Archived: Natural Ability

This service provides care and support to nine people living in six small ‘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.

This inspection had been brought forward due to concerns. This was because staff had raised concerns about safeguarding incidents that had occurred. These had not been reported to the local authority or to the Care Quality Commission, and had not been investigated by the provider. This meant vulnerable people had not been protected and safeguarding adults’ protocols had not been followed. Also, the provider’s quality monitoring processes were not effective in identifying gaps and shortfalls in the quality and safety of the service.

People were supported with their medicines in a safe way but there was no guidance for staff about when to support people with over the counter or ‘when required’ medicines. We have made a recommendation about this.

Staff told us they had not always felt well supported and had not received some of the training they needed. We have made a recommendation about this. Individual supervisions with staff had not been held in a confidential way. On-call management arrangements had not always been supportive to staff who worked with people who used the service. The provider showed us how these issues were being addressed.

There had been a registered manager at the service but they retired in November 2017. A new manager had applied for registration but left the organisation during this inspection. Another manager (from the organisation’s education department) was acting as manager in the interim until a new manager could be appointed. 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.

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.

People were fully included in their local community and lived ordinary, fulfilled lives as local citizens. They took part in meaningful occupations, such as farming and gardening. They also enjoyed a number of individual leisure activities that they were interested in.

People were treated with dignity and respect. They were encouraged to make their own decisions and to lead as independent lives as possible.

People who could express a view felt the staff were caring and kind. People said they “liked” the support workers and described them as “nice”.

Staff were extremely knowledgeable about individual people and were aware of their individual preferences. People were supported to do their own shopping and make their own meals, with support only where needed.

The service was working within the legal requirements of the Mental Capacity Act 2005 (MCA 2005). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; they understood the need to obtain consent when providing care. Staff had completed training in relation to the MCA 2005.

Senior manager had recently identified a number of areas for improvement and development. The organisation was committed to implementing those improvements and was considering better ways of monitoring the service in future.

We found two breaches of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014. These related to safeguarding people and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Natural Ability is registered with the Care Quality Commission as a supported living service which provides care and support to people in their own homes who have a learning disability or autistic spectrum disorder. A registered manager was in post who was also the registered provider of the service.

At the time of our last inspection there was only one person in receipt of personal care and support from the service on a supported living basis (living in their own home and in the community), and this number had increased to a total of six people at this visit. There were a further two young adults/children with disabilities receiving personal care in the pursuit of activities in the community, on a respite/outreach basis. The day farming service was attended regularly by groups of between one and six adults on weekdays.

People told us they felt safe when they received care from the service. Most staff had received training in the safeguarding of vulnerable people and they were aware of their individual responsibility to report matters of a safeguarding nature. Records showed there had not been any safeguarding incidents since our last inspection and the local authority safeguarding team confirmed that there were no on-going safeguarding cases.

Risks that people had been exposed to in their daily lives and within the environment of their own homes had been assessed and mitigated against. Regular health and safety checks were carried out. Accidents and incidents were monitored, analysed and measures were put in place where necessary to prevent repeat events.

Staffing levels within the service were tailored to the needs of the people in receipt of care, and as much as possible, staff worked in teams around the care of each individual. Staff files demonstrated that the provider’s recruitment and vetting procedures of new staff were appropriate and protected the safety of people in receipt of care from the service. Medicines were managed safely and appropriately. Most staff were trained in key areas relevant to their role, such as manual handling and emergency first aid, and also in areas such as epilepsy awareness which was relevant to the needs of some of the people they supported. One staff member's training had been overlooked and we have made a recommendation that the provider "Reviews all staff member's training to ensure they are all fully equipped with the skills they need in respect of the role they carry out within the service". There was an induction package in place and supervisions and appraisals took place but had fallen behind in recent months.

CQC monitors the application of the Mental Capacity Act (2005) and deprivation of liberty safeguards. The Mental Capacity Act 2005 (MCA) was appropriately applied and the service understood their legal responsibility under this Act. Documentation around capacity assessments and decisions that were made in people’s best interests in line with procedures set out in the MCA, were not well maintained. People's capacity was informally assessed by the service when their care commenced and on an on-going basis when necessary. The provider told us that records in this area would be improved in future.

People were supported to eat and drink in a way that allowed them to remain healthy. Monitoring tools were used to ensure that any changes in people's health and wellbeing could be identified and actions taken where necessary to identify any changes in people's conditions. For example, food and fluid charts were used to promote healthy eating and people were weighed regularly. People were also supported where necessary to access healthcare appointments in order to maintain their overall health and wellbeing.

Staff and people enjoyed good relationships and we observed friendly, caring and respectful engagements between both parties when we visited two people in their own home. People described how staff supported them to do what they wanted and to become as independent as possible. They told us they were pleased with the service they received. Relatives described how they had noted positive and visible changes in their family member's abilities, their independence levels and their overall presentation since they started using the service. People accessed the community and pursued activities of their choosing with staff support and goals and targets to becoming more independent were set for them to work towards, such as working towards being able to travel independently and safely. Staff were responsive to people's needs; they provided person-centred care and supported people to make their own choices in all aspects of their daily lives.

Personalised care records were in place for each individual in receipt of care which identified their abilities and areas of daily living in which they required support from staff. Care and support plan, and risk assessment documentation was kept under review throughout the year. Staff told us they felt they had enough information about each person they supported and consequently that they were able to care for them in both a safe and appropriate manner. We found that further information and detail was needed in some care records. We have made a recommendation that the provider, "Reviews all people's care records to ensure they are an accurate, complete and contemporaneous record in respect of each service user and that care delivered and decisions made are appropriately recorded".

People, their relatives and staff spoke highly of the service and management team. The organisation had clear vision and values to enrich people's lives, and to promote independence and community involvement as much as possible. This echoed the provider's statement of purpose. The registration requirements of the service had been met and there was no evidence that any incidents or changes had occurred within the service which needed to be reported to us in line with the requirements of the Care Quality Commission (Registration) Regulations 2009.

We identified some minor concerns with the governance and management oversight of the service which we fed back to the registered provider. These related primarily to the maintenance of records, where the provider had not identified these through their own quality monitoring and assurance systems. There was a lack of oversight of staff training as a whole and no system was in place for monitoring that supervisions and appraisals were carried out. These had fallen behind. There was also no formal observation of staff practice when they delivered care, or their competencies related to the administration of medicines.

We have set a recommendation about this which states, "We recommend the provider reviews their governance and quality assurance systems within the service, to ensure that shortfalls such as those highlighted above, are identified and then addressed promptly".