Archived: St Michael's Support & Care

St Michaels Support & Care provides services to adults with learning disabilities and mental health needs. People who used the service previously lived in hospital, long term residential care or had moved away from their home for the first time. The service supports people in supported living accommodation. At the time of our inspection there were 34 people who received personal care from the service based across five supported living units. During this inspection we visited the office the service operates from and two supported living units. One specialised in provision for people with a learning disability and the other specialised in mental health provision.

We last inspected the service on 7 and 17 April 2014 and found the provider was meeting the required standards at that time.

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.

Most of the risk assessments were recorded and plans were in place to minimise risks. We found risk assessments for two people were not reviewed and updated following a serious safeguarding incident to ensure people were protected at all times.

We did not see evidence that regular and recent fire tests had been carried out at the service to ensure people were safe during an emergency. Staff confirmed recent fire tests had not been carried out but were able to tell us what to do in the event of an emergency. Staff had been trained in fire safety. Checks had been made in gas safety, electrical hardwiring and portable appliance to ensure the premises was safe.

Supervision for the supported living service that provided support to people with learning disabilities was not consistent and regular one to one meetings were not being carried out. Staff had not received annual appraisals. The team leader and registered manager told us this had not been carried out. Supervisions were being carried out in the supported living unit that supported people with mental health needs.

Due to risks to their safety, most people living at the supported living unit that supported people with learning disabilities, were not allowed to go outside without staff or relative accompanying them. Appropriate Deprivation of Liberty safeguards had not been applied for. The registered manager and the team leader told us that people lacked capacity. However, we did not see capacity assessments were carried out to ascertain if people had capacity to make decisions. We were informed that all people living at the service will be assessed in accordance to the Mental Capacity principles.

Spot checks were not routinely documented and there was no information on how often staff had received spot checks. Keeping detailed records of spot checks is important to keep track of the number of checks undertaken and help identify areas of improvements or best practise that could be used in staff supervision and appraisals.

There were appropriate systems in place to monitor the service. Regular audits were undertaken; however, these did not identify the shortfalls we found during the inspection.

Staff and resident meetings were not held regularly at the supported living unit that supported people with learning disabilities. The last staff meeting was held on June 2015 and we did not see evidence of residents meetings being held since May 2015. Staff and resident meetings were regularly carried out in the supported living unit that supported people with mental health needs.

People told us they were happy with the support received from the services. Staff members knew how to report alleged abuse and were able to describe the different types of abuse. Staff knew how to ‘whistleblow’. Whistleblowing is when someone who works for an employer raises a concern about a potential risk of harm to people who use the service.

People were supported by suitably qualified and experienced staff. Recruitment and selection procedures were in place and being followed. Checks had been undertaken to ensure staff were suitable for the role. Staff members were suitably trained to carry out their duties and knew their responsibilities to keep people safe and meet people’s needs.

People were involved in the planning of their care and received a service that was based on their personal needs and wishes. The care plan was then signed by people to ensure they were happy with the care and support listed on the care plan. Care plans were regularly reviewed.

Systems were in place to ensure that medicines were stored, administered and managed safely in both the supported living services we visited.

People had access to healthcare services to ensure their health needs were met. For example people were visited by GP’s, nurses and dentists.

Regular questionnaires were completed by people about the service, which we saw were positive.

There was a formal complaints procedure with response times. People were aware of how to make complaints and staff knew how to respond to complaints in accordance with the service’s complaint policy.

We identified breaches of regulations relating to consent, risk management and staff support. You can see what action we have asked the provider to take at the back of the full version of this report.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

The majority of the people we spoke with were happy with the care and support they received. One person said, 'I'm comfortable here,' and a second person said, 'staff treat me well.' There were warm and pleasant relations between staff and people using the service and relatives we spoke with told us that there had been improvements. One relative said, 'it's better now, they've got the right staff and the managers are doing their best.'

People were being supported to use community facilities and go out for social activities. Staff were identifying what people wished to do and were respecting people's diversity when planning and providing the service. Person centred support plans had been drawn up for people in the learning disabilities side of the service and these were kept up to date and used for planning and delivery support. Managers had set up a monitoring system to check that support was being provided as planned.

People told us they felt safe. We saw that the positive relationships at the units helped towards this as well as the provision of safeguarding training for staff and that safeguarding matters and people's support needs were discussed at team meetings.

The care staff we spoke with demonstrated a good understanding of the aims of the service, policies and procedures and people's needs. Staff told us they felt supported in their work and that staff supervision, staff training and responsive managers all helped to support them.

There were a variety of quality monitoring initiatives designed to test that support was provided as planned. The provider had an overall auditing system and there were also local checks in each unit to monitor the service provided. People using the service were involved in this through use of surveys, meetings and a suggestion box. The service was small enough for people to meet with staff informally each day within the units to discuss support needs and arising matters.

Is the service safe?

People using the service told us they felt safe. One person told us, 'it's alright,' and a second, 'I've always felt safe.' There were positive relations between people using the service and staff and we saw examples of warm interactions. Staff often asked people how they were and what support was needed. Relatives told us that they thought the service was safe. One said, 'I think it's safe. Staff would respond to things I'm sure and let me know.' Other relatives told us that they had seen improvements at the service and could communicate with the managers if needed.

Support plans had been updated and were being regularly reviewed. There were also risk assessments which were being reviewed and we saw that incidents were assessed with action taken if improvements were needed. Staff were knowledgeable about safeguarding matters including how to identify abuse and how to respond to incidents of abuse. Staff had received safeguarding training and the staff team had discussed how best to safeguard people in team meetings.

Is the service effective?

There were checks in place to monitor that support plans were effective and that support was being provided as planned. Team meetings and staff supervision were being used to address any areas where staff needed help or guidance when providing support. Staff had been provided with a range of relevant training and staff demonstrated a good knowledge of these areas as well as the provider policies.

Staff told us that they thought the service was effective because the quality of support had improved, the aims of the service were clearer and managers were more responsive. Relatives, in general, were in agreement that there had been improvements to the service.

Is the service caring?

There had been improvements to the way people were being supported since our last inspection of May 2013. Support plans were now more person centred and there was evidence that people were more involved in how these were drawn up. People were being provided with more opportunities to go out of the unit and take up training, jobs and social activities. Individual wishes and needs were being respected. People's diversity was being respected in the planning and delivery of the service and the service was more responsive to people's culture and ethnicity.

Is the service responsive to people's needs?

The support plans were comprehensive and contained information about people's full range of needs including health care needs and finance. Records were kept of reviews and consultations with healthcare professionals. Regular reviews and ongoing monitoring of people's support allowed the service to be responsive. An example was the support given to one person who wished to adjust their day-to-day programme so that they had more time for social activities. We also noted another example involving supporting people to eat healthily and to attend a healthy eating class.

Is the service well-led?

There were two overall managers. One for learning disabilities and the other for mental health. Both the managers provided staff with clear guidance about the aims of the service. Staff told us that they felt the service had improved and this was due to a clearer way of working and focus on making the service run to the ethos of a supported living service. There were quality monitoring systems in place to check that the service was being provided as planned and there were systems in place to support and train staff for the work they were asked to do. One relative said, 'the management team are much better and they are dealing with this kind of thing."

We spoke with the management team and five care staff. We looked at a sample of support plans and risk assessments and we saw that these had all been updated since our February 2013 inspection. We saw returned surveys from people using the service, professionals and relatives. We were told that work was to start to decorate and improve one of the sites where care is provided. We also found that medication arrangements were properly organised.

The management team told us that further improvement work was planned such as the introduction of regular quality audits. We were told that action had been taken to address staffing arrangements and to make sure people were helped to go out on activities. We met the provider service improvement manager and we were told this person would work at the service until the improvements were made

People using the service told us that staff were kind and respected their privacy and we saw evidence that people who use the service were able to go out to the local community.

People using the service had their own individual support plan. However these plans were not always up to date and risk assessments had not always been reviewed on a regular basis.

People told us that they felt safe with the staff who supported them. They told us they had no concerns about this service but would talk to their relatives if they needed to. One person told us, 'I'm happy with the staff. They treat me OK.'

Staff were positive about the training provided by the agency and confirmed they had undertaken supervision recently so they could discuss their learning and development needs.

The provider did not have an effective system to regularly assess and monitor the quality of service that people receive.