Archived: Care and Support Sunderland

This inspection took place on the 5, 6, 7 and 10 August 2015 and was announced. This meant the provider knew we would be visiting. This was the first inspection of Care and Support Sunderland.

Care and Support Sunderland provides personal care for adults who have a learning disability in several separate supported living services. They are all close to local amenities such as shops and community centres. At the time of the inspection there were nine supported living services. Some people lived on their own, in other services six people lived together.

At the time of the inspection there was a registered manager in post. 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 organisation was introducing a new training strategy which changed refresher timeframes for training. Some of the houses we visited had very organised training records and we could see that training was in date; in one house however we were unable to assess whether training was up to date as systems were quite disorganised. Training needs analyses were in place which identified required training and a new training strategy was being implemented.

Staff said they felt well trained and well supported. We saw that the staff had regular supervisions but not all staff had recorded evidence of an annual appraisal.

Some of the care records we viewed included mental capacity assessments which had assessed that people lacked the capacity to make decisions around care and treatment. They also had reviews which stated that consideration should be given to applying for community DoLS. We asked staff in other houses about deprivation of liberty safeguards (DoLS) and mental capacity and they explained that assessments were required and that social workers had been reminded but we saw no evidence of this. One operations manager said, “Customers at [house] do not require DoLs due to any restrictions with the home presently.” This was in relation to the house where reviews stated consideration should be given to applying for DoLS.

Not all care records had been kept up to date. We found the support being provided to one person was in line with new guidelines from specialist healthcare professionals but their care records did not reflect their current needs. In another house care plans were dated 2012; they had been reviewed on a regular basis and temporary changes to care had been recorded on implementation sheets but the care plan itself had not been re-written which meant people may not have received the appropriate level of care to meet their current needs.

In other houses care records were up to date; detailed and contained specific information about the person’s preferences and routines. People and their relatives were involved in care planning and in one house the people living there had written their own care plans with the support of staff.

People and their relatives told us they were safe living at Care and Support Sunderland services. Staff were knowledgeable about protecting people from harm and a recent campaign had been launched to encourage staff to speak up about concerns; this gave a direct line of contact with the chief executive officer.

Bed side guides had been introduced which included a range of information needed by staff who were supporting people with mobility needs; this included an occupational therapist assessment and a record that information and moving and handling strategies had been cascaded to all staff.

Care and support plans had integral risk assessments which identified control measures for managing and reducing risk. Emergency contingency plans were in place in relation to specific risks such as epilepsy and behaviour which might challenge the service as well personal emergency evacuation plans.

There were mixed messages about staffing levels. Some staff explained that they had moved services several times which they had found unsettling, but they did say that when they raised this with the manager they hadn’t been moved again. Some relatives had also commented that there had been lots of changes over the past year. Others said there were enough staff.

Staff were recruited in a robust way which had recently included a panel of relatives; induction was well organised and included the care certificate; two weeks of training and in-house induction.

Medicines were managed safely although some care plans were more individualised than others.

Care plans in relation to managing behaviour which may challenge were detailed and well evaluated.

Referrals had been made to specialist health care professionals for people who had specific needs in relation to epilepsy management; behaviour management and dietary needs.

Relatives felt their family members were well cared for. One relative said, “One thing that gives the greatest comfort is knowing they are well cared for.” People also told us they liked living where they did.

Relatives said they knew how to complain and we saw there were procedures in place for staff to follow should any concerns or complaints be raised.

There was an open culture and several lines of communication in place to ensure people, their relatives and staff were kept up to date with changes happening across the organisation. Staff were positive that the changes were improving the quality of the service provided and motivation remained high. One relative said, “If there is something they always consult us.”

There were a range of audits in place to monitor and assess the service, some of which were repetitive and time consuming but there was work being completed to streamline the quality assurance process to ensure it was fit for purpose.