Archived: Voyage (DCA) (North East)

After the inspection the provider wrote to us to say what they would do to meet legal requirements.

We carried out this comprehensive inspection on 11 and 12 May 2015 to check whether the provider had addressed these breaches. We found there had been improvements in all these areas.

Voyage (DCA) (North East) offers a supported living service to people within their own homes or shared houses. It offers personal care to people within the North East area. People who use the service have learning disabilities, autism and/or physical disabilities. They are supported with personal care, medicines, cooking, shopping, activities and other day to day tasks. At the time of this inspection 24 people were using the service.

Since the last inspection a registered manager had been appointed. 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 were able to express a view told us they felt safe using the service. Some people said it was “better” than it had been at the last inspection. Staff told us, “It’s a much happier place for people.”

Since the last inspection we found that the provider had reported any safeguarding issues to the relevant local authorities and had notified CQC of these. Staff had training in safeguarding and there was a ‘hotline’ for them to use if they were concerned about any poor practice. Staff said they were confident about reporting issues.

There were enough staff on duty to support the people who lived there. The provider carried out checks to make sure only suitable staff were employed. Medicines were managed in a safer way for people and staff had had training in specific emergency medicines.

People and relatives we spoke with felt staff were competent to provide the right support. Staff felt well trained and supported in their roles. Staff now understood and worked within the principles of the Mental Capacity Act 2005 (MCA). This meant safeguards were in place for people who did not have capacity to make some significant decisions. All the people were encouraged to make their own day to day choices.

Staff were knowledgeable about individual people and were able to spot any changes in their well-being. There were now personalised ways of supporting people with their individual behavioural needs. Staff liaised with other health agencies to support people with their healthcare needs.

Since the last inspection people were more involved in choosing, planning and shopping for their meals. People were also encouraged to have a healthy lifestyle to help their nutritional well-being.

The people we spoke with who were able to express a view said they were “happy” with the support they received. One person told us, “I get on well with the staff.” Another said, “I like living here, it’s good. The staff are nice.”

Staff felt the service was a “much happier place” for people. One staff member told us, “They’ve all got a life now." One staff member commented, “It was very stressful through all the changes but the staff who stayed are really attached to people and that’s why we stayed.”

There had been improvements to people’s care records and these were now up to date and personalised. All the support plans for people who used the service had been reviewed by the care staff members who knew the person best. People had been involved in planning their own support for the future.

In the past three months the provider had put into place a structured quality audit system to continuously monitor the quality and safety of the service. However it was too early to tell if this would be effective in driving sustained improvements.

Since the last inspection a new manager had registered with CQC. People said the registered manager was “absolutely champion” and “really great”. They said she visited the different houses and asked if everything was alright. People now had the chance to discuss their views of the service at house meetings.

Staff said the registered manager was open and approachable. There were now regular staff meetings for staff to share ideas.

All the people, staff and visitors we spoke with said there had been significant improvements to the running of the service since the last inspection.

The last inspection of this service was carried out on 4 November 2013. The service met the regulations we inspected against at that time.

The previous registered manager had left the organisation in September 2015. The service did not have a registered manager at the time of this inspection. 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.

This inspection had been brought forward due to several safeguarding incidents raised by the provider and serious concerns of the local authority which had led to the reassessment of people and relocation of some people. The provider had identified that many incidents of physical and verbal aggression had occurred between people who used the service, but these had not been reported or investigated by the agency staff. This meant vulnerable people had not been protected by the agency and safeguarding adults protocols had not been followed until new management staff visited the service in October 2015.

Risk assessments of people’s safety and individual needs were either inaccurate or not in place, for example the risk of falls for some people. The agency had not supported the people in one shared house to keep their house clean which could have affected their health, and waste bins were spilling out at the side of the premises which had attracted vermin.

People did not have information about the service they should expect. There were no records to show people agreed or consented to the support they received. People were supported with their medicines but guidance plans about ‘as and when required’ medicines were incomplete or missing so staff may have been giving these inconsistently.

The records about how staff had been recruited did not always include satisfactory checks such as references and disclosure and barring checks (these are checks about criminal convictions and whether applicants are barred from working with vulnerable adults). This meant the provider had not always made sure that staff were suitable to work with the people who used the service.

Staff did not know how to make sure people’s rights under the Mental Capacity Act 2005 were upheld. (MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’). Staff felt people did not have capacity but this had not always been effectively assessed and people were expected to make some complex decisions, for example about finances regardless of their capacity.

The provider had not made sure people received personalised care. People’s individual care records did not accurately reflect their needs or were incomplete. This meant that it was not always possible to be clear if a person was supported in the right way or in the way they preferred.

The provider’s quality monitoring processes were not effective in managing risk or making sure people received a safe or quality service. Shortfalls had been identified earlier in the year but no remedial action had been taken. Staff had computer-based training in appropriate areas of care, but the provider had arranged to renew the training for all staff following the identified concerns at this agency. Staff said they had not felt well supported over the past year but felt things were “getting back on track”.

People who could express a view, and their relatives, felt the staff were caring and helpful. People described the support workers as “nice” and “lovely”. Visiting health and social care professionals told us the staff were knowledgeable about individual people and were aware of their individual preferences. People were supported to do shopping and encouraged to make their own daily decisions for example about meal choices.

During this inspection we identified six breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘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, they 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.

Staff were fully supported to meet people's needs because they received regular supervision sessions, appraisals and training.

The provider had systems in place to regularly check the quality of the care, people were consulted about the care they received and an effective complaints procedure was in place. One person told us 'I am happy with everything.'

We observed staff members interacting appropriately with people within the service and attending to their needs promptly. During our inspection staff and people were engaged in polite conversation and the atmosphere was relaxed.