DSAS- South Network

DSAS South is a supported living service providing personal care for people with a learning disability, autism or a physical disability. 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.

The service provides personal care and support to 57 people living in 14 supported living properties or in individual flats within a block, so that they can live in their own home as independently as possible. People live on their own or in small groups, each person having their own bedroom and sharing the lounge, bathroom and kitchen. Where required staff either slept in the house to be available in the event of an emergency or stayed awake throughout the night.

The size of properties meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

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

Care plans, risk assessments and health action plans were regularly reviewed and up to date. These identified people’s support needs and provided guidance for staff how to meet these identified needs. People’s needs for being involved in activities and their communities had been recognised, with additional funding now available. Complaints were responded to appropriately, with support from the Manchester City Council central complaints department. People’s wishes for their support at the end of their lives was discussed and recorded.

There was a clear management structure in place. A quality assurance system was used to monitor and improve the service. People and staff were involved in reviewing their care and support. Staff said they enjoyed working at the service and felt well supported. The service worked well with a range of professionals and had adapted to use more video and telephone conferencing during the Covid-19 pandemic.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 19 June 2019). We met with the provider following the inspection to check the issues found during the inspection were being actioned.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 7 May 2019. The service was rated as requires improvement, with no breaches of regulations. This was the fourth consecutive requires improvement rating.

We undertook this focused inspection to check they had made improvements and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for DSAS South on our website at www.cqc.org.uk.

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.

DSAS South provides care and support to 44 people living in 13 ‘supported living’ properties or in individual flats within one block, so that they can live in their own home as independently as possible. People lived on their own or in small groups, each person having their own bedroom and sharing lounge, bathroom and lounges. Where required staff either slept in the house to be available in the event of an emergency, or stayed awake throughout the night.

The size of properties meets current best practice guidance. This promotes people living in a small domestic style property to enable them to have the opportunity of living a full life.

People’s experience of using this service:

Improvements had been made at DSAS South, with stable staff and care co-ordinator teams in place, resulting in less short notice agency cover being required. Temporary cover was being arranged for a care co-ordinator so the rest of the team would not have to cover their role during their absence.

Quality auditing systems had been strengthened and the registered manager had more oversight of the service. Matrices were used to monitor staff supervisions, review dates for person-centred plans, risk assessments and health action plans. Further matrices to monitor additional documents were being introduced.

The majority of person-centred plans, risk assessments and health action plans had been reviewed and were current. Plans written by external professionals, for example positive behaviour support plans, eating guidance and epilepsy support plans, had been reviewed by the staff teams. Where there were changes referrals had been made for a re-assessment of people’s needs.

However, two person-centred plans and a health action plan had not been reviewed on time. We were told this was because they were waiting for a formal review meeting to be arranged with social services and family to review the documents. The registered manager agreed these would be reviewed immediately by the care co-ordinator and staff team.

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received their medicines as prescribed.

People said they felt safe supported by DSAS staff. The staff knew people and their needs well.

People were supported to maintain their health and nutrition.

New staff were safely recruited and received the training and support to fulfil their roles. Most care co-ordinators visited the homes they were responsible for at least once each week. One co-ordinator said they were planning to do this going forward.

All accidents and incidents were recorded and reviewed by the care co-ordinators and registered manager.

Rating at last inspection:

At the last inspection the service was rated requires improvement (published 9 November 2018) and there were three breaches of regulation. At this inspection we found improvements had been made, which meant that there were no breaches of regulations. However further improvements were identified to ensure all care plans, health action plans and risk assessments were reviewed on time.

Following the last inspection, we took enforcement action which included issuing two warning notices relating to care plans, health action plans and risk assessments not being up to date and the governance of the service. We met with the provider to discuss the improvements they were making to improve the service and address the shortfalls we had identified.

The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This service provides care and support to 44 people living in 13 ‘supported living’ settings or flats, 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 lived on their own or in small groups, each person having their own bedroom and sharing lounges and bathroom. Where required staff either slept in the house to be available in the event of an emergency, or stayed awake throughout the night.

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.

DSAS South had a new registered manager, who had been in post since November 2017. 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.

At the last inspection in September 2017 we found three breaches in regulations because person centred plans and risk assessments had not yet been completed in some properties, support plans had not been reviewed and the governance of the service was not robust as the issues with care plans and risk assessments had not been addressed. Staff job consultations (supervisions) had not been regularly completed.

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 of safe, effective, responsive and well led to at least good.

At this inspection we found there were continued breaches in the same three areas. Staff and regular contracted agency staff (called R1s) told us they now received regular supervisions with their care co-ordinator although the written record of these meetings was not always stored in the staff files.

There was a variation across the properties we visited, with some risk assessments, care plans, positive behaviour support (PBS) plans, epilepsy care plans and eating and drinking care plans having been reviewed and updated to reflect people’s current needs.

However in other properties these had not been reviewed and updated. One person did not have a person centred plan in place. A plan had been partly completed but the care co-ordinator had moved to a sister service within Manchester and the person centred plan had not been finished. Other people’s risk assessments and health action plans had not been reviewed. Therefore staff may not have the information they needed about people's needs to support them effectively.

Not all care co-ordinators were confident to review the care plans that had been written by other agencies, for example the PBS plans. At our last inspection in September 2017 the community learning disability team (CLDT) nurse said the service had been informed that they needed to review all the PBS plans and refer people back to the CLDT if there had been any changes in people’s needs and behaviours. This was not consistently applied at DSAS South.

The care co-ordinator team had not been fully staffed, due to sickness, vacancies and co-ordinators moving roles, until May 2018. This had impacted on the service’s ability to review and update all of people’s care and support plans. The provider had not ensured there was sufficient continuity across the care co-ordinator team to complete the review of all care files which had been identified in our previous inspections. We were told the team was now fully staffed and any sickness or vacancies were quickly filled.

The registered manager had started a tracker matrix to monitor what paperwork was in place and reviewed in each property, for example person centred care plans and risk assessments. However, a similar matrix had been put in place by a previous registered manager following an inspection in 2016, but this had not been provided to the current registered manager.

The registered manager also used tracker matrixes to monitor and review incidents, capacity assessments and staff training. The care co-ordinators reviewed the medicines administration records and finance records each month.

An auditing system had been introduced across the three Manchester Council supported living services whereby care co-ordinators from one service audited properties in another service. These audits had been reviewed and streamlined and were being re-introduced. At the time of our inspection three DSAS South properties had been audited in 2018 and action plans written. The findings were in line with what we found during this inspection.

People and their relatives thought they were safe supported by DSAS South. There were sufficient staff to meet their needs and support them to participate in activities. Regular R1 agency staff were used to ensure continuity of the support provided. Relatives told us the staff teams supporting their relatives were stable and the staff knew their relative’s needs.

Additional staff were provided when people’s needs changed. However, people’s needs were not reviewed by the local authority social service department so these hours were not recognised in the service’s budget. We were assured that these hours would not be removed for budgeting reasons. This also meant the service could not recruit permanent staff to these hours as they were not recognised in their budget. R1 agency staff were used to cover these hours.

Staff had completed the training they needed to meet people's needs. On line e-learning courses were now available for staff to complete when working in the properties. Medication training had been arranged for all staff who administered medicines.

People received their medicines as prescribed. People were supported to maintain their health, although not all health action plans had been reviewed and updated. People were supported with their nutritional needs.

The service was meeting the principles of the Mental Capacity Act (2005). People’s capacity had been assessed and referrals made to the local authority where appropriate for formal capacity assessments to be completed and applications made to the Court of Protection if required. Any restrictions in place were recorded and staff could explain why they were needed.

Staff said they enjoyed working at the service and felt well supported by their care co-ordinator. Regular staff meetings were held. The care co-ordinators said the new registered manager was approachable and supportive.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

South Network provides support for 62 people living in their own homes. Thirty-seven people live in shared supported accommodation with staff support 24 hours per day. Twenty-five people with physical disabilities live at Alsager Close, 16 of whom live in their own flat with a range of different support hours each day and nine who live in two shared bungalows with staff support 24 hours per day. Each house or set of flats had a designated staff team. The staff teams were managed by a care co-ordinator. There were seven care co-ordinators in total.

Manchester City Council has two other similar services covering the North and Central areas of the city. An improvement plan had been established in 2016 covering all three services. Regular meetings were held to monitor the implementation of the improvement plan.

The service had 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.

At the last inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found some improvements had been made; however progress was not always consistent across the properties.

We found a new risk screening tool and person centred risk assessment and safety management plan was being introduced. This clearly identified any relevant risks and referred to the guidance in place for staff to follow to mitigate the risks. However the person centred risk assessment and safety management plan had not been completed in all properties. Where applicable positive behaviour support plans were in place to guide staff how to manage people’s behaviour.

New person centred plans were being written. These gave good details of people’s life history, likes and dislikes, the support they needed and what they were able to complete for themselves. Most of the plans were in the process of being reviewed by the staff teams and relatives at the time of our inspection. Again we found not all properties had the draft person centred plans in place.

This meant staff in some properties did not have up to date information about the support people required and how to mitigate the identified risks.

People and their relatives told us they felt safe when supported by DSAS South staff. Staff had completed training in safeguarding vulnerable adults and were able to explain the action they would take if they suspected any abuse had taken place.

We saw sufficient staff were on duty to meet people’s needs. Regular contracted agency staff were used to cover vacancies, which meant they got to know the needs of the people they were supporting. We were told other agency staff were sometimes used to cover annual leave and staff sickness. We were told that shifts at weekends were more difficult to cover, especially if staff due to work were unable to at short notice. Relatives we spoke with said that the staff teams were more stable at the moment.

An exercise had been completed to record the exact support each person required. This was because people’s needs had not always been re-assessed by the relevant social services department. The service increased people’s support above the social services assessed need if their needs had changed.

A safe system of staff recruitment was in place at the service. Staff we spoke with knew people’s needs well and were able to describe to us people’s care and support needs.

Staff training had increased. The service was now able to specify what training their staff required and this would be sourced for them. Staff said they felt well supported by the care co-ordinators and had staff meetings every two months. Job consultation sessions (supervisions) were not held as frequently as planned. Care co-ordinators were due to visit their properties each week but not all of them did so.

We found a safe system for administering medicines was in place. Staff had received training in the administration of medicines. People we spoke with told us that they received the medicines as prescribed.

We found that people were supported to maintain their health. However health action plans required updating. We saw records of medical appointments attended. Systems were in place to monitor

people's nutritional intake where required.

People’s capacity to make decisions had been assessed and referrals made to the local authority for formal capacity assessments and best interest decisions to be made on their behalf. Any restrictions in place were clearly recorded in the supported living properties; however this detail was not available at Alsagers Close. Staff were now more aware of the Deprivation of Liberty Safeguards and why any restrictions were in place. The service was working within the principles of the Mental Capacity Act (2005).

Staff gave us a good example of the support provided to one person at the end of their life. Additional staff were available to ensure they were able to stay at their home. End of life training was planned which should give staff the confidence to discuss advance care planning with people and their relatives.

A system of audits was in place at the service, including for medicines, trackers for training and supervisions. An audit tool had been developed which covered care files, health and safety, people’s finances and the environment. These were completed by care co-ordinators from one of DSAS South sister services. The compliance rating from the audits had shown an improvement since they had been introduced. However consistent improvements had not been made across the service.

Accidents, incidents and safeguarding were monitored by the registered manager. We saw investigations had been completed where required.

At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.