Accept Care Limited

Accept Care provides personal care on a supported living basis to people living in their own houses and flats in the community on three sites in County Durham. It provides a service to adults with learning disabilities and mental health issues. At the time of our inspection there were 56 people using the service.

People’s experience of the service and what we found:

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Staff supported people to have the maximum possible choice, control and independence and they supported people to make decisions following best practice in decision-making. Staff communicated well with people and ensured others were supported to do so through good information sharing. People were enabled to make a range of choices and to pursue a range of new activities and experiences, where they wanted.

Right Care

Staff protected people from poor care and abuse. Staff had a range of training to equip them to support people and regularly had access to additional training. Staff were deployed to keep people safe and enable them to fulfil their goals. Risks to people were assessed and people were enabled people to take positive risks in order to fulfil their goals. Leaders worked well with a range of agencies to ensure risk management plans were not overly restrictive.

Right Culture

The culture was geared towards supporting and empowering each person who used the service in a way that worked for them. People were supported to explore the things that mattered to them and to live the lives they wanted. Staff supported this and this inclusive ethos of the service was evident throughout. Leaders were passionate about advocating for people’s rights and celebrating their achievements. Staff worked together to ensure people enjoyed improved quality of life outcomes. The culture was open and positive. Leaders had made a range of local and wider links that helped continually improve the service, sharing best practice. They had a positive impact on the broader landscape of social care and were a source of information and advice for others in the sector.

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 (report published 4 April 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service and the time since the last inspection.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in November 2016 we rated the service as ‘Requires Improvement’. We found breaches of regulations 11 and 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was not meeting the requirements of the Mental Capacity Act 2016 and was not mitigating risks to people using the service. Following the same inspection we also made recommendations to follow best practice guidelines with regard to electronic data storage and to review care plans in relation to people’s medicines.

At this inspection we noted people’s care plans identified their personal risks and clear guidance was given to staff on how to mitigate those risks. Staff had engaged people’s care managers to assess people’s mental capacity and made decisions in their best interests. People’s medicines were being managed appropriately. Documents were now stored safely using an electronic device known as a cloud. It was evident from this inspection that significant improvement had been made to areas identified previously.

This service provides personal care to people living in their own houses and flats in the community on three sites in County Durham. It provides a service to adults with learning disabilities and mental health issues. The service provided support for up to 57 people across the three sites. At the time of our inspection there were 54 people using the service.

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

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.

We found people were cared for by kind, caring and respectful staff across the organisation. A range of opportunities to suit people’s individual needs and promote inclusion were given to people so that they could contribute to the service. Staff listened to people and their views and responded to them.

Relatives and other professionals described the service as ‘outstanding’ or ‘brilliant’. They saw positive changes in people as they led fulfilled lives.

People were supported to maintain relationships. Staff provided support to people to visit or meet up with their family members.

Staff displayed a good knowledge of people and were skilled to manage the different relationships of people who lived in close proximity.

Staff understood the purpose of advocacy which includes having an independent person to speak up. They encouraged and supported people to self-advocate in their care reviews. They also advocated on behalf of people to use the service ensuring their safety and well-being.

Promoting people’s independence was a key them of the service. Relatives and other professionals spoke to us about people’s increased independence and the positive impact this had.

Professionals told us the service worked well with them and communicated the information they needed to know. Relatives told us they felt involved and were given the information they needed to support their family members.

Staff felt valued and supported by management who had set up an additional service called, “Inspiring Lives”. This was a day service where people could go and participate in activities. The centre had been purchased by Accept Care and they had developed a crafts room, a quiet room, a computer room, a hairdressing salon and a kitchen where people cooked their own meals.

The service had effective quality assurance systems and processes in place which highlighted any improvements needed. As a result of these systems changes had been made in the service which showed a culture of continuous improvement. People and staff had regular meetings where they were given updates on the service and were able to explain any concerns.

We found the culture of the service was focused on continually improving the quality of people’s lives. The registered manager felt strongly that the direction of the service should be led by the people who used it. We found the senior management team had driven the values encompassed in their m mission statement and throughout the service. Where they told us about improvements or people’s care needs we found staff echoed the same comments. This showed us the service had an integrated approach to people’s care.

We found there had been changes to the management structure of the service. This had led to clear governance systems and processes being implemented. House managers had been empowered and given greater accountability in their role. They told the inspection team they were happy to have the increased responsibility. A roles and responsibilities document was visible in each section of the service. Relatives and other professionals were extremely complimentary about house managers and the support they had given to people to make valued changes to their lives.

People who used the service, their relatives and other professionals were regularly asked for feedback about the service. We found responses were mainly positive. Comments had been drawn together, reviewed and responses provided by the registered manager to state what actions had been taken.

People were protected from the risk of harm by the systems, processes and practices in the service. Staff had received training in safeguarding people from abuse and had made safeguarding alerts. One of these alerts led to changes being made to hospital systems to improve hospital services for people with learning disabilities.

People received their medicines from staff who were trained and competent.

We found there were sufficient staff on duty to meet people’s needs. Some people had additional support hours allocated to them. These hours were delivered to meet people’s needs.

Assessments of people’s needs were carried out before they received a service. We found people had detailed and person centred care plans in place which described their needs and any personalised risks. Staff were given detailed guidance on how to provide people’s care.

End of life care was provided in a sensitive and caring manner. Staff worked alongside other professions to ensure people received dignified and pain free end of life care.

People were encouraged to be part of their community and continue activities that were important to them.

When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support. Staff knew people well, were well trained and demonstrated the skills, knowledge and experience to care for people effectively. We found staff were given a comprehensive induction and increased supervision and support through their probationary period. On-going training was provided and staff received an annual appraisal.

We found staff had been trained in the Mental Capacity Act and understood what actions to take if a decision needed to be made and a person’s capacity to make the decision was in question. They knew the processes to follow if they considered a person's normal freedoms and rights were being significantly restricted. People were able to make choices about aspects of their daily lives. They 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

Staff supported people to have a healthy diet. People spoke to us about how staff encouraged them to increase the range of foods they ate. We saw people had lost weight when necessary and were proud of their achievements.

Managers dealt with people’s concerns and complaints and provided appropriate written responses when required.

At our last inspection of Accept Care on 25, 26 February and 1 and 3 March 2016 we reported that the registered provider was in breach of the following:-

Regulation 9 – Person Centred Care

Regulation 11 - Consent

Regulation 12 – Safe Care and Treatment

Regulation 16 – Receiving and Acting on Complaints

Regulation 17 – Good Governance.

We asked the registered provider to make improvements and they sent us an action plan with actions they intended to take. At this inspection we found the service had made improvements, however further work was required to ensure improvements continued and were sustained.

The service had 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.

We found the plans for people’s topical medicines and PRN medicines (as and when required medicines) were not consistent across the service and recommended the registered provider review the plans to ensure each person receives a consistent level of good service.

The registered provider had arrangements in place for monitoring and reviewing accidents and incidents across the service. We saw they had taken action to prevent re-occurrences. This meant actions were taken to keep people safe.

We found the registered manager carried out a robust recruitment procedure to ensure staff who were employed in the service were safe to work with vulnerable people. The registered manager had in place and used staff disciplinary procedures to prevent people who used the service being subjected to inappropriate staff behaviour.

Staff were provided with an induction to the service and received supervision and an appraisal to review any concerns they may have about the service as well as their performance. The registered provider had a training programme in place to ensure staff were trained in their role and were able to support people in their care.

The registered provider had communication systems in place to ensure information was passed between staff and tasks about people’s care needs were not lost. We found the staff to be caring and observed the people who used the service had positive relationships with the staff on duty. We found staff respected people’s dignity and choices.

Staff contacted people’s GPs when medical attention was required. Staff also supported people to attend medical appointments and engaged family members who wanted to be involved in their relative’s care.

Staff listened to people’s relatives who were acting as advocates on behalf of people who used the service. The registered manager was able to list people in the service who had an advocate and staff were aware of the role of advocates in the service.

Since our last inspection care plans had been updated for people living at Station House and Eshwin Hall. The registered manager told us they had completed an update on approximately three quarters of people’s care plans in Ash Grove. We saw the updated care plans were person centred and focused specifically on each individual person. Further work was required to update the care plans for everyone who used the service.

Following our last inspection the registered provider had ensured the same complaints process was in place across all three sites. They had responded to people's complaints and made sure there was an outcome for each complaint.

We discussed with the registered manager the culture of the service and our finding that the service was lacking in confidence in working with statutory services. The registered manager felt the culture of the service was changing and they were increasing in confidence.

We found the service stored people’s documents in an electronic cloud device and we used best practice guidelines to discuss with the manager the safest use of a cloud. We recommended to the registered manager they review their use of the cloud in line with the best practice guidelines.

The service carried out surveys to assess the quality of the service. We found the numbers of questionnaires sent out did not reflect the numbers of people in the service. Although the responses were low we found actions had been taken once the responses of the survey had been analysed to improve the service.

During our inspection we found a number of breaches of the Health and Social Care Act 2008

(Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

This was the first inspection at this location.

Accept Care provides personal care and support to people with learning disabilities and mental health needs across three sites. Station House is located in Bear Park and is a house for four people with learning disabilities. Esh Hall located in Esh Winning is a large building converted into 19 self- contained flats for people with learning disabilities who require supported living. In Consett, 41 – 45 Ashgrove is a group of buildings proving personal care for people. Houses 41 and 42 provide communal living. People with learning disabilities and physical disabilities live in house 41 whilst people with mental health conditions live in house 42. The remaining houses are divided into self-contained flats for people with additional learning needs.

There was a registered manager in post who was also the registered provider. 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.

Staff spoke to us about actions they would take to keep people safe in the service. This included taking any safeguarding concerns they had to the managers.

The registered provider had in place a robust recruitment process which included the involvement of service users and which was followed up by continuous assessment of staff who were newly employed.

We found peoples’ risk assessments needed to include more personal information to ensure the risks to people had been fully assessed.

With regard to eating and drinking we found practices across the service varied. We observed people who needed support to eat and drink received the support. Other people who needed to be taken shopping were also supported. However where staff were expected to support other people in planning healthy menus we found this had not taken place.

People were supported by staff who treated them with respect and explained to them the support they were providing.

We found staff knew people well. They were able to tell us about peoples’ backgrounds and their likes and dislikes.

The registered manager agreed to look into one site of the company having in place a different complaints policy to the other’s with different threshold in place for complaints. The policy which the registered provider and the registered manager expected to be used had been used for people wishing to make a complaint. We saw investigations into peoples’ complaints had been carried out. People had received the outcome of the investigation into their complaint.

We found the writing of peoples’ care plans varied across the service. In one part of the service we found the plans were person-centred and described the person’s needs. However in another part of the service the care plans did not document peoples’ needs in detail. This meant staff did not have the required guidance for writing person centred care plans.

We found staff had been trained in models of mental health care, but these models had not been implemented in the service. This meant the service was not utilising tools to monitor peoples’ mental health.

We found peoples’ activity planning varied across the service. Some people had an activities plan, whilst for others activities were more ad-hoc without the safety net of staff being able to suggest a range of options for people.

We saw people had regular access to dentists, opticians and other primary health care professionals such as epilepsy nurses, speech and language therapy staff and behaviour management specialists.

The service and family members worked together to ensure people were supported to attend medical appointments.

The registered manager spoke to us about the work they had carried out to date to put in place a cultural change and improve the service. We found further work was required to achieve this change.

We saw the registered provider had set up a staff forum as a way of engaging staff in the service. The registered manager told us there was still work to be done with the forum.

Staff told us they found their respective managers approachable and felt they were supported by them if they needed to raise any issue.

We found that the service had in place contacts with a variety of different professionals including GP’s, practice nurses, occupational therapists, SALT to improve and support peoples’ well-being.

The service had in place quality audits carried out by house managers. We saw the managers had identified ways to improve the service, however their findings did not reflect those of the inspectors.

We found not all of the documentation used by the service was accurate or up to date.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.