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Inspection carried out on 17 December 2018

During a routine inspection

About the service:

HFT Forest of Dean is a service who provide care and support to people living in ‘supported living’ settings, so that they can live in their own home as independently as possible. At the time of our inspection there were five people receiving a service. 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.

Not everyone 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.

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

What life is like for people using this service:

People told us they felt safe. They were protected from potential abuse and discrimination. Risks to people were identified, assessed and action had been taken to reduce these or remove them. Medicines were managed safely and staff provided the support people needed to take their medicines as prescribed. Enough suitably recruited and skilled staff were deployed to meet people’s needs.

People’s health needs were assessed and people had access to a variety of healthcare professionals to support them. People were provided with the right amount and type of food to meet their health needs, and were supported to do their own food shopping and prepare their own meals. People’s religious preferences were being met.

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 were kind and caring towards people they supported. They maintained people’s dignity and privacy. People’s choices, preferences and wishes were known to the staff who had taken time to find these out. Care plans gave staff guidance on how to meet people’s needs. Further detail about people’s care needs was also communicated to staff by means of staff handover meetings and daily notes.

The service met the characteristics of Good in all areas; more information is available in the full report below.

Rating at last inspection:

The last inspection was on 24 May 2017 when the service was rated as ‘Requires Improvement’ overall. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care and treatment was not always provided in a safe way and not all risks to service users had been assessed and fit and proper persons had not always been employed. The provider sent us a detailed action plan at that time. At this inspection we found significant improvements and the breaches of regulation 12 and 9 had been met.

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Further information is in the detailed findings below.

Inspection carried out on 24 May 2017

During a routine inspection

We had not previously inspected this service. This comprehensive inspection took place on 24 and 25 May, 23 and 28 June 2017. The first day of the inspection was unannounced. The provider was given notice on subsequent days because the location provides a domiciliary care service and we needed to be sure that the manager would be available. We also arranged to visit people in their own homes to observe the care provided.

The service was providing care and support to six people living in their own homes, Forest Close and Ormiston, so that they could live as independently as possible. People supported by the service lived with a learning disability and some with autism.

At the time of our inspection the service did not have a registered manager. 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. The manager had been overseeing the service since November 2016 and had started the process of registering with the Care Quality Commission to ensure the provider would meet the conditions of their registration.

During this inspection we identified breaches against two of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. Regulation 19 Fit and proper persons employed was not met. Pre-employment checks had been carried out in line with the provider’s recruitment processes. However, these fell short of regulatory requirements for staff working with vulnerable adults. Where staff had previously worked in health or social care, checks did not always include evidence of their conduct in these roles or verifying their reason for leaving, to ensure they were of good character.

Regulation 12 Safe Care and Treatment was not met. People were not always supported by staff who had the knowledge and experience to support them safely and effectively. When incidents occurred these were investigated but the action taken was not always robust or timely enough to reduce future risks.

You can see what action we told the provider to take at the back of the full version of the report. We also recommended the provider consider reviewing the mix of temporary and permanent staff on each shift and seek guidance about the frequency of supervision meetings for new staff.

The provider was recruiting more staff and making training and support available to ensure staff would develop the skills they needed. Key worker sessions were being introduced to ensure people had regular meetings with their key support worker to capture their feedback about their care and activities.

Staff and relatives gave us mixed feedback about the leadership in the service. Some were complimentary of the provider. Others told us improvements were needed to the communication in the service and to ensure concerns would always be responded to in a timely manner.

The provider had systems in place to monitor the quality of the service provided to people. They identified that improvements were needed during their audit of the service in May 2017. We saw the concerns they identified were similar to the ones we found at this inspection. However, the manager had not identified the extent to which one person’s community involvement and opportunity for social interaction had been compromised. The provider was working on a service improvement plan with commissioners. Time was needed before we could evaluate the effectiveness of the provider’s action plan in making and sustaining the required improvements.

Staff were caring and motivated to support people to enjoy meaningful activities and relationships. People’s likes and dislikes were respected and they were assisted to communicate their wishes. Where appropriate, people’s relatives were involved in decision-making and care review