Consensus Support Services Limited - 121 Station Road

Consensus Support Services Limited - 121 Station Road is a care home that was providing personal and nursing care to 10 people with a learning disability or autistic spectrum disorder, a physical disability and younger adults.

People’s experience of using the service:

Quality assurance systems and processes did not always identify gaps in people’s care records. A new audit tool was implemented to address this.

The service worked within the principles and values that underpin Registering the Right Support and other best practice guidance. This ensured that people could 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 over their own lives, choice, and independence.

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 practice.

People were supported by staff that were kind and caring and enjoyed spending time in their company. Staff promoted people’s independence.

Keyworker meetings enabled people to discuss what was working and not working for them, so people could be supported to address any issues or concerns.

People's privacy and dignity was respected. People's diverse needs were embraced, and staff supported people to express their individuality.

People were supported to access activities of their choosing and to engage in their hobbies and interests.

Relatives told us they knew how to raise a complaint and felt confident these would be addressed to their satisfaction.

People received safe care from staff that understood how to recognise and protect them from abuse. Staff had received training relevant to their role and felt well supported and valued by the management team.

Risk assessments and care plans were reviewed at regular intervals to ensure these were reflective of people’s needs.

People received their medicines as prescribed and equipment for managing people’s health needs was maintained in line with the manufacturer’s guidance.

The service met the characteristics for a rating of ‘good’’ in all of the key questions. Therefore, our overall rating for the service after this inspection was ‘good’.

Rating at last inspection: Requires Improvement (Published 23 May 2018).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our re-inspection schedule for those services rated Good.

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

121 Station Road is registered to accommodate 11 people with learning disabilities and complex needs; at the time of our inspection, there were nine people living in the home. The service has 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.

There was no registered manager. 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.

There had been two changes in registered manager since the last inspection and since August 2017 there had been no registered manager. At the time of the inspection, there was a registered manager from another of the provider’s services who was overseeing the service; an application to vary the registration of another of the providers registered managers was in progress to become the registered manager at 121 Station road. However, the person was not available to take up the post at the time of the inspection.

The lack of a consistent manager had affected the stability of the service. Staffing levels were not consistently maintained, which meant that there was not always sufficient staff to provide support outside of providing for people’s basic care needs. This had affected the opportunities for people to undertake individual meaningful activities.

Staff training and supervision was not up to date and systems to monitor and audit the service had not consistently been maintained. The management of staff leave had left it difficult at times to provide sufficient cover.

People received care from staff that knew them well and were kind, compassionate and respectful. Positive therapeutic relationships had been formed and staff understood people’s different ways of communication.

People’s needs were assessed prior to coming to the home and detailed person-centred care plans were in place and were kept under review. Risks to people had been identified and measures put in place to mitigate any risk.

There were appropriate recruitment processes in place and relatives were confident that their loved ones were safe in the home. Staff understood their responsibilities to keep people safe from any risk or harm and knew how to respond if they had any concerns.

People and their families were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day-to-day routines. People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the care their family member received and felt that they could approach management and staff to discuss any issues or concerns they had.

There was a 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.

Improvements were required to quality monitoring of the home to ensure care plans contained current and relevant information. People at the home reacted positively to the registered manager and the culture within the home focussed upon supporting people’s health and well-being and for people to participate in activities that enhanced their quality of life. Systems were in place for the home to receive and act on feedback and policies and procedures were available which reflected the care provided at the home.

People felt safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. There were sufficient staff to meet the needs of the people and recruitment procedures protected people from receiving unsafe care from care staff unsuited to the job.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Care records contained risk assessments and risk management plans to protect people from identified risks and helped to keep them safe but also enabled positive risk taking. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.

People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Care plans were written in a person centred manner and focussed on empowering people; personal choice, ownership for decisions and people being in control of their life. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People participated in a range of activities and received the support they needed to help them do this. People were able to choose where they spent their time and what they did.

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

The service provides nursing care to people with learning disabilities who require a high level of nursing care. The local Clinical Commissioning Group raised several concerns about the service with the Care Quality Commission (CQC). The concerns included a lack of permanent and well trained staff to meet the needs of people to ensure their safety and welfare.

Is the service safe?

Many of the people living at the home were unable to communicate verbally with us, to tell us their experiences of living at the home. However, we observed that people appeared happy and relaxed in their environment and received suitable support from the staff. The staff demonstrated an understanding of the support required to enable people to receive a good standard of care. However, we found that people's care records were not always reviewed in line with their needs to ensure staff provided safe care. The systems required to ensure people's safety and welfare were not always followed in practice. Accidents and incidents that had been recorded at the service were not always reviewed by the manager to ensure staff had taken the correct action to ensure people's welfare.

The provider set a safe level of staffing at the service. Staff working rotas were in place to ensure enough staff were on duty. However, sometimes the staffing levels fell beneath the safe level of staffing set by the provider. There were vacancies for nursing and care staff at the service. The provider was actively recruiting to these posts. We saw staff received basic training to enable them to care for people. However, some people living at the home required staff to care for them in a special way and training was not always provided to ensure staff were competent to do their jobs. The system of staff supervision and performance appraisal was also not in place. This meant there was a breach of the Health and Social Care Act regulations. Enforcement action has been set and the provider is required to take action to improve.

Is the service effective?

We observed that people appeared happy living at the home and staff provided them with respectful and sensitive support. Staff told us that they had a good knowledge of people's preference for care and this included preparing meals that they enjoyed. We observed that some people required a soft and pureed diet and saw that staff supported them to eat and drink in a way that met their needs. We saw that staff had developed a new sensory room at the service and this contained special equipment to make sure people received sensory stimulation to meet their needs.

People's health and care needs had been assessed with them; however people's needs were not always reviewed by the staff on a regular basis. This put some people at risk of developing health related complications. Advice from health professionals was not always recorded in people's plans of care to make sure they contained accurate information about people's needs. People at risk of malnutrition and dehydration were monitored by the staff to check they had consumed sufficient food and fluids. However, staff did not always add up the amount of fluid consumed each day to ensure people's welfare. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. The staff working for the service told us that people were well looked after and they cared for the people that lived at the service. A health professional who was working at the service told us that Consensus Support was a good service and people were well cared for there. They said 'The level of care of brilliant here, it is a very clean place and the staff are a caring group of workers'.

Is the service responsive?

We observed that staff were responsive to a range of people's needs. We saw that people were supported by the staff to access the local community and to undertake activities in the home. For example, one person wanted to spend time listening to their music and another person wanted to help the staff prepare the evening meal.

Is the service well-led?

At the time of the inspection visit, the registered manager was not in post. The provider had appointed an interim manager to manage the home in the registered manager's absence. Staff told us that the new interim manager had already made several improvements in the running of the home including improving the staff working rotas. The provider had also appointed a nurse to provide staff with clinical leadership at the service. We spoke with the new clinical lead nurse and they told us their plans to improve the service and ensure nursing staff stayed up to date with the clinical guidelines to ensure people received good care. Staff told us the new clinical lead was 'very professional and well respected' by staff working at the service.

The service had a quality assurance system in place, which consisted of a yearly audit of the service by a senior manager. An action plan was also in place with information about any concerns identified and the improvements required. However, we found that some identified concerns had not been fully resolved to ensure people's safety. We also found that medication and cleanliness audits were not always completed routinely and there were insufficient systems in place to obtaining feedback from people who used service and their relatives. Professional advice and reports from external agencies was not always followed in a timely way to ensure service improvement. This meant there was a breach of the Health and Social Care Act regulations. A compliance action has been set and the provider must tell us how they plan to improve.

We spoke with the relatives of five people. They all told us that they had either been fully satisfied or generally satisfied with the care their relatives received.

One relative said; 'Care is second to none. It is way above and beyond what I expected'.

We observed the relationship between staff and people who lived in the home. This was friendly and helpful. For example, staff assisted a person to move, commented on how nice a person's hair looked and provided people with activities.

This was a generally positive inspection. We observed generally good care from the staff of the service. All the relatives we spoke with, except one, said that they had no concerns. This relative wanted more stimulation for her son, his bedroom to be tidier and for staff always to pay attention to people, rather than speaking amongst themselves. The manager said she would follow these issues up. The essential standards we inspected, except medication, were found to have been met.

There was one suggestion made; for teamwork sessions to be held with staff so that staff work better together to always support each other.

We spoke with five relatives. They told us that the care that staff provided was either very good, or they were generally satisfied. One relative said: 'Staff are very good at their jobs'.

This was a mixed inspection. People living in the home indicated concerns about the care they had been provided with. Relatives were mainly satisfied with the service, but two expressed concerns about some aspects of care. . The main issues identified were; to ensure that people were always treated with respect, that care provided always met people's needs, staffing levels were always able to meet people's needs, and complaints were always recorded and acted on.