London Borough of Hackney, Housing with Care

London Borough of Hackney Housing with Care provides care and support to people living in self-contained flats across 14 schemes located in the London Borough of Hackney. The service can support up to 288 people. The schemes provide a 'supported living' setting which enables people to receive care and continue to live independently in their own homes. CQC does not regulate premises used for supported living; this inspection looked at the personal care provided by the service. 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. At the time of our inspection there were 150 people using the service.

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

We received feedback about staffing levels at the weekends being reduced. We have made a recommendation about the deployment of staff during the weekend. The provider had not submitted notification of safeguarding alerts without delay. We found care records for people who used the service were not always consistent or accurate. We received mixed feedback about how different schemes were managed and communication.

People and most relatives felt the service was safe. Staff understood what action to take if they suspected somebody was being harmed or abused.

Staff knew how to report accidents and incidents and learning from these took place.

The provider ensured there was infection control guidance in place. Staff confirmed they were provided with adequate amounts of personal protective equipment such as masks and gloves.

People had risk assessments to keep them safe from the risks they may face, including risks related to the Covid-19 pandemic

People and most relatives told us they felt the service was well-led. Quality audits carried out prior to our inspection identified Inconsistencies with care records.

Rating at last inspection

The last rating for this service was requires improvement (published 18 September 2019).

Why we inspected

We carried out this inspection following a routine review of information we held about this service. Our intelligence indicated that that there may be a higher level of risk at this service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Ratings from previous comprehensive inspections for those key questions not rated were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same requires improvement. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm. Please see the safe, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for London borough of Hackney, Housing with Care on our website at www.cqc.org.uk.

London Borough of Hackney Housing with Care provides care and support to 223 people living in self-contained flats across 14 schemes located in the London Borough of Hackney. The schemes provide a ‘supported living’ setting which enables people to receive care and continue to live independently in their own homes. CQC does not regulate premises used for supported living; this inspection looked at the personal care provided the service. 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

New systems for monitoring the quality of the service were being implemented. The service improvement plan was detailed and documented the provider’s commitment to continuously improve the quality of the service. The provider had made several improvements since our last inspection in November 2018, however, some of these changes had yet to be fully embedded. We found some gaps in staff records and care records for people who used the service. We made recommendations related to the management of records for staff and care records related to people who used the service.

People’s needs were jointly assessed by the housing provider and the service. Relatives told us they were involved in the assessment process. Choice in which care provider people were able to use varied across schemes, whilst some people had care provided by an external agency, most people used the care provided by housing with care as part of the accommodation tenancy.

People and relatives said they felt safe. Systems were in place to protect people from abuse and staff understood their role and responsibility in reporting and acting on abuse. Staff were aware of the procedure to report their concerns to external authorities. Staff followed safe infection control practices when caring for people. Where things went wrong the service held a lessons learnt meeting to improve the service provided to people.

People were cared for by staff who felt supported and well trained to effectively carry out their roles. People’s nutritional needs were met, and their likes and dislikes for food were respected. 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 treated with dignity and respect and said staff were caring and kind. Most people and relatives felt involved in the care provided by the service.

People received personalised care tailored to their needs. Systems were in place for dealing and acting on complaints, people and relatives felt able to approach senior management with their concerns. People had their end of life wishes considered and recorded in their plan of care.

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

Rating at last inspection and update

The last rating for this service was Inadequate (published 14 January 2019) and there were multiple breaches of Regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since January 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

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 London Borough of Hackney, Housing with Care provides care and support to people living in 14 ‘supported living’ settings, so they can live in their own home 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 looked at people’s personal care and support. The 14 schemes were all located in the London Borough of Hackney and ranged in size from eight to 40 self-contained flats. Most of the schemes were designed to meet the needs of older adults, although some were specialised for particular groups including adults with learning disabilities aged over 50 and people living with a particular type of dementia.

There was one registered manager who was responsible for seven of the schemes. A second manager had applied to register with us who was responsible for the other seven schemes. 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 told us they felt safe and staff were able to describe the support they provided to ensure people were safe. However, care plans and risk assessments were poor quality, lacked details and were not personalised.

Risks faced by people in the receipt of care had not been appropriately identified and measures in place to mitigate risks were not clear or robust. There was insufficient information about people’s medicines to ensure they were managed safely and records did not show people had been supported to take medicines in a safe way. Although staff had a sound understanding of safeguarding and incident reporting, the systems in place to monitor and respond to incidents and allegations of abuse were piecemeal and there was a risk that trends and themes were not identified.

People did not feel involved in developing their care plans and did not always feel they had been offered choice about their care provider. Care plans had not been developed in line with best practice and guidance for meeting people’s specific needs. There was insufficient information about people’s healthcare needs, dietary requirements, cultural background and sexual and gender identity. We made a recommendation about ensuring the provider was able to offer appropriate support about people's sexual and gender identity. There was a risk that people’s preferences and needs would not be met because these were not recorded.

People gave us mixed feedback about the staffing levels in the service and the impact this had on their experience of care. While some people felt there were enough staff who had time to chat, others found staff rushed and busy. Staff were recruited in a way that ensured they were suitable to work in a care setting. Some of the schemes had very high agency use, with half of their shifts being covered by agency workers. Staff received regular supervisions, but the records did not demonstrate they had received the training they needed to perform their roles.

People did not always know how to make complaints, but were confident that if they had cause to make a complaint their feedback would be responded to appropriately. Records showed complaints were responded to in line with the provider’s policy. The systems in place for learning from complaints were not operating effectively.

People told us they liked living in the schemes and would be happy to stay there until the end of their lives. Information about people’s end of life wishes was not captured and the provider was not following their end of life policy.

Staff at the registered location did not have access to all of the documentation about people's care, which showed a lack of good governance at the service. We also identified shortfalls in how information was recorded and the reliability of the IT systems in use. The quality assurance and audit systems were not operating effectively. They had not identified or addressed issues with the quality and safety of the service. A range of audits were completed by managers at different levels but there was no central oversight or action plan. Actions to improve the quality of the service were not embedded or sustained.

The management structure of the service was new, and the managers were committed to improving the service. Staff felt supported in their roles. Staff worked closely with other organisations to ensure people were able to be active in their communities and attend a range of activities if they wished.

We found breaches of four regulations relating to person centred care, safe care and treatment, staffing and good governance. Full information about our regulatory response is added to reports when all appeals have been exhausted.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Supported Living Schemes (also known as Housing with Care) provides personal care and support to people living within supported housing. At the time of our visit the service was providing support to 270 people in 15 schemes across the London Borough of Hackney. All of the people using the service were funded by the local authority.

There were two registered managers in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

One of the registered managers was responsible for eight schemes, the other for seven schemes. There were10 scheme managers covering the 15 schemes, who each reported to one of the registered managers.

People and their relatives told us they felt safe using the service and care workers had a good understanding of how to protect people from abuse. Staff were confident that any concerns would be investigated and dealt with. All staff had received training in safeguarding adults from abuse and had a good understanding of how to identify and report any concerns. Scheme managers were notified when training was due to expire and requested refresher training for care workers.

People’s risks were managed and care plans contained appropriate risk assessments which were updated regularly when people’s needs changed. Care workers worked with all people across individual schemes to ensure they were aware of the needs of each person. The service had a robust recruitment process and staff had the necessary checks to ensure they were suitable to work with people using the service.

People who required support with their medicines received them safely and all staff had completed in-depth training in the safe handling and administration of medicines, which was refreshed every three years. However not all schemes had a recording system in place for the disposal of medicines.

Care workers received an induction training programme to support them in meeting people’s needs effectively and were always introduced to people when they started work at the scheme. They shadowed more experienced staff before they started to deliver personal care independently and received regular supervision from management. They told us they felt supported and were happy with the supervision they received.

Staff understood the principles of the Mental Capacity Act 2005 (MCA). Care workers respected people’s decisions and gained people’s consent before they provided personal care.

Care workers were aware of people’s dietary needs and food preferences. Care workers told us they notified the team leaders or scheme managers if they had any concerns about people’s health and we saw evidence of this in people’s care plans. We also saw people were supported to maintain their health and well-being through access to health and social care professionals, such as GPs, occupational therapists and district nurses.

People and their relatives told us care workers were compassionate and caring and knew how to provide the care and support they required. Care workers understood the importance of getting to know the people they supported and showed concerns for people’s health and welfare.

People told us that staff respected their privacy and dignity and promoted their independence. There was evidence that cultural requirements were considered when carrying out the assessments and making sure these needs were met.

People were involved in planning how they were cared for and supported. An initial assessment was completed from which care plans and risk assessments were developed. Care was personalised to meet people’s individual needs and was reviewed if there were any significant changes, with health and social care professionals being contacted to authorise changes in care received. People and their relatives were actively encouraged to express their views and were involved in making decisions about their care and whether any changes could be made to it.

People were supported to follow their interests, take part in social activities and maintain relationships with relatives and friends that mattered to them.

People and their relatives knew how to make a complaint and were able to share their views and opinions about the service they received. There were also surveys in place to allow people and their relatives the opportunity to feedback about the care and treatment they received.

The service promoted an open and honest culture and the registered managers were transparent in their discussions with us. Staff spoke highly of their teams and felt well supported by their scheme managers and team leaders. Staff were confident they could raise any concerns or issues, knowing they would be listened to and acted on.

The registered managers had a good understanding about the importance of links with community services and other organisations involved in adult social care.

There were effective quality assurance systems in place. The registered managers followed a monthly and annual cycle of quality assurance activities and learning took place from the result of the audits. They were aware of their Care Quality Commission (CQC) requirements in relation to notifying us about incidents that happened within their schemes.

We made one recommendation in relation to medicines records.

Each person who spoke with us agreed the care workers met their individual needs. One person told us, "I'm very satisfied, everyone is lovely. I wouldn't change anything." Another person commented, 'I'm happy about everything, I'm quite contented.' A friend of one person said, "it's very good, I'd say it is five star accommodation. I've never seen her so happy.' The housing officer told us, "the staff are good. The standard of care is very good.' Staff working in the scheme were able to meet people's needs. They were aware of each person's care needs and their cultural and religious backgrounds.

There were enough qualified, skilled and experienced staff to meet people's needs.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

The provider was ensuring that the Care Quality Commission was informed without delay allegations of abuse in relation to the service as required.

People were involved in planning their care and they were supported with dignity and respect. There was a stable group of care workers working in the project. Staff were aware of each person's care needs and their cultural and religious backgrounds.

Staff told us they felt supported by the management team. They felt they were able to access appropriate training, but they commented it would sometimes take some time before the training would be made available to them.

The registered person failed to notify the Care Quality Commission without delay of any abuse or allegation of abuse in relation to a service user, as required by Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.