South East Supported Living

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.

This inspection took place on 11, 13 and 15 June 2018. This was an announced inspection which meant the provider knew two days before we would be visiting. This was because the location provides a supported living service. We wanted to make sure the registered managers, or someone who could act on their behalf, would be available to support our inspection and make arrangements to meet with people who used the service. At the time of our inspection 24 people were receiving personal care from the service.

There were two registered managers in post at the service. 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 and associated Regulations about how the service is run. The registered managers shared out the management responsibilities of overseeing the supported living settings where people received care and support.

At the last inspection in September 2017 we identified that improvements were needed to the way people were supported to manage their medicines, the records staff kept of the support they provided to people and the way complaints were handled. The provider also needed to ensure they submitted notifications of important events to us, as required by legislation. At this inspection we found these areas had all been improved and the provider was meeting their legal obligations.

People who used the service were positive about the care and support they received and praised the quality of the staff and management. We observed staff interacting with people in a friendly and respectful way. Staff respected people’s choices and privacy.

People told us they felt safe when receiving care and were involved in developing and reviewing their care plans. Systems were in place to protect people from abuse and harm and staff knew how to use them. Medicines were managed safely and staff had received suitable training in medicines management and administration. People received the support they needed to take their medicines.

There were sufficient staff available to provide the care and support people needed. People told us they received care and support from staff they knew and got on well with. Staff said they felt there were sufficient staff to provide the care and support people needed. Staff understood the needs of the people they were providing care for and had the knowledge and skills to meet their needs.

Staff received a thorough induction when they started working at the service. They demonstrated a good understanding of their role and responsibilities. Staff had completed training to ensure the care and support provided to people was safe and effective to meet their needs.

The service was responsive to people’s needs and wishes. People had regular meetings to provide feedback about their care and there was an effective complaints procedure.

The management team regularly assessed and monitored the quality of the service provided. Feedback from people was encouraged and was used to make improvements to the service. The registered managers had a good understanding of improvements that were needed in the service and had plans in place to implement them. Staff were confident in the skills of the registered managers and their ability to manage the service effectively.

After the comprehensive inspection, two warning notices were served on the registered provider requiring them to make improvements to the management of medicines and their systems to improve the safety of the service provided. The warning notices required the provider to meet the legal requirements by 3 October 2016. At this inspection we found that although there were still concerns with the management of people’s medicines and the accurate assessing and analysing of these concerns after the 3 October 2016; the provider has now made sufficient improvements which need appropriate time to embed within the service.

We requested the provider send us an action plan informing us when and how they would meet the legal requirements to ensure applicant’s fitness for work and their character was assessed and there were sufficient staffing levels across each scheme. The provider’s action plan said they would be compliant with these areas by 31 December 2016. At this inspection we found recruitment checks were completed and there were sufficient staffing levels across each scheme.

This inspection was completed on the 12 December 2016 and 16, 17 and 18 January 2017. The inspection started as an unannounced focused inspection on 12 December 2016 to follow up on the warning notices served on the provider and to confirm the provider was now meeting the legal requirements. We identified further non-compliance with our regulations on 12 December 2016 and changed the inspection to a comprehensive inspection of the service which continued on the 16, 17 and 18 January 2017 to confirm the provider was now meeting the legal requirements after our inspection on 28, 29 July and the 1, 2 August 2016 had been carried out.

At the last inspection, the service was Inadequate overall and was placed 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.

Community Integrated Care Southern Regional Office is the regional headquarters for a group of fourteen supported living schemes (schemes) and domiciliary care placements throughout Portsmouth and Hampshire. The Southern Regional Office provides support and care services to people with learning or physical disabilities, sensory impairments, autism or other complex needs, such as epilepsy or a mental health condition. At the time of this inspection there were 30 people receiving a personal care service across twelve of the fourteen supported living schemes.

There were 68 permanent support workers supported by 15 bank support workers who delivered care to people, working across the schemes. Each scheme was managed by a service lead who was responsible for the overall management of the supported living schemes. The service leads were supported by a deputy manager or senior care staff who were responsible for the day to day running of each of the schemes.

There was a registered manager in post who was also the regional manager for Community Integrated Care and was based at the Southern Regional Office. 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.

Although people’s medicines were now being managed safely, medicine errors had occurred in the recent past and the Commission were not always notified. New systems introduced to manage people’s medicines and finances had improved but required time to embed into the service.

Staff felt supported, received regular supervision and training but did not receive an appraisal. Although staff received an induction in line with recognised standards they may not have received all the training required by the provider.

Staff were kind and caring but relatives felt management did not communicate well or involve them in their relatives lives.

People and their relatives were not always involved with the planning and review of their care and support. Complaints were not always responded to or dealt with to the satisfaction of relatives. We have made a recommendation for the manager to review the provider’s complaints policy and seek guidance on how to handle and respond to complaints.

Audits were in place but originally did not identify all medicine errors which were identified on the 12 December 2016. However a new auditing system had been implemented following feedback and audits now in place were more effective; however they required time to embed into the service.

Safe recruitment processes were now being followed and the fitness and character of applicants were now being checked by the provider. Staff had a good understanding of the signs and patterns to look for when someone may be at risk of potential abuse. There were sufficient staffing levels at each scheme to keep people safe and meet their needs.

Capacity assessments were present in people’s files to evidence if they lacked capacity to make decisions relating to their finances, medicines and care. Not all were decision specific and we have made a recommendation about this. We have made a recommendation that the provider ensures that sufficient and regular review of mental capacity assessments are undertaken to ensure they are decision specific and sufficiently detailed in all instances.

People were supported to eat and drink sufficiently and regularly access healthcare. Support plans were in place, reviewed regularly and personalised. Staff knew people well and respected their privacy and dignity at all times.

Additional audits and measures were being completed to assess the overall quality and safety of the service. We have made a recommendation about satisfaction surveys.

The provider had displayed their rating.

We identified one breach of the Care Quality Commission (Registration) Regulations 2009 and have made two recommendations. You can see what action we told the provider to take at the back of the full version of this report.

Community Integrated Care Southern Regional Office is the regional headquarters for a group of fourteen supported living schemes (referred to as schemes throughout the report) and domiciliary care placements throughout Portsmouth and Hampshire. The Southern Regional Office provides support and care services to people with learning or physical disabilities, sensory impairments, autism or other complex needs, such as epilepsy or a mental health condition.

At the time of the inspection there were 32 people receiving a personal care service across twelve of the fourteen supported living schemes. There were 85 support staff working across the schemes and 78 staff who delivered care to people. There were seven service leads in post at the time of the inspection and one vacant post. The service leads were responsible for the overall management of the supported living schemes. The service leads were supported by a deputy manager or senior care staff who were responsible for the day to day running of each of the schemes.

There was a registered manager in post who was also the regional manager for Community Integrated Care and was based at the Southern Regional Office. 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 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, 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.

There were insufficient staffing levels at one scheme which meant people did not always receive support with meaningful activities and medicine and financial errors were occurring. People’s medicines were not managed safely mostly at one scheme and there were discrepancies with medicines records at further schemes. There were widespread concerns that people’s finances were not being managed safely.

Recruitment processes were in place and mostly followed; however assessments of the health and fitness of staff were not always in place to ensure they were able to carry out their role safely. Risk assessments were completed for each person which identified risks to themselves and others. However this information was not always transferred to people’s care plans to ensure consistent written guidance.

The registered manager and staff had a good understanding of the Mental Capacity Act 2005 (MCA) but did not always put this understanding into practice. We have made a recommendation for the provider to review the Mental Capacity Act 2005 principles, code of practice and staff application of this.

Staff received an induction, training and had regular supervisions and appraisals. There was a training plan in place which identified when staff had completed training and when the training was due to be updated. People were supported to have enough to eat and drink and access healthcare services.

People were involved in their care planning; however care records did not always reflect who had been consulted in the development and review of the care plans. Relatives did not always feel involved and felt the service was not caring. People were supported to be as independent as possible and care plans were personalised and detailed in how people liked to be supported. People’s dignity and privacy was respected.

The service had a complaints process in place; however relatives felt the service was not responsive when it came to dealing with concerns or complaints. People were supported to raise concerns and said they felt comfortable to raise concerns with staff and the service leads.

People had individual care folders which contained a number of support plans including behavioural plans. Staff knew people well and could provide examples of what personal care support people required and the types of behaviours people displayed and the reasons for this behaviour. People’s care plans were up to date.

Management was not always visible or present at the schemes. Relatives expressed concerns with management and felt communication and relationships needed to improve between them, the registered manager and service provider. Staff felt supported by the service leads within each scheme but felt the registered manager was not always available.

A number of audits were in place. However audits were not always completed accurately and did not help to minimise the likelihood and impact of risks on people and drive improvements at the service. Although some recent audits had identified concerns with the management of medicines and people’s finances, this information was not used effectively to improve quality in these areas.

We identified a number of 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 this report.

Records we reviewed showed us that people had a detailed plan of care that included individual needs and wishes as well as their physical and emotional healthcare needs. We saw that care plans were kept under regular review.

People were protected from the risk of abuse or harm by there being safeguarding policies and procedures in place and by staff knowing how and when to use them.

Risks to people's safety were assessed and plans to reduce and monitor risks to both people using the service and others were recorded.

We saw there was a caring and experienced staff team and that staff were well supported and trained to carry out their duties safely and effectively.

Quality audits were carried out at regular intervals to ensure each service was kept under review. Outcomes from the last audits were positive.

People we spoke with told us they were "very happy with my carer" and "the staff are very kind to us".