Supported Lives Services Ltd

Supported Lives Services manages a supported living service providing personal care for people with a learning disability and / or autism. People lived in small domestic style properties to enable them to have the opportunity of living a full life. People had their own bedroom and shared lounge and kitchens. Where required staff slept in the house to be available in the event of an emergency.

In addition, Supported Lives Services provides a domiciliary care service, providing support to people in their own homes.

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.

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

Systems were in place to protect people from the risk of financial abuse. Where staff supported people to manage their finances, records were kept and audited.

Staff and people wore Personal Protective Equipment appropriately. Policies, procedures and risk assessments for COVID-19 were in place. Additional checks and staff supervisions had been introduced following a complaint at the Supported Lives Services offices.

One person accessed the office as part of their support during the pandemic, especially in bad weather, as their usual activities were closed.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

People lived in small houses in their community and were involved in their day to day choices and activities. People were supported to gain skills be as independent as possible.

Right care:

Support was person-centred and promoted people’s dignity and privacy.

Right culture:

The service promoted people’s independence and choices and supported people to be part of their community and participate in the activities they wanted to do.

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 24 October 2019).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the use of personal protection equipment, following national guidelines during the COVID-19 pandemic and the management of people’s finances where they required support to do this. The overall rating for the service has not changed following this targeted inspection and remains good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Supported Lives Services provides a domiciliary care service, providing support to people in their own homes. In addition, it provides service to people living in three supported living settings. In these instances, 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 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. At the time of our inspection, 10 people were receiving this service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

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. Records relating to decision making needed improvement and the registered manager responded to this need.

People felt safe and protected from the risk of harm. Staff understood their safeguarding responsibilities and records showed appropriate action was taken to safeguard people.

There were sufficient numbers of staff who had been safely recruited. They received a regular programme of support through training, supervision and appraisal. The training matrix showed high levels of completion in mandatory and specialist subjects.

Care plans were sufficiently detailed. Further developments were needed in respect of end of life care. Staff demonstrated their knowledge of people’s care needs and action needed to reduce risks to people.

People were supported by staff to access healthcare services and records. People’s dietary needs were identified and met by staff.

The service was well-led by the registered manager who people knew well. Staff felt able to approach the registered manager with any queries or concerns.

People and relatives spoke positively about the care provided by staff. People’s privacy and dignity needs were maintained and staff supported their equality, diversity and human rights. Communication needs were met through support plans and easy read documentation.

People received their medicines as prescribed. Medicines were safely managed by staff who had received up-to-date training. All but two staff had an up-to-date competency check.

Systems of governance provided sufficient oversight and lessons were learned when things went wrong.

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 requires improvement (published 5 September 2018)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Not everyone using Supported Lives receives the 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 provide regulated activity we also take into account any wider social care provided.

We undertook the inspection between 12 and 25 July 2018.

The inspection was announced. We gave a small amount of notice of our visit to the providers’ office because we wanted to make arrangements to telephone people who used the service to ask them for their views. At the last inspection in October 2018 we found widespread failings and rated the service as Inadequate. We identified seven breaches of regulation in relation to Safe Care and Treatment, Safeguarding, Dignity and Respect, Person-centred care, Staffing, Receiving and Acting on Complaints and Good Governance. At this inspection we found the service was no longer in breach of any regulations.

We found the service was now more organised. Documentation relating to people’s care and support had been updated and there was now a clear management structure which was more effective in checking, monitoring and improving the service. The new manager had a good oversight of the service and of the people who used it.

People and relatives’ feedback was mixed about the quality of the service, although overall people said things had improved since the last inspection. There had been a number of management changes over the past year and people and relatives said they would need consistency in both support staff and management before they were fully assured that the service had changed for the better.

People and relatives said people were safe using the service. Concerns raised were taken seriously and fully investigated. Risks to people’s health and safety had been assessed with clear plans of care put in place for staff to follow. The manager had a good oversight of the risks people were exposed to and how to control them.

Medicines were managed safely overall. Clear medicine records were kept which were audited and checked on a regular basis.

Overall there were enough staff to ensure people received regular care and support. Additional staff were going through the recruitment process to increase the size of each person’s support team to further increase reliability and availability of staff.

Some relatives told us there were still too many different staff supporting their relatives. Whilst each person had a relatively small group of support staff, there had been a number of staff changes over recent months resulting in this inconsistency.

Staff told us they now felt well supported and settled in their role. Staff received a range of training tailored to the needs of the people they were supporting.

People were offered choices and consented to their care and support arrangements. Where people lacked capacity, the service worked within the legal framework of the Mental Capacity Act (MCA).

People and relatives said staff were kind and treated them well. Staff we spoke with had a good understanding of the people they supported. People’s independence and self-confidence was promoted by the service. People’s views and opinions were valued.

People’s needs were assessed and clear and detailed plans of care put in place. The service worked with healthcare professionals to meet people’s healthcare needs. People and relatives were involved in reviews of their care and support.

People’s complaints were listened to and acted on by the service. We saw the manager had improved engagement, meeting with people and relatives to discuss issues with the care they had been receiving.

The new manager had improved staff morale. Staff said they now felt supported and able to approach the management team. People and relatives reported better engagement, although some relatives still said communication could be improved.

The new manager had good oversight of the service. New systems had been put in place to ensure areas such as staff training, supervision and care reviews were closely monitored to ensure they did not become outdated. A range of audits and checks were undertaken. The service had ensured significant improvement to the overall quality of the service since the last inspection.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Not everyone using Supported Lives receives the 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 provide regulated activity we also take into account any wider social care provided.

We undertook the inspection between 20 October 2017 and 3 November 2017. The inspection was announced which meant we gave a small amount of notice of our visit to the providers office to ensure a manager would be present. At the last inspection in September 2016 we rated the service ’Good’ overall. At this inspection we found the quality of the service had deteriorated. Feedback from relatives and staff was poor. They said that the service was no longer reliable, calls had been cancelled and management did not get back to them about their concerns and complaints. People said the staff delivering care and support were kind and caring.

Medicines were not managed safely as there was no proper oversight of the medicines management system to ensure staff were working safely and adhering to best practice.

Whilst people and relatives said people were safe in the company of regular staff, we received complaints that people’s care was provided by staff that were unfamiliar with people’s needs. We received complaints this caused upset and worry to people and their relatives.

Safeguarding procedures were in place. We saw evidence they had been followed. However, concerns about staff conduct had not been properly logged and investigated. Risks to people’s health and safety had been assessed but many assessments were out of date. Staff and management told us they thought they did not reflect people’s current needs. Incidents were not consistently recorded and properly investigated.

There were insufficient staff deployed in the right places to ensure a consistent and reliable service. People, relatives and staff reported missed and cancelled calls and some staff arriving without the necessary skills to deliver appropriate care. There was a lack of staff available to undertake duties such as supervision, spot checks and care reviews.

People said regular staff had the right skills and knowledge to care for them. However we saw there was no effective system in place to monitor staff training and ensure it did not expire. We saw a number of staff were not up-to-date with their required training. Staff said they did not feel supported by management. There had been no recent support mechanism such as meetings, supervisions or appraisals.

People and relatives reported appropriate support at mealtimes, although we saw issues with the reliability of the service had impacted on the consistency of this support.

We concluded the service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) although where people lacked capacity more information needed to be recorded to robustly demonstrate this.

People said the staff delivering care and support treated them well. We saw some good relationships had developed between people and regular staff. Staff demonstrated they cared about the people they were supporting. However we found the service as a whole did not treat people well as people had been let down with cancelled visits and not being informed who would be offering care and support. People were not always listened to as the office did not always get back to people and meetings and reviews no longer took place.

People’s care needs were assessed prior to using the service. However these had not been regularly reviewed and staff and management said they were no longer an accurate reflection of people’s needs. Reviews and meetings had stopped early in 2017 which meant that mechanisms to respond to people’s changing needs were no longer in place.

The number of complaints logged by the service did not reflect the widespread concerns reported by relatives and staff. The manager told us they recognised complaints had not been properly logged. Relatives said their complaints had not been appropriately responded to.

We identified widespread failings in the service which should have been prevented from happening through the operation of robust systems of governance. There was a lack of oversight of the service with office staff unable to tell us about people’s needs and whether there was anybody who was particularly at risk due to the service’s current failings. Audits and checks did not consistently take place to check the service was operating appropriately.

Mechanisms to obtain and act on people’s feedback were not in place and relatives said they didn’t feel listened to.

A new manager had been appointed and senior managers were regularly working at the service to help ensure improvements were made. Management were open and honest with us about the current failings and following the inspection they sent us an action plan and supporting documentation stating how they would ensure the service was improved.

We found seven breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of the report.

The overall rating for this service is 'Inadequate' and the service is therefore placed into 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

This inspection took place on 27 October 2016 and was announced. The service was last inspected February 2014 and was found to be compliant with the regulations inspected at that time.

There was a registered manager in post. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff were not always provided in enough numbers to meet the needs of the people who used the service. This meant people had not received the support they needed to pursue their chosen activities, and had created unnecessary distress for one person and their family. We have made a recommendation about this.

Staff knew how to report any safeguarding issues they may become aware of or witness. They knew they had a duty to protect people and had received training in how to recognise abuse and how to report this to the proper authorities. Staff had been recruited safely and checks had been done to ensure people who used the service were not exposed to staff who had been banned from working with vulnerable people.

People who used the service were cared for by staff who had received training in how to effectively meet their needs; this training was updated as required. Staff were supported to gain further qualifications and experience. Legislation was used when people needed support to make informed decisions; actions were taken to protect people and to make sure decisions made on their behalf were in their best interest.

People were cared for by staff who were kind and caring. Staff understood people’s needs and supported them to lead a fulfilling life. People were involved with their care planning and staff respected their dignity and rights to lead a lifestyle of their choosing. Staff understood the importance of maintaining confidentially and respecting people’s right to privacy.

The registered provider had a complaints procedure in place, which people who used the service could access and all complaints were investigated. Any learning from the investigation of complaints was shared with the staff. On the whole people were supported to undertake activities which maintained their independence and develop their life skills. People were also supported to undertake leisure activities as well.

The registered manager undertook audits of the service and put in place action plans to rectify any shortfalls. People and other health care professionals were consulted about the service and their responses were collated and published. Staff meetings were held to disseminate knowledge and to pass on information about any recent changes to the service.

People we spoke with told us they were satisfied with the service and they felt that their dignity was respected. One person we spoke with said, 'They are absolutely fantastic' another said, 'They are so efficient'. Staff we spoke with said people were treated with respect and their privacy and dignity was respected at all times.

Support workers told us that staffing levels were appropriate and staff were supported through their training. The staff we spoke with were complimentary regarding the training that had been provided. One member of staff told us, 'You are in a good place here' another said, 'I like the varied jobs that I get to do'.

This provider had systems in place to monitor people's comments and complaints and their satisfaction with the quality of the service.

The manager explained the arrangements in place for the storage, security and retention of information obtained about people who used the services.

We spoke with three relatives of people who used the service. They all told us staff listened to them and they could make changes to the care and support their relative received at any time.

All three people said their relatives received the care and support they needed. One person said the care was 'absolutely fabulous' and another person said it was 'brilliant'.

People told us they felt their relatives were safe when they were with their carers. One person said, 'I feel secure and don't have to worry when they are out with their carer'.

People said staff were generally caring, approachable and knew how to meet their relative's needs. One person said, 'you really can not fault staff, they are so friendly and patient'.

However, despite the positive comments people made, we found evidence the provider did not have an effective system to regularly assess and monitor the quality of service people received. We also found evidence people were not always protected from the risks of unsafe or inappropriate care as the documentation was inconsistent and unclear.