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Cheshire Care Services Ltd t/a Independent Living Support Good

Reports


Inspection carried out on 2 December 2019

During a routine inspection

Cheshire Care Services provides personal care to up to 14 people who live within 10 separate supported living properties. The service provides support for older people and younger adults and those with physical disability, mental health needs, dementia or learning disabilities or autism. At the time of the inspection there were six people using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Care plans lacked background information about people however staff members were knowledgeable about people’s backgrounds. We found some people’s care plans referred to a staff room being located in people’s homes. People who live in supported living properties should have access to all rooms within their homes.

People felt safe and their needs were being met. Relatives told us people were safe and raised no concerns over how staff supported people. Staff knew how to escalate issues and concerns and were aware of potential risks when providing support. New staff received induction and shadowing. Staff received regular training, supervision and appraisals.

People felt well cared for by staff who treated them with respect and dignity and encouraged them to maintain relationships and keep their independence for as long as possible. People could maintain friendships and contact with families, and when needed had access to advocates.

People felt staff supported their individual needs and requirements. People received food and drinks as required and attended any medical appointments. People were supported in the least restrictive way possible and in their best interests.

Staff liaised with other health care professionals to ensure people's safety and meet their health needs. Where people lacked capacity, staff worked with the local authority to make sure they minimised any restrictions on people's freedom for their safety and wellbeing.

Staff spoke positively about working for the provider. They felt well supported and that they could talk to management at any time, feeling confident any concerns would be acted on promptly. They felt valued and happy in their role.

The service applied the principles and values of Registering the Right Support and other best practice guidance. 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.

Rating at last inspection: The last rating for this service was Good (published 14 June 2017).

Why we inspected: This was a planned comprehensive inspection based on the rating of good at the last inspection.

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

Inspection carried out on 8 May 2017

During a routine inspection

Our inspection took place on 08 May 2017 and was unannounced.

At our last inspection on 27 July 2015 the service was rated good in four of the five questions we ask: Is the service effective? Is the service caring? Is the service responsive? Is the service well-led? The remaining question, ‘Is the service safe?’ was rated as ‘requires improvement’ as improvement was required in relation to medicine management. During this, our most recent inspection, we found that improvements had been made in that area.

The provider is registered to provide personal care to adults. People received their care and support within supported living facilities where more than one person could live in a house, or in their individual homes within the community. Supported living enables people who need personal and/or social support to live in their own home supported by care staff instead of living in a care home or with their family.

The manager was registered with us as is required by law. The registered manager was on leave on the day so the assistant manager was involved in our inspection process. 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.

Medicine systems had improved which confirmed that people had been given their medicines as they had been prescribed. Staff were available to keep people safe, to allow care and support to be provided flexibly and to meet all people’s needs. Staff were aware of the procedures they should follow to ensure the risk of harm and/or abuse was reduced. Recruitment processes ensured that unsuitable staff were not employed so reduced the risk of harm to people.

Staff told us that they had received the training, [and refresher training had been secured] to provide them with the knowledge they needed to support people appropriately and safely. Staff knew that people must receive care in line with their best interests and not be unlawfully restricted. Consent was obtained before support was provided. Meal options were offered to ensure that people’s food and drink preferences were met. Input from a range of external healthcare professionals was secured to meet people’s healthcare needs.

Staff promoted a friendly atmosphere within the supported living services. People were supported by staff who were friendly and caring. People were encouraged to make decisions about their care and support. People were treated with dignity and respect and their independence was promoted. People could see their family when they wished to.

People and their relatives were involved in the pre-admission assessment of need process and follow on review meetings. Systems were in place for people and their relatives to raise their concerns or complaints if they had a need to. People could attend religious services if they wished to and accessed leisure activities that they enjoyed.

People, staff and relatives felt that the quality of service was good. The registered manager, the assistant manager and provider carried out regular audits and spot checks to determine good practice and shortfalls where changes were then implemented to improve. People and relatives were aware of who the registered manager, assistant manager and provider were.

Inspection carried out on 27 July 2015

During a routine inspection

Our inspection took place on 27 July 2015. The provider had a short amount of notice that an inspection would take place. This was because we needed to ensure that the registered manager or provider would be available to answer any questions we had or provide information that we needed. We also wanted the registered manager or provider to ask some people who used the service if we could visit them in their homes.

The service offered personal care and support to adults who lived in their own flats or houses in the community. At the time of our inspection 16 people received support and/or personal care from the provider. People who used the service had needs associated with living with a mental health condition and/or a learning disability.

At our last inspection of 16 June 2014 the provider was meeting the regulations that we assessed.

The manager was registered with us. 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.

We found that medicine management systems needed some improvement so that people would consistently receive their medicine safely and as it had been prescribed by their doctor.

Staff had received training about safeguarding the people in their care. People told us that they had not suffered any abuse or bad treatment. People safe and relatives had no concern about their family member’s day to day safety.

Our inspection findings assured us that there were enough staff to keep people safe. A number of staff had left that had caused people having to be supported by different staff which led to a lack of consistency. The provider had started to take action to address this.

The people and their relatives that we spoke with told us that the service provided was good and effective and met their or their family member’s needs. Feedback that we received provided evidence that the service was effective and met peoples needs in the way they wished.

Staff had understanding and knowledge regarding the Mental Capacity Act and the Deprivation of Liberty Safeguarding (DoLS). This ensured that people who used the service were not unlawfully restricted.

Processes were in place to induct new staff to ensure that they had the support and knowledge they required when they first started work. Staff were adequately supported on a day to day basis in their job roles, received formal one to one supervision sessions and had the opportunity to attend staff meetings.

People who used the service described the staff as being nice and kind. Relatives told us that the staff were polite and showed their family member’s respect.

A complaints procedure was available for people to use. People and their relatives confirmed that they were confident that any dissatisfaction would be looked into or dealt with effectively.

There was a strong and consistent management team that people and relatives could access if they had the need. The registered manager and provider had established systems to ensure people were safe and their needs were met.

Inspection carried out on 16 June 2014

During a routine inspection

In this report the name Mrs Tracy Archer appears. This person was not in post and not managing the regulatory activity at this location at the time of this inspection. Their name appears because they were still identified as the registered manager on our register at the time.

The care provision was personal care and support. This meant that people lived in their own homes within the community and staff provided the care and support that they needed.

Our inspection was unannounced. On the day of our inspection ten people received personal care packages from the service. Additional people received support that did not involve personal care provision, for example, shopping and community access support. Day care was also provided. However, we did not inspect this area of care as day care did not fall within our regulations.

With their permission we spent time at the homes of four people who used the service so that we could meet and speak with them and the staff who provided their care and support. We also spoke with two relatives by telephone and asked the local authority their view on the standard of service provided. We looked at questionnaires that had been completed by relatives and people who used the service. We did this so that we could get a picture of what it was like for the people who used the service and to find out their views.

All of the people who used the service and their relatives we spoke with were complimentary about the service and care provided. One person said, �I think it is good and I like the staff�. Another person told us, �I am happy and the staff are nice�. One relative told us, �The service is good�. Another relative said, �They are cared for and given a lot of opportunities�. Feedback from the local authority was that the care provided was good and that there were no concerns at that time.

The summary is based on our observations during the inspection, discussions with people who used the service, the staff supporting them, and by looking at records. If you wish to see the evidence supporting our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. This is a summary of what we found:

Is the service safe?

The provider had a rolling training programme that covered core areas such as safeguarding vulnerable adults which incorporated the Mental Capacity Act. Staff we spoke with had some knowledge about the need to uphold people�s rights. The duty manager told us that if they identified issues concerning possible harm or limitations being imposed on people they would speak with the relevant professionals in the local authority safeguarding team.

Safeguarding procedures were in place so that staff would recognise and report any allegations of abuse to protect people from the risk of harm.

We found that systems were in place to manage day to day risks and to promote safety. This included the monitoring of falls. We found that where staff had identified concerns regarding risks associated with people�s health and welfare they had been referred to appropriate agencies.

Recruitment processes were in place which gave people who used the service assurances that only suitable staff had been employed.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was safe.

Is the service effective?

All of the people we spoke with confirmed that they were happy with their care and support. They told us that the service provided met their needs. One person said, �They look after us well�.

All staff we spoke with told us that they felt that the people were well cared for and were safe. One staff member said, �The service we provide is very good. All people are well cared for�.

We found that systems were in place to ensure that people could select food and drink which was nutritious and varied. One person said, �I enjoy the food�.

People had their needs assessed and staff knew how to support people in a caring and sensitive manner. The care records showed how they wanted to be supported and people told us they could choose how this support was provided.

We found that staffing numbers were adequate to meet people�s needs and preferences.

Staff received on-going support from senior staff to ensure they carried out their role effectively. All staff we spoke with told us that they felt supported. One staff member said, �All seniors and the manager are good. We can call for help any time of the day or night. We feel supported�.

Arrangements were in place to request heath, social and medical support to help keep people well.

We found that the provider had processes and systems in place to meet the requirements of the law to ensure that the service was effective.

Is the service caring?

We saw that care was provided with kindness and compassion. People told us that they could make choices about how they wanted to be supported, and that staff listened to what they had to say. All of the people we spoke with were extremely complimentary about the staff. They described them as being, �Kind� and �Caring�. One person who used the service said, �The staff are all very nice�.

We spent some time observing interactions between staff and the people who used the service. We saw that staff showed patience when supporting people.

The staff knew the care and support needs of people well enough to ensure individual personal care was provided.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was caring.

Is the service responsive?

We found that people were asked if they wanted to raise any issues. This showed that the provider was willing to listen to the views of the people who lived there to improve the overall service provision.

We found that the provider had taken note of the findings from our previous inspection and had taken action to address issues for example; records had been produced to show that people consented to their care.

When people became unwell the staff noticed this and secured appropriate medical input.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was responsive.

Is the service well led?

The registered manager left the service a month prior to our inspection. Staff we spoke with all confirmed that a new manager had been appointed and was due to start their job soon.

The staff were confident they could raise any concern about poor practice at the service and these would be addressed to ensure people were protected from harm.

Plans and systems were in place to ensure people knew how to act in the event of any emergency to keep people safe.

The staffing was organised to ensure people�s needs were met and support was available for any appointments and activities.

We found that the provider had adequate processes and systems in place to meet the requirements of the law to ensure that the service was well led.

Inspection carried out on 17 January 2014

During a routine inspection

On the day of our inspection we found that twenty two people used the service. We met and spoke with three of these people and one relative on the telephone following our visit. We spoke with the registered manager and five members of care staff. We looked at four people's care records and four staff files. We looked at the provider's policies and documents relating to the quality of the service including a report from the local authority contract monitoring team.

We found that the provider did not have a consent policy in place or a process to gain people's consent to the care they received.

We found that staff had an understanding of the needs of people who used the service. We found that care and treatment was planned and delivered in a safe way, which met people's individual care needs. People we spoke with were positive about the care they received. One person told us, "The staff are very good and caring."

We found that the provider worked well with other services to ensure the health and wellbeing of the people who used the service. One person told us, "They help me with my appointments."

We found that staff were supported to carry out their role and received training on a regular basis.

We found that the provider did not have systems in place to monitor and improve the quality of service provided.

Inspection carried out on 2 January 2013

During a routine inspection

This inspection was unannounced so no one knew we would be going there. During our inspection we spoke with one relative, three staff, the manager and the registered provider. We also spoke with three people who were using the service. We spoke with two of those people by phone and spoke with the third when we met with them at the registered provider�s office. People we spoke with told us positive things about the overall service provided. One person told us, "I am very happy and have a good service". Another person said "I am very happy with my care and my staff". A relative told us, "I would say that the service is excellent. The staff meet all our requirements�.

People told us that choices were offered and their views had been taken into consideration. They also told us that their privacy and dignity was promoted and maintained.

Staff ensured that where needed people were assessed by a range of health professionals including specialist doctors and the optician. This meant that staff had enabled people to have their health care needs monitored and met.

Staff were able to give a good account of what they would do if they were concerned about anything or witnessed abuse.

Recruitment processes ensured that staff members were suitable to work with the people using this service which protected them from harm.

We found that systems had been used to monitor how the service had been run and people had been encouraged to raise concerns.