Archived: Living Ambitions Limited - Chorley

At the time of our inspection there were 18 supported living homes and 49 people who received support from the service.

This service provides care and support to people living in 18 ‘supported living’ settings, 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.

At the last inspection in December 2016 we asked the provider to take action to make improvements because breaches of legal requirements were found. The provider had failed to ensure there were effective systems in place to monitor the safety and quality of all aspects of the service.

There was a registered manager in place. 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.

During this inspection we found the management team had addressed the issues and had implemented systems to ensure people were safe.

Audits were completed and conducted by independent auditors, they included, medication processes, each environment at the supported houses and care records. These were now taking place regularly. Any issues found on audits were quickly acted upon and any lessons learnt to be implemented to improve the quality of service provided for people.

The management team had addressed the issues and had implemented systems to ensure people were safe. For example risk assessments were completed for all people living in supported houses to ensure they were safe.

Medication administration had been improved and made safer to ensure people received their medicines on time and correctly.

People who lived in supported houses and their relatives told us staff were caring and kind towards them. Staff we spoke with understood the importance of high standards of care to give people meaningful independent lives. One person who was a tenant in supported housing said, “Yes they are great always looking after me so well.”

The service had systems in place to record safeguarding concerns, accidents and incidents and took necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

We found there was an appropriate skill mix of staff to ensure the needs of people who lived in supported houses were met. New staff worked alongside experienced staff members and shadowed them to ensure they understood their role.

Care plans were organised and had identified care and support people required. We found they were personalised and informative about care people received. They had been kept under review and updated when necessary. They reflected any risks and people’s changing needs.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

Staff received regular training and were knowledgeable about their roles and responsibilities. They had skills, knowledge and experience required to support people who lived in supported housing.

People who lived in supported houses were sufficiently supported to maintain their physical and mental health. Staff escorted people to appointments and maintained contact with community health and social care professionals.

We spoke with people in the houses and they told us mealtimes were a relaxed social occasion. One staff member said, “We generally pick and choose on the day and it is their choice what anyone wants.” People had a choice of what they wanted to eat and staff were aware of people's needs in this area. One person who lived in one of the houses said, “I like pizza a lot and help cooking it.”

People told us staff, the registered manager and management team were polite, sensitive and respectful in their approach to caring for people in supported houses.

People who lived in supported housing and their relatives knew how to raise a complaint and who to speak with. The management team had kept a record of complaints received and these had been responded to in a timely manner.

The service used a variety of methods to assess and monitor the quality of the service. These included staff meetings, surveys and visits to the supported houses.

We last inspected the service 14 and 17 March 2016. At that inspection, we found five breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Living Ambitions Limited - Chorley supports people to live independently. There are 24 properties in the area. There is a staff team on hand 24 hours a day to cater to any support or healthcare needs. Every person has full control over their life in a space which looks and feels very much like home.

Each supported tenancy is managed on a day to day basis by a support team leader and is provided line-manager support by the registered manager. The registered manager for this service was not available on the day of inspection. However the registered manager from another part of the service was spending some time at the office to offer some support and so they were available throughout the 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.

When we last inspected the service in March 2016, we found concerns with, how risks to people were managed, the safe management of medicines and safe staffing levels. Following the inspection, we took action to ensure the provider made improvements to the service.

During this inspection we found that medicines were not always managed safely. We saw that risk assessments still require improvements as these were not completed consistently. We looked at staffing levels during this inspection and asked staff if they felt there were sufficient numbers of staff to provide care and support for people who lived within the service. At the time of our inspection, staffing levels were adequate to meet people’s needs, although there is still agency use.

We looked at how people were protected from bullying, harassment, avoidable harm and abuse. We felt reassured by the level of staff understanding regarding abuse and their confidence in reporting concerns.

When we last inspected the service in March 2016, we found multiple examples of where the standard of care had fallen short of meeting people's nutritional health needs. The service was unable to evidence staff support by way of supervision and appraisal. We also found valid consent was not always sought before people received care and restrictions were put in place without the legal frameworks. During this inspection, we checked to see what improvements had been made.

We found that peoples consent to care and treatment in line with the Mental Capacity Act 2005 (MCA) was inconsistent throughout the service. We found that staff supervision had improved but that there remained some improvements to be made.

People were sufficiently supported to maintain their physical and mental health. Staff escorted people to appointments and maintained contact with community professionals. We found examples across the care records we looked at of people being referred for external health and social care support and professional advice being followed.

People had a choice of what they wanted to eat and staff were aware of people’s needs in this area. Care files included people’s likes and dislikes about eating and we did not find any shortfalls with the care in this area.

When we last inspected the service in March 2016, we found caring relationships between people who lived at the houses and staff members. During this inspection, we observed people being supported at four houses staff interacted well with those who used the service. These observations were very positive. It appeared from the observations at the time of inspection that the staff teams shared genuine, warm relationships with those who used the service.

During our last inspection in March 2016, we found people did not always receive personalised care that was responsive to their needs. We found that the standard of care planning differed across the homes and staff teams.

We found that care records to aid transition in services were not always fully completed. Documentation to aid staff in caring for people’s individual needs was not consistent throughout the service. We saw evidence in care files that the service was making necessary referrals and seeking support on how best to meet people’s needs. We received conflicting feedback from professionals around this.

During our last inspection in March 2016, we found processes designed to assess and monitor the quality of service provision were not being operated effectively. There was not always access to the on-call system for staff working out of hours.

During this inspection, we found the service had improved the way it used quality assurance systems, however these systems were not always robust.

It was noted that although significant improvements had been made, the service would benefit from the stability of a management and staff team. We will check this during our next planned comprehensive inspection.

We found the management team receptive to feedback and keen to improve the service. They worked with us in a positive manner and provided all the information we requested.

Since our inspection the interim manager has informed us of progress that has been made as a result of our feedback and recommendations made, which is considered good practice.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment and consent. We have made a recommendation around the quality of staff supervision, infection control and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.