Archived: Chosen Care Supported Living

Chosen Care Supported Living is a supported living and domiciliary care service providing personal care and support to adults with a variety of needs. This includes learning disabilities, autistic spectrum disorder and mental health needs. At the time of the inspection, 22 people using the service were receiving the regulated activity ‘personal care’. A further 21 people were receiving support which was not regulated by CQC.

Personal care was being provided to people in 10 supported living houses located in the suburbs of Gloucester. Each house could accommodate between two and five people who had their own bedroom and access to shared communal spaces.

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

People felt safe and supported and were happy with the service they received. Risks to people had been assessed and detailed support plans were in place. Staff followed people’s support plans and provider policies to keep people safe, for example, in relation to COVID-19. Outcomes for people were good and the feedback we received from relatives and health care professionals reflected this. Significant progress had been made in meeting some people’s health and anxiety related needs, where previously people had experienced challenges and obstacles in these areas.

People were supported by the provider to ensure their accommodation was safe, suitable for their needs and was well maintained.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were enabled to participate in reviews of their needs and have their voice heard. This was done through effective planning and use of a variety of communication methods, such as social stories. People were supported to develop life skills including cooking and managing their emotions. This enabled them to live meaningful lives in the community, including accessing mainstream services and maintaining relationships with others who were important to them.

People and staff benefitted from a highly inclusive culture and leaders who were committed to good outcomes for people. The management team were supported by the provider whose systems, governance and quality work had undergone significant investment and improvement. These improvements had been embedded since our last inspection. Comments from professionals included, “Overall really positive steps are being taken” and “They are getting to grips with everything.”

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, at the previous premises where the service was known as 'Chosen Court', was Requires Improvement (published 8 February 2020) with two breaches of regulation. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We carried out an announced focused inspection of this service on 21 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this inspection to check whether the Warning Notices we previously served in relation to Regulation 12 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chosen Care Supported Living on our website at www.cqc.org.uk.

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.

Chosen Court is a supported living service to people with a learning disability. A supported living service is where people live in their own home and receive care and support in order to promote their independence. The service was supporting 17 people at the time of our inspection.

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

The provider’s quality assurance systems to assess, monitor and improve the quality and safety of the service were not operated effectively. Shortfalls in the service had therefore not always been promptly identified and addressed.

At the time of the inspection the local authority was working closely with the provider to make the required improvements. The provider kept us updated of the action they were taking to address the risk and quality concerns.

The service did not always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons:

People were supported by staff who had been recruited safely. However, not all practices were safe enough.

Risks associated with people's care needs were not always appropriately assessed and information for staff on how to provide safe support to people were not always documented.

People were not always adequately supported to keep their homes well maintained and cleaned.

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 this service was good (published 13 December 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of people’s medicines, the environment and people’s safety. A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the Key Questions of safe and well-led only.

Enforcement

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have identified breaches in relation to safe care and treatment as well as the governance of the service at this inspection.

We issued two warning notices to the provider informing them they must be compliant with both regulations.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Chosen Court on our website at www.cqc.org.uk

Follow up

The provider started taking immediate action during our inspection to address the shortfalls we found and to mitigate the risks.

We will request to meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good and we will request an updated action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Improvement action plan issued following the previous inspection

Where we asked the provider to complete an improvement action plan following the last inspection, include the text below, adapting where necessary:

'Following the last inspection, what they would do and by when to improve the key question(s) to at least good.' Then describe at a high level what you found, adding detail in the detailed findings section for the relevant key question(s).

Focused inspection

'We undertook an announced / unannounced focused inspection of on . This inspection was done to check that improvements to meet legal requirements planned by the provider after our inspection had been made. The team inspected the service against of the five questions we ask about services: is the service well led, , (more as needed)? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection'

Comprehensive or focused inspection

Where breach topic has moved to a different key question in Next Phase

When we completed our previous inspection on DD/MM/YYYY we found concerns relating to . At this time this/these topic area(s) was/were included under the key question of . We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this/these topic area(s) are included under the key question of . Therefore, for this inspection, we have inspected this key question and also the previous key question of to make sure all areas are inspected to validate the ratings.

Provide a brief overview of the service (e.g. Type of care provided, size, facilities, number of people using it, whether there is or should be a registered manager etc).

Service Types and descriptions

Care at Home services

Domiciliary care agency

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community [and specialist housing]. It provides a service to [older adults], [younger disabled adults], [children].

Provider of care to people living in specialist housing

Location proving care to people housed under supported living arrangements

This service provides care and support to people living in [a] [insert number of] 'supported living' setting[s], so that 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.

Location proving care to people living in extra care housing

This service provides care [and support] to people living in specialist 'extra care' housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is [bought] [or] [rented], and is the occupant’s own home. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people's personal care [and support] service.

Describe the specialist housing setting[s] people live in, there are some examples below:

People using the service lived in…

[number] ordinary flats and bedsits across [town/city/area]

a single 'house in multi-occupation' shared by [number] people

[number] of [bedsits], [flats], [houses], [and] ['houses in multiple occupation'] across [town/city/area]

a large gated community on the outskirts of [city]

Where the service supports people living in houses in multiple occupation (HMOs), add:

Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities.

Give a summary description of the houses, the facilities that are shared, and either the number or the range of numbers who share them. Include information about any office or sleep in arrangements. Give less detail and more summarised information where larger numbers of HMOs are supported.

Do not provide a detailed, estate agent style description of the premises lived in by people using the service; only an outline summary able to broadly explain the context in which it provides regulated activity

All Care at Home services

Where needed, explain that not everyone using the service receives personal care, for example:

Not everyone using [service name] receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

Residential care home

[Care home name] 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.

Describe the care home's premises, for example:

(The care home) accommodates xx people in one adapted building.

(The care home) accommodates xx people across three separate units, each of which have separate adapted facilities. One of the units specialises in providing care to people living with dementia.

Do not provide a detailed, estate agent style description of the premises; only an outline, broad summary.

Services for people with learning disabilities and autism

'The care 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.' Registering the Right Support CQC policy

You will need to reflect where a service does not conform to Building the Right Support and Registering the Right Support guidance. It is very difficult for large services for people with autism to meet the standards.

Complex or multiple service location

If you are inspecting a complex, multiple service type location you will need to adapt and edit the above paragraphs as needed, probably substantially.

N.B. If there is or should be a registered manager include this statement to describe what a registered manager is:

'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.'

Give a summary of your findings for the service, highlighting what the service does well and drawing attention to areas where improvements could be made. Where a breach of regulation has been identified, summarise, in plain English, how the provider was not meeting the requirements of the law and state 'You can see what action we told the provider to take at the back of the full version of the report.' Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.

There was a registered manager in post. 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.

People were safe. Their risks were assessed and managed appropriately and they were able to take part in activities they enjoyed and make decisions about their day to day needs with the support of the staff. They had their medicines administered safely and were supported by caring staff whose focus was their well-being at all times.

People’s care plans were tailored for them as individuals. Family and those important to them were involved in their care and support and staff ensured people kept in contact with them whenever they wished.

People’s healthcare needs were met by ensuring they had the appropriate access to healthcare professionals in the community such as the district nurse and GP.

Staff were supported by each other and the registered manager and had access to the relevant training to equip them to do their job well. Staff felt able to voice their concerns and provide ideas on how to shape the service. The staff reflected the values of the service.

Staff’s on-going competency was overseen by the registered manager.

The service had a caring and committed registered manager. The provider supported the registered manager in ensuring the service was safe and providing high quality care. Regular quality assurance spot checks and audits ensured that all care and support was delivered safely and effectively.