Archived: East Lancashire Deaf Society

At the time of our inspection this service was registered with the Care Quality Commission (CQC) as East Lancashire Deaf Society. However the registered manager informed us the service was trading as Lancashire Rose Care Services, operated by East Lancashire Deaf Society. The provider was in the process of changing the registration information held by CQC in order to ensure this accurately reflected who was responsible for the service.

The service specialises in offering support to people who use deaf sign language by providing staff with appropriate communication skills. The range of services provided includes personal care, support with community activities and daily living. At the time of this inspection there were 13 people using the service across Lancashire and Cumbria.

The service had a registered manager in place as required under the conditions of their registration with the Care Quality Commission. 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 three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because recruitment processes were not sufficiently robust to protect people who used the service from unsuitable staff, a complete record had not been maintained of the support people required and quality assurance systems in the service were not sufficiently robust to identify this shortfall regarding care records. You can see what action we have told the provider to take at the back of the full version of the report.

When we looked at the recruitment records relating to three staff we noted all the personnel files included references and pre-employment checks. However we saw that the application form for one person contained gaps in employment which had not been explored by the registered manager at the time of interview; such checks are important to ensure people who use the service are protected from the risk of unsuitable staff. The registered manager told us they would amend their recruitment procedure with immediate effect.

We noted that there were no support plans in place on three of the care records we reviewed. The registered manager told us that they were relying on the assessment completed by the local authority to determine the support each person required, although they acknowledged that this did not give specific guidance to staff about how they should meet each individual’s needs. In addition they told us there was no system of care plan audits in place which would have identified that these records had not been completed. We were told that action would be taken to ensure support plans were put in place as a matter of urgency.

Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who used the service from the risk of abuse. They told us they would also be confident to use the whistleblowing procedure in the service to report any poor practice they might observe. They told us they were certain any concerns they raised would be taken seriously by the managers in the service.

We were told that staff were matched with people who used the service; this helped to ensure they had the best chance of getting on well together and being able to provide the support individuals required.

Although most people who used the service did not require support from staff to take their medicines as prescribed, we saw that arrangements were in place to ensure all staff received training in the safe handling of medicines. Spot checks were completed by the registered manager to help ensure that staff were working in line with the service’s policies and procedures regarding the safe administration of medicines.

Risk assessments for physical and mental health needs as well as environmental risks helped protect the health and welfare of people who used the service. Staff were aware of the action to take to prevent the risk of cross infection should they be required to provide personal care to people who used the service.

Where necessary people who used the service received support from staff to ensure their nutritional needs were met. People told us staff would accompany them to appointments if necessary to help them communicate their needs to health professionals.

Staff told us they received the induction, training and supervision they needed to be able to deliver effective care. We noted that staff had not completed specific training in the Mental Capacity Act (MCA) 2005; this legislation helps to ensure that people are supported to make their own decisions wherever possible. Both staff and the registered manager told us all people using the service at the time of the inspection were able to make their own decisions. The registered manager was aware of the action they would need to take if this situation were to change in order to ensure people’s rights were upheld.

The registered manager and staff we spoke with were caring and respectful in the way they spoke about people who used the service and the way they provided support. Staff demonstrated a commitment to providing person-centred care and supporting people to be as independent as possible.

We saw that systems were in place to involve people in reviewing the support they received. We were told that, if they considered a person’s needs had changed, the registered manager would contact the relevant local authority to request a review of the commissioned care package. This helped to ensure people received the appropriate level of support for their needs.

We noted that there was a complaints procedure in place for people to use if they wanted to raise any concerns about the care and support they received. We saw that the registered manager responded immediately they were informed of minor concerns a person had shared with us during the inspection. The registered manager provided feedback to us about the action they had taken to ensure the person always received the support they wanted.

Staff supported people to attend social activities, including deaf clubs, to help prevent social isolation and maintain people’s health and well-being. Social workers who had been involved in commissioning packages of care from the service told us they considered people received high quality care and support from staff.

Staff told us they enjoyed working in the service. They commented that the registered manager and other senior staff were always approachable and supportive. They also told us they felt able to use staff meetings to make suggestions as to how the service could be improved.

Below is a summary of what we found. The summary is based on speaking with one of the two people who were using the service at the time of our inspection. We also spoke with two staff and looked at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

The person we spoke with who used the service told us they were happy with the support they received. They told us, 'I feel safe when I see my support workers'.

Systems were in place to complete and update risk assessments regarding the support people needed. People were not placed at unnecessary risk but remained in control of the decisions about how their support was provided.

Policies were in place in relation to the administration of medicines. This should help ensure, when necessary, staff were able to support people to take their medicines safely.

Is the service effective?

People's health and social care needs were assessed with them and they were involved in writing and updating their support plans. We were told, 'I will be having a review in May but I want my support to stay the same'.

Staff told us they promoted people's independence and encouraged them to do whatever they could for themselves.

Is the service caring?

Staff knew the people they supported well, including their backgrounds and personal preferences. The person we spoke with who used the service spoke positively about the staff who were involved in supporting them. They told us, 'I like both my support workers; they are very nice'.

Is the service responsive?

Systems were in place to record concerns or complaints from people who used the service or their representative. People had been asked their opinions about the support they received. We saw some action had been taken to address any comments or concerns raised.

Is the service well-led?

Although the service had a manager registered with the Care Quality Commission (CQC), we were told this person was no longer responsible for East Lancashire Deaf Society as they had transferred to another managerial position within the organisation. During our visit we spoke with the person who had been responsible for managing the service since November 2013 although they had not yet submitted an application to register with CQC. They assured us they would make the necessary application as a matter of urgency.

Staff told us they felt the service was more organised since the new manager had been in post. They told us they were always able to contact the manager for advice and support.

Systems were in place for the manager to monitor the effectiveness of support provided by staff.

We reviewed the care files of four people who used the service and found evidence that there were procedures in place to ensure their consent was gained in relation to the support provided for them.

We found that care files contained individualised support plans which were based on an assessment of the needs and strengths of people. We found that support plans and risk assessments had been reviewed on a regular basis.

People spoken with told us they were happy with the staff who were employed to support them. We found there were appropriate arrangements in place to ensure support was provided flexibly to meet the needs of people.

At our previous inspection on 25 February 2013 we found the provider did not have sufficient arrangements in place to monitor the quality of the service provided. On this visit we found improvements had been made to the quality assurance systems and positive feedback had been received on the support provided.

We found the provider had appropriate arrangements in place to ensure records were stored securely. We saw that records relating to the support of people were updated on a regular basis.

Following the inspection visit we were sent an action plan informing us the recruitment and selection procedure would be amended and that a number of quality assurance mechanisms would be put into place.

We revisited the service and found improvements had been made in the recruitment and selection procedures of staff to the service which meant that people were protected from the risk of unsuitable staff. However, the relevant policies still required updating.

Although we found improvements in some aspects of the quality assurance processes, further work was required to ensure there was an effective system in place to monitor the quality of the service provided.

We were told that people were happy with the care they received. The carer told us that their relative always looked forward to the visits from the support worker who was described as being "fantastic". We were also told by the carer that the specialist communication skills of the staff were important and ensured that the needs of the person using the service were understood and met in an appropriate manner.

Staff had access to safeguarding policies and procedures and were aware of how to raise a safeguarding concern. People spoken with told us they had no concerns about the service provided.

We found that staff were provided with appropriate support and training to ensure they could effectively meet the needs of people using the service. However the recruitment and selection procedure needed improving to ensure that people using the service were protected from unsuitable staff.

We found that systems in place to monitor the quality of the service needed improving. This was necessary to ensure that people using the service were protected against the risks of inappropriate or unsafe care.