Archived: Brandon Trust Supported Living - Earlsfield

At our previous inspection on 26, 27 and 28 April 2016 breaches of legal requirements were found. After the inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to safe care and treatment and person-centred care.

We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met the legal requirements in relation to the breaches found.

There was a registered manager at the service. 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.

Brandon Trust Supported Living – Earlsfield provides support to people with learning disabilities with a wide range of support needs. Support ranges from a couple of hours to 24 hours cover across services ranging from people’s individual homes to shared group homes in the Southwark, Wandsworth and Croydon boroughs of London.

At the time of the inspection, the provider was supporting people living in 20 different supported living services. The landlords in most cases were housing associations. There were registered managers for the services, known as locality managers. They each managed a number of services between them.

At our previous inspection we found that care records were not always fully completed in the services that we visited. For example, some risks were not fully assessed, care and support plans were not always in place and key worker reports were not always completed. We also found that some people may have been at risk of not receiving their medicines in a safe manner as some medicine administration record (MAR) charts were not always completed.

At this inspection, we found that improvements had been made.

Risks to people were identified and assessed appropriately. Records were up to date and included ways in which the risk could be managed including steps that care workers could take. Care workers we spoke with were aware of the risks to people and how they would manage them.

Each person had a care plan in place which was up to date. Care plans contained person centred information and included ways in which people could be supported to lead independent lives. Each person was assigned a key worker who met with them monthly. Monthly reports were available for each person, written by their keyworker documenting if people were happy with the support they received in relation to any complaints, housing issues, food and their general health. Keyworkers also completed more generalised yearly reports.

MAR charts were completed accurately and regular audits took place to try and minimise the occurrence of errors. Where specific concerns had been raised in relation to medicines management managers had implemented a number of changes to make improvements, including changes to staff shifts, improving care worker’s medicines practice and requesting support from the dispending pharmacy.

People using the service told us they were happy with the care and support they received. They said staff were caring and supported them to lead independent lives. People were able to pursue interests and activities of their choice. They told us they had no concerns about the support they received in relation to food or their health.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA). If there were concerns around peoples’ capacity to make decisions in certain areas, formal capacity assessments took place in line with the MCA. If people lacked the capacity to make decisions, best interests meetings took place to ensure their rights were protected.

Robust recruitment procedures were in place which helped to ensure care workers were safe to work with people. The use of agency staff was closely monitored by managers. Care workers completed a comprehensive induction and ongoing training for employees was monitored and tracked by a learning and development coordinator.

Concerns and complaints were documented and responded to. Incident and accident monitoring took place and was overseen at management level. This meant that any root causes could be identified and action taken in response.

There was a formal quality assurance programme that had been put in place by the provider. This included measuring each service against CQC standards, risk assessments for each service and a health and safety audit to monitor incidents such as safeguarding, complaints and accidents. There was evidence that the provider acted on feedback from people using the service and other stakeholders.

Brandon Trust Supported Living – Earlsfield provides support to people with learning disabilities with a wide range of support needs. Support ranges from a couple of hours to 24 hours cover across services ranging from people’s individual homes to shared group homes in the Southwark, Wandsworth and Croydon boroughs of London.

At the time of the inspection, the provider was supporting approximately 100 people living in 20 different supported living schemes. The landlords in most cases were housing associations. There were seven registered managers for the provider. They each managed a number of schemes between them, with each being responsible for approximately four schemes.

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 using the service told us they were happy with the care and support they received from staff. They said they led independent lives and were supported by staff to do so. We spoke with and observed them in their homes and saw that where they were able to, they were free to come and go and had the freedom to live their life how they wanted.

People’s nutrition and hydration needs were met by the provider. People who were more independent told us they helped staff when preparing and cooking food. Staff involved people when planning menus and used picture cards to offer a choice to those people who were not able to communicate verbally. Care records included risk assessments and support plans in relation to nutrition and referrals were made to dietitians to provide specialist input where needed.

The provider supported people with regard to their health needs by corresponding with professionals such as their GP, psychologists and other community teams.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA). Capacity assessments for specific decisions such as finances and self-administration of medicines took place. If people lacked the capacity to make decisions, best interests meetings took place to ensure their rights were protected. If any restrictions took place to protect people, referrals were made to ensure these were lawful.

There were thorough recruitment checks in place which helped to ensure care workers were safe to work with people. New staff submitted written references and underwent Disclosure and Barring Service (DBS) checks before starting work. All staff completed a comprehensive induction based on the Care Certificate and this training was refreshed regularly.

We found that care records were not always fully completed in the schemes that we visited. For example, some risks were not fully assessed, care and support plans were not always in place and key worker reports were not always documented.

We also found that some people may have been at risk of not receiving their medicines appropriately or in a safe manner. Some Medicine Administration records (MAR) were not accurately completed.

There was an open culture at the service. There was evidence that concerns and incidents were documented and investigated, sometimes involving external agencies where appropriate. Senior managers had a good oversight of the services and an action plan was in place to drive improvement.

We found two breaches of regulation in relation to safe care and treatment and person centred care. You can see what action we have told the provider to take at the back of the full version of this report.