Bolton Supported Living

Bolton Supported Living Service is a supported living service providing personal care to people living in the Bolton area. The service provides support to people with a learning disability and autistic people as well as people with mental health needs. At the time of our inspection there were 218 people using 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.

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.

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

Right Support: People’s independence was promoted where possible by the provider and some staff; however, due to to staff shortages across the health and social care sector the provider was not fully staffed with Bolton Cares staff. This had led to a higher than ideal use of agency across the service at various times. In some services this limited the number of staff working with people who knew them well. In some services people’s choices were limited, particularly in relation to activities.

The provider acknowledged the service was in the process of transition following a restructure within the management team and had identified areas for improvement before we started our inspection. However, at the time of our inspection systems being implemented had not become standard practice across the service. The level of quality varied across each supported living service particularly in relation to paperwork. In some instances we found support plans to be person centred and contained sufficient detail to enable staff to understand who people were and how to support them; in others we found further information was required to amend language used and some support plans needed linking to relevant risk assessments.

Where permanent contracted staffing levels allowed, we found examples of people being supported to achieve positive outcomes following innovative and creative support. However, in other areas of the service we found people’s goals and aspirations had not been met and some people were only able to access the community in the form of ‘going for a drive out’. The provider shared how they had promoted recruitment; this included promotional videos, continuous recruitment drives and analysis of staff’s feedback on why people were leaving their roles.

People were not always supported to have maximum choice and control of their lives. However, staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care: People received kind and compassionate care. Staff protected people’s privacy and dignity. Regular staff understood and responded to individuals needs in a way they were comfortable with. People had access to healthcare professionals when they needed them. Medicines were not always managed safely; we found evidence medication errors had occurred; this included an incident where untrained staff had administered medication in error and other incidents where medical advice was not sought following missed medicines. Following our inspection, the provider immediately arranged to review audits which generally showed medication practice to be scored at ‘100%’ while at the same time identifying that medicines had not always been administered safely.

Right Culture: Staff feedback on working in partnership with the provider and senior leadership team was mixed. On the whole staff reported they felt Bolton Cares was a supportive company to work for, particularly in relation to career progression and practical development. However, the same staff also felt a disconnect had developed between the provider and staff working within the supported settings resulting in a lack of understanding of the challenges staff were facing. The provider evidenced attempts to engage with staff; however, these hadn’t had the desired impact. For example, the provider setup sessions where staff could meet with the Nominated Individual and Managing Director; attendance at these sessions was poor. We discussed this with the provider who demonstrated a commitment to finding new ways to engage with staff.

The service had two registered managers (registered manager 1 and registered manager 2) for Bolton Supported Living Service. Both had been working for Bolton Cares in other areas but became the services registered managers within the 12 months prior to the start of our inspection. We found they had identified similar issues to those we found during this inspection and they shared these openly along with the work they had already done to start addressing some of the issues. One example of this was staff’s compliance with training which had been impacted by a frequent turnover of staff and a new team of assistant operating managers (AOMs) had been recruited. Part of their role was to manage and improve training compliance locally within the supported settings. The registered managers felt the AOMs in post at the time of our inspection would continue to improve compliance and showed evidence this had already started.

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 20 October 2017)

Why we inspected

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Bolton Supported Living provides personal care and support to people with learning and physical disabilities and mental health related illnesses. People who used the service lived in shared tenanted accommodation in the Bolton area. The service previously operated under another provider and had transferred to a new provider. Some staff had transitioned to the new provider whilst others had chosen to leave.

There was a manager in post who was currently going through the process of registering with the Care Quality Commission. 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 used the service told us they felt safe. Staffing levels were good and the recruitment process was robust.

Appropriate policies and procedures were in place around safeguarding, staff had undertaken training and were confident that they would recognise any issues and report them immediately. Safeguarding incidents, accidents and incidents were documented and followed up appropriately.

Health and safety measures were in place and records were complete and up to date. General and individual risk assessments were in place and were relevant. Systems for medicines ordering, storage, administration and disposal of medicines were robust and staff had undertaken relevant training.

The induction for new staff was thorough and the Care Certificate was undertaken by newly recruited staff. Training was on-going and the training matrix evidenced refresher courses had been undertaken or were planned to take place very soon.

The houses we visited were clean and bright and the environments were suitable for the people who lived there. Care files included appropriate information about people’s health and well-being. Each house had information in the kitchen around people’s dietary requirements, likes and dislikes. Nutritional guidelines were in place.

The service was working within the legal requirements of Mental Capacity Act (2005) (MCA). There was evidence that decisions were made with full involvement of people who used the service and in their best interests.

People who used the service told us staff were caring and kind and we observed friendly, respectful interactions between staff and people who used the service at all the houses we visited.

People told us they were included in decisions about their care and support and this was evidenced in the care plans we looked at and via notes of house meetings. The service user guide was available in an easy read version which helped ensure people could understand and use the guide effectively.

Privacy and dignity was respected within the houses we visited. There were relevant policies and procedures around confidentiality, data protection and diversity in care.

Care files we looked at were person-centred and included a range of health and personal information. The service actively sought feedback from people who used the service and relatives via surveys and the ‘tell us how it is’ cards, which were readily available to people.

Activities were varied and tailored to the individual. They were also flexible and staff told us that, although they had a programme of activities within the houses, these could be changed to reflect the mood, well-being or wishes of the individuals.

There was an appropriate complaints policy and complaints were followed up appropriately. There was a quarterly Customer Voice newsletter, which informed staff of compliments and complaints received. We saw examples of learning and service improvement within the Customer Voice.

People who used the service, relatives and staff felt the management were approachable and supportive. Team meetings took place regularly as well as weekly locality meetings. Supervisions and observations of practice were meaningful and were undertaken on a regular basis.

There was a monthly dashboard in which we saw accidents and incidents, compliments, complaints and medicines issues were analysed. Any issues were recorded and addressed appropriately in order to drive improvement to the service delivery.

We saw evidence in the houses we visited of audits and checks. Systems and processes were reviewed on a monthly basis to ensure these were still effective and fit for purpose.