Archived: Grove Villa Supported Living

Grove Villa Supported Living is a supported living service. At the time of the inspection people all lived together in two houses. The service shares the same staff, office and manager as another supported living service (The Bungalow) which is based on the same site. The Bungalow and Grove Villa Supporting Living were inspected on the same dates. The houses were based on a large site where there were two other services provided by the same provider.

People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Not everyone using Grove Villa Supported Living receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were 4 people receiving personal care at the time of our inspection.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using this service:

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions, Safe, Responsive and Well-led to at least Good. We found that the provider had not undertaken actions in their action plan: all key questions had deteriorated: Safe and Well-Led were found to be Inadequate with Effective, Caring and Responsive all requiring improvement.

There was no management oversight of the service and no oversight by the provider. For example, there was a lack of auditing, complaints were not always recorded, and staff performance was not monitored. This meant that there was a risk that people were not always receiving the high quality, person centred, safe service they should expect the receive.

People were at risk of harm. Risks to people were not always managed and monitored safely. Therefore, people could not be assured that the provider, manager or staff would provide the right support to keep them safe from harm. People’s medicines were not audited, and this could have a possible impact on their health and well-being.

Staff had not received all the training they needed to enable them to support people and meet all of their needs. Staff were not up to date with training, including medicines management, which could have an impact on people’s safety.

Safe recruitment practices had not been followed before some staff started working at the service.

The outcomes for people using the service did not always reflect the principles and values of Registering the Right Support; Although staff recognised that people had the capacity to make day to day choices, people did not always receive the right support to keep them safe. People did not have person centred care plans in place. Although people’s goals were recorded, they were not dated, and it was not clear whether they were current.

People were supported to be independent and undertake daily living activities. People were engaging in the community, for example through attending clubs, accessing local shops and visiting local pubs.

People told us they liked living at the service and that they liked the staff. People were engaged in a range of activities in the community and staff supported them to maintain their independence. Staff supported people to access healthcare when needed.

We found a number of breaches of the regulations. The service did not meet characteristics of Good in any area; more information is in the full report.

Rating at last inspection: At the last inspection on the 31 May 2018 the service was rated Requires Improvement for the second consecutive time.

Why we inspected: This inspection was brought forward due to information of concern.

Enforcement and Follow Up

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 six months to check for significant improvements.

This service provides care and support to people living in a ‘supported living’ setting, so that 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.

People using the service live in a ‘house in multiple occupation’. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. There were sleep in arrangements for staff on site.

Not everyone using Grove Villa Supported Living receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were seven people using the service at the time of our inspection.

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.

A registered manager was working at the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was not in day to day charge of the service and had delegated many responsibilities to the acting manager, who planned to apply to be registered by CQC.

At the last inspection in April 2017 and the service was rated Requires Improvement. We found that the provider was in breach of four regulations in relation to staff training, the assessment and management of risks to people, people’s involvement in planning their care, records and checks of the service. Following the inspection, the provider sent us an action plan of how they would address the shortfalls. At this inspection we found that the action plan had not consistently improved records about people’s support and the effectiveness of checks and audits at the service. We found a new breach of regulation in relation to keeping people safe and informing CQC of incidents at the service.

The provider had not send us information we require at least once a year, about what the service does well and improvements they plan to make.

People were not discriminated against and received support tailored to their needs and preferences. Assessments of people’s needs and any risks had been completed. People told us and records showed that staff knew people well and provided their support in the way they preferred. Guidance had not been provided to staff about how to support people to manage behaviours that challenge. Each person had planned their support with staff, including taking into account their goals and aspirations. People had opportunities for lifelong learning and some people had jobs.

Staff knew the signs of abuse and were confident to raise any concerns they had with the managers. The local authority and CQC had not been informed of one incident of possible abuse.

Checks on the quality of the service had improved since our last inspection. However, these had not identified all the areas for improvement we found during our inspection and further improvements were necessary. Accidents and incidents had been analysed and action had been taken to stop them happening again. Information about people was stored securely.

Services that provide health and social care to people are required to inform the CQC, of important events that happen in the service like a serious injury. This is so we can check that appropriate action had been taken. We had not been notified of three significant events at the service.

People’s medicines were managed safely and people received their medicines in the ways they preferred and as their healthcare professional had prescribed. People were able to tell staff when they needed some medicines, however the provider did not have guidance for staff to follow when administering ‘as required’ medicines.

People had not been asked about their end of life care preferences and had not been supported to make plans for the future. We made a recommendation about this.

People 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 assumed people had capacity and respected the decisions they made. When people needed help to make a particular decision staff helped them. Decisions were made in people’s best interests with people who knew them well.

Changes in people’s health were identified and staff supported people to contact the relevant health care professionals. People were encouraged to eat a balanced diet which met their health needs. People planned what they cooked and prepared it with staff support where necessary.

Staff were kind and caring to people and treated people with dignity and respect. People told us staff gave them privacy. Everyone was supported to be as independent as they wanted to be. People told us they had enough to do during the day and were involved in their local community. They used community facilities such as the local leisure centre.

People knew how to make complaints and were confident to raise concerns. The complaint process was accessible to everyone in a way they understood.

There were enough staff to provide the care and support people needed. Staff were recruited safely and Disclosure and Barring Service (DBS) criminal records checks had been completed. Staff were supported meet people’s needs and had completed the training they needed to fulfil their role. Staff were clear about their roles and responsibilities and worked as a team to meet people’s needs.

Staff felt supported by the registered manager, were motivated and enthusiastic about their roles. A manager was always available to provide the support and guidance staff needed.

Services are required to prominently display their CQC performance rating. The registered manager had displayed the rating in the entrance hall of the service. The provider does not have a website.

This is the second consecutive time the service has been rated Requires Improvement. You can see what action we told the provider to take at the back of the full version of the report.

Grove Villa Supported Living provides domiciliary care and support services to people with a learning disability living in their own home. The service has an office in another service, which shares a site and is owned by the same provider. The service currently provides support to 7 people in Deal who share a house. There were staff at the service 24 hours a day, including a member of staff who stayed awake all night.

The service has a registered manager in place and they have been in this role since 2016. The registered manager had worked at the service for many years and knew people well. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 had good relationships with the staff who supported them. Staff knew people well and treated them with dignity and respect. People had some opportunities to express themselves and have a say about their care on a day to day basis but people were not involved in planning their support or writing their care plan. People’s care plans had not been reviewed or updated regularly, some not reviewed for over 12 months. The care plans contained inaccurate or out of date information and needed more detail about how people preferred to be supported. Some care plans contained derogatory language about people.

Staff worked closely with local health and social care professionals to manage people’s health needs and develop new opportunities for them. However, there were occasions when staff did not contact health professionals following an accident which could have placed the person at risk of having an untreated injury. When people’s needs changed advice was sought and followed to make sure the staff could still meet people’s needs safely. However, staff would benefit from more detailed guidance about how to manage risks related to people’s health.

Risks to people were assessed and people were supported to take risks and try new things. However, staff would benefit from more detailed guidance about how to minimise risks to people. Staff could recognise the different types of abuse and knew who to report any concerns to, both within the organisation and externally. Medicines were managed safely and people were encouraged to be as involved as possible with their medicines.

Staff had some understanding of the Mental Capacity Act and followed the principles on a day to day basis. However, people’s ability to make a decision had not been assessed before decisions were made on their behalf. There was a risk decisions could be made for people who were in fact able to decide for themselves. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. For people who live in their own homes this is managed by the Court of Protection. No applications had been made for people as none were needed.

Staff were recruited safely and people were involved in the interview process. Staff had induction training and were introduced to people by established staff before supporting them. Staff completed basic training; however further training was required for staff to have the skills to meet people’s needs. Staff were in regular contact with the management team and had regular one to one meetings, but appraisals had not been completed. There were enough staff to meet people’s needs and people told us they felt supported.

Some people attended local day services, went to college or completed voluntary work. People were supported to be part of their local community and follow their interests or hobbies. People had support to eat healthily and planned their own menus. They were supported to purchase their weekly shop and prepare meals. However, there were no personal goals recorded for people or plans to help people reach their goals or develop new skills.

No complaints had been received, the service had an accessible complaints procedure and people knew who to speak to if they had a complaint. People’s confidentiality was respected and records were stored securely.

There was an open culture, people and staff could contact or visit the registered manager whenever they wanted to. The registered manager spent time with people regularly to check if they were happy with the service and they were accessible to people, professionals and staff. However, the registered manager did not have a plan to develop or maintain their management skills.

Views were sought from people, relatives and professionals and were acted on. Audits were completed but had not identified the issues found at this inspection.

The CQC had been informed of any important events that occurred at the service, in line with current legislation.

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.