions support was offered by an independent advocate, so ensuring their interest was taken into account.

We saw that people’s needs were planned and delivered so as to ensure they received individualised support based on their needs. People were supported by staff to be involved in a range of domestic and social activities that they had chosen and enjoyed doing to help them to maintain their independence. Most people and their relatives told us that they were able to talk with staff about their concerns and were confident that they would respond and deal with any concerns.

There was no registered manager in post at the time of our inspection and we found that the provider had appointed a person to be in charge of the service on a temporary basis, but had not monitored the situation to ensure the service was well led during this period. There were systems in place to monitor the quality of the service, but they were not consistently maintained and were therefore ineffective in identifying shortfalls within the service. It was helpful to note that the head of service that was present at the inspection fully acknowledged that the systems were not effective and gave us clear assurances that the organisation would correct the shortfalls.

The provider was not meeting the requirements of the law in regards to safeguarding people and effectively monitoring the quality of the service. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 2 July 2013

During a routine inspection

Our inspection was unannounced which meant that no one knew that we would be visiting. There were eight people living there on the day of our inspection. We spoke with five people who lived there, the manager and seven members of staff to find out their views about the service provided. Because some people living there had complex needs, not everyone was able to tell us about their experiences. We used a number of different methods to help us understand the experiences of people which included observation. We saw good interactions between the staff and people who lived there and that people were at ease with the staff. One person said, “it’s fine here, staff support me.”

People's consent to having their medicines and to the care they received was sought. Where people were not able to consent, decisions were made in their best interests.

We saw that people's needs had been assessed by a range of health professionals and people's health care needs had been monitored and met.

We saw that the systems to manage people's medicines were safe and ensured that people received their medicines as prescribed by their doctor.

Sufficient numbers of staff were recruited so that people were supported to meet their needs.One person said, “I enjoy living here. I go shopping, swimming and to discos.”

People were asked for their views about the home and these were listened to. Audits were completed but action was not always taken to make improvements.

Inspection carried out on 19 September 2012

During a routine inspection

Our inspection was unannounced no one knew we would be visiting. There were eight people living there on the day of our inspection. We spoke with four people, the manager and five staff to find out their views about the service provided. Some people were unable to express their views verbally, so we spent time observing how staff supported them.

People were supported to make choices about what they did and what they ate. One person told us they had chosen to go on holiday abroad the week before and had enjoyed this.

Staff supported people to meet their health needs and ensured they had regular health checks.

We saw that people were supported to have a varied and nutritious diet of their choice.

Arrangements were in place to ensure that people were safeguarded from harm. Staff were confident that any concerns they reported would be listened to and action taken to safeguard people.

People lived in their own flat and we saw that these were comfortable and personalised to individual tastes. One person told us they had chosen their furniture and decoration.

Before staff started working there the required checks were completed to ensure the safety of the people living there.

Staff told us they were supported in their role and received the training they needed to support the people living there.

The risks to people's safety and welfare were identified and action taken to reduce these to ensure people's safety and well being.