Allerton C&S SW

About the service

Allerton C&S SW is a domiciliary care service which provides support to 20 people in supported living settings. The people receiving support may have a learning disability, autism, mental health needs, physical disability or sensory impairment.

A supported living service is one where people live in their own home and receive care and support to enable people to 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.

Not everyone who used the service received 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 the inspection 16 people were receiving personal care. We visited three houses, but people were only receiving personal care at two of these premises.

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

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.

Based on our review of the safe, effective and well led key questions, the service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

• People had not always had a consistent team of staff working with them recently because of staff turnover. This was now improving, and permanent staff were being recruited.

• Staff supported people with their medicines safely and to achieve the best health outcomes. Sometimes staff needed to make sure people’s creams were used and recorded consistently.

• Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

• People were protected from infection or illness, such as covid 19, by the guidance and safe practice of staff.

• Staff supported people to play an active role in maintaining their own health and wellbeing. Staff enabled people to access specialist health and social care support in the community.

• Staff supported people to have the maximum possible choice and control and make their own decisions where possible. Policies and records supported this practice.

Right care

• People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

• Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.

• People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. Staff had the skills to understand people who had individual ways of communicating.

• When possible, staff and people worked together when considering the risks people might face. Some risk assessments needed review to ensure they were detailed enough or up to date.

Right culture

• People led inclusive and empowered lives because of the ethos, attitudes and skills of the management and staff. Staff received additional training to safely support people with specific or complex needs.

• Managers ensured staff were competent and held the appropriate values to work for Allerton C&S SW. Actions were taken to address concerns and improve standards where necessary.

• Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing.

• Staff turnover had been high, but people now had consistent teams and key staff who knew them well.

• Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Some written reviews and assessments needed updating.

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 14th April 2021).

Why we inspected

We received concerns in relation to safeguarding and risk management at one of the supported living homes. As a result, we undertook a focused inspection to review the key questions of safe, effective and well led only.

We found the supported living home concerned did not provide personal care to the people who live there. This means it is not regulated by CQC. Therefore, the concerns relating to that home are being managed by other stakeholders and are not included in this report.

We found no evidence during this inspection that people were at risk of harm at the services which are regulated by CQC.

For those key questions 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 Allerton C&S SW 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 re-inspection programme. If we receive any concerning information we may inspect sooner.

Allerton C&S SW is a supported living service providing personal care to people living in their own homes. The service supported a total of 19 people, of these seven were receiving a regulated activity. We inspected one of the services which provides personal care to two people living in a shared house. This was to follow up previous concerns.

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

People’s experience of the service had improved since our last inspection. People now received care that was centred around their needs and preferences. One person told us that things had improved. When we last inspected there had been a serious lack of service user compatibility at one service; this had now been resolved. People were happier and living in an environment that felt warm and homely. Staff told us care had improved and their focus was on supporting people as they wished.

The service we visited was much cleaner than previously. Staff understood how to protect people from the risks of Covid-19 and other infections.

Provider oversight and management of the service had improved and we were assured that these changes had been effectively embedded. There was a comprehensive system in place to monitor the effective running of the service and assess the quality of care people received. The provider informed relevant people of any significant events.

Staff morale was good; the staff we spoke with felt supported to provide a good standard of care to people. Staff worked with colleagues and external professionals to provide effective care for people who used the service.

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.

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 lived in a service that supported them with their independence. Staffing was available for people to access their choice of activities. Care was person centred and promoted people's dignity, privacy and human rights. The culture of the service had improved significantly. The manager and staff team had a good set of values focused on promoting the wellbeing of the people they supported. The ethos of the service was for people using services to lead empowered lives.

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 under the previous provider was inadequate (published 30 September 2020). 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 30 September 2020. 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

We carried out an announced focused inspection of the key questions Safe and Well-Led of this service on 03 and 06 August 2020. 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 person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, fit and proper persons employed, staffing and duty of candour.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 inadequate to good. This is based on the findings at this inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Allerton C&S SW on our website at www.cqc.org.uk.

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.

About the service

South West Independence Limited Care at Home is a supported living service providing personal care to people living in their own homes. We inspected one of the services which provides personal care to three people living in a shared house.

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

People living at the service were not safe. People had not always had a thorough enough assessment and transition period which had impacted on other people already receiving a service. Staff had not always been able to keep people safe. Whilst incidents had been logged and reported similar incidents had not always been prevented.

The service had not taken steps to ensure that the Mental Capacity Act 2005 was followed to protect people who lacked capacity. There were restrictive practices in place, which had not been assessed and recorded in line with the Mental Capacity Act 2005.

Infection control risks had not been assessed and monitored. We identified one specific infection control risk to people living at the service and staff. There was no risk assessment or management plan in place for this. There was no specific plan in place to reduce and manage the risk of Covid-19. In one toilet there was a shared hand towel and no paper towels which increased the risk of cross-infection.

Risks to people had not been assessed and plans put in place to mitigate these risks. Some risks had not been identified whilst others did not have suitable management plans. Risk assessments were of poor quality. Care plans were not always accurate and had not always been updated to reflect the most current information.

Staff had not always been recruited safely; the provider’s recruitment policy had not been followed Records sent to us following the inspection demonstrated staff had received training.

There was poor governance and oversight of the service. The provider had failed to ensure people received person-centred care following the new admission. Systems had not been operated to ensure the accuracy and effectiveness of care records, infection control risks had not been monitored and the provider had failed to comply with the Mental Capacity Act (2005).

The provider had not met the duty of candour regulation and had not informed relatives of the incidents at the service.

Staff morale was low, staff felt they had not been listened to about the unsuitability of the arrangements made for people receiving a service. Staff expressed distress at the unhappiness and disruption this caused to people. Staff evidently cared about the people they supported and were focussed on their welfare.

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 04 January 2019).

Why we inspected

We received concerns in relation to safeguarding people and staffing. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report. We have received an action plan from the provider and action has been taken to mitigate risks.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for South West Independence Limited Care at Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified seven breaches in relation to person-centred care, safety, safeguarding, staffing and recruitment, governance and duty of candour.

Please see the action we have told the provider to take at the end of this report.

Follow up

The provider sent us an action plan promptly following feedback about the inspection.

We will request an 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

At the time of the inspection five people were receiving the regulated activity ‘personal care’.

This inspection was announced and took place on 18 October 2018. The provider was given 48 hours' notice because the location provides a domiciliary care service to people in their own homes and we needed to be sure that someone would be at the office and able to assist us to arrange home visits.

“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

A registered manager was 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.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good

People told us and indicated they felt safe living when receiving care and support from the service, one person said, “Safe? Yes, always safe they are really good.”

There were processes and practices in place to keep people safe. The provider had a robust recruitment programme which meant all new staff were checked to ensure they were suitable to work with vulnerable people. All staff had received training in safeguarding vulnerable people. All staff spoken to were able to tell us what they would look for and how they would report anything they thought put people at risk of harm or abuse.

People received effective care and support from staff who had the skills and knowledge to meet their needs. All staff attended regular updates of the organisations mandatory training Staff also received training about the specific needs people had for example, the safe management of epilepsy.

People who were able told us, and we saw, they were cared for by kind and caring staff some of whom went over and above what was expected of them. Staff respected people’s privacy and dignity at all times. People told us they were involved in their care planning and they could express an opinion about the care provided and contribute to any changes.

People received responsive care and support which was personalised to their individual needs and wishes. There was clear guidance for staff on how to communicate with people and how to know when a person was not happy or distressed. People were supported to access health care services and see healthcare professionals when necessary.

People took part in a range of activities which included not only their regular clubs and daily routines but achieving goals and their wish list. People were supported to go on regular holidays and pursue interests. People were also actively involved in the local community and one person was supported to be an advocate talking out for people with a disability.

People were supported by a team that was well led. Everybody spoken to said they thought the service was well led. People and staff said the registered manager was open and approachable. All staff worked towards achieving the organisations philosophy of, supporting and encouraging people to attain their independence and achieve their goals.

There were systems in place to monitor the quality of the service, ensure staff kept up to date with good practice and to seek people’s views. Records showed the service responded to concerns and complaints and learnt from the issues raised.

Further information is in the detailed findings below.

South West Independence provides personal care to people in an assisted housing complex. People who use the service have individual tenancy agreements for self-contained flats within a shared building. At the time of the inspection they were providing personal care to five people. We visited three people in their homes to discuss the care package they received.

This was the first inspection of the service since they re-registered at their new location. No concerns have been identified with the care being provided to people.

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.

People who received care and support from South West Independence told us they were happy with the service provided. They said the registered manager and staff were open and approachable and cared about their personal preferences and maintaining their independence. One person said, “I Like it here they are all very nice and they know what I like and don’t like.” Another person said, “I am really happy here, they know I like football and snooker.”

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. We observed the registered manager and staff took the time to talk with people during visits to their flats. One person said, “I know everybody and I know who is coming and when.” That person also said the staff went further to make them happy. They explained, “They got me a letter from Arsenal for my 50th, and took me to Cardiff for the snooker.”

People told us they received care from care workers who were knowledgeable about their needs and were appropriately trained to meet them. Care workers had access to training specific to their roles and the needs of people For example they had attended training in the management of percutaneous endoscopic gastrostomy (PEG). This is a way of ensuring people with swallowing difficulties receive the nutrients they need through a tube direct into their stomach. Staff told us the training they received was good one staff member said, “I have managed to attend plenty of training and achieved my qualifications.”

People said they were cared for and supported by care workers who were polite, compassionate and caring. One person indicated “Yes,” when we asked if people respected their privacy and dignity another person said, “They always wait until I say they can come in to my flat.”

People’s care needs were recorded and reviewed regularly with senior staff and the person receiving the care. All care plans included written consent to care. Care workers had comprehensive information and guidance in care plans to deliver consistent care in the way people preferred. One person said, “We have talked about my care plan so I know it’s there.”

During our visit to one person’s apartment we observed a relaxed and friendly relationship between the person and care worker. The person communicated through their computer and through facial expressions. They were very happy and laughing throughout the visit and indicated they were very happy with the staff delivering their care.

The registered manager had a clear vision for the service. They explained they aimed to, “Support people with a level of independence they could achieve themselves.” They also said they aimed to do this by providing care and support in a person centred way, respecting their individual wishes as far as was possible. Staff said they knew the philosophy and values and hoped they supported people to live their lives as independently as possible. One staff member said, “”We try really hard to ensure people are supported to maintain their independence and do what they want like any other young person in society.”

People were protected from abuse because the provider had systems in place to ensure checks of new staff character and suitability to work with vulnerable adults were carried out. Staff had also received training in protecting vulnerable people from abuse.

The service had a complaints policy and procedure that was included in people’s care plans. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

There were systems in place to monitor the care provided and people’s views and opinions were sought on a daily basis. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.