Opportunities for Adults and Children

Opportunities for Adults and Children provides care and support for people who may have a learning disability, mental health needs or autistic people. At the time of the inspection, 54 people were receiving support.

The provider had a several 24 hour supported living houses, each with their own allocated house manager and staff team. Other people living in the community received care and support under the same registration.

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

The provider failed to ensure sufficient numbers of suitably skilled, qualified, and experienced staff were deployed to meet people’s needs at all times.

People were not always provided with appropriate support to manage their medicines, and monitoring medication administration was not carried out effectively.

The provider did not always conduct robust assessments to determine risk. Risk was not always managed effectively.

The providers governance systems were not embedded and on occasions failed to drive improvement in a reasonable timescale.

Safe recruitment processes had not always been thoroughly followed. We have made a recommendation about this.

Decisions made in people’s best interest were not always assessed in line with the requirements of the Mental Capacity Act 2005. Records failed to demonstrate referrals had been made to the Court of Protection when this was required.

We received mixed feedback from people, relatives, and staff about the quality of care provided and the organisations leadership and governance procedures.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: Model of care and the setting failed to consistently maximise people’s choice, control, and independence

People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible.

Right Care: Care was not always person-centred and, at times failed to promote people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff sometimes failed to ensure people using services lead confident, inclusive and empowered lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 November 2019).

Why we inspected

We received information of concern relating to the quality of care provided, the leadership within the organisation and the arrangements in place for governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We identified breaches in relation to regulation medicines, staffing and quality assurance processes. Please see the action we have told the provider to take at the end of this report. We have also made a recommendation in relation to recruitment shortfalls found at this inspection.

During our inspection, the provider sent us various action plans, records and correspondence demonstrating they had responded promptly and appropriately regarding the concerns we identified. The provider also contacted the local authority safeguarding team to share information of concern.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Opportunities for Adults and Children on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Opportunities for Adults and Children is a domiciliary care and supported living service which is registered to provide personal care. The office operates from the Wellington Centre in Andover and is run by Andover and District Mencap. They specialise in providing care and support to people with a learning disability. At the time of the inspection the agency was providing a service to ten people living in their own homes and to 21 people living in six supported living houses. People living in three of the supported living houses received 24 hour support from the agency. People living in the other three houses received support at key times of the day. Some people in the supported living service had received care from the same service for many years. They had grown older and so had different needs due to their changing physical capabilities.

The service was safely managed. People felt safely cared for. Personal and environmental risk was assessed, and action was taken to mitigate identified risks. There were sufficient numbers of safely recruited staff to meet the needs of people the agency supported. People received their prescribed medicines as they would expect. Infection control procedures were good.

Staff supported people well and had a good understanding of what their needs and preferences were. Staff had a range of training to help to ensure they could provide the support required to a good standard. They worked well with other agencies so people could experience effective healthcare. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff treated people with kindness dignity and respect. Staff knew the people they supported well and interactions we saw were caring and positive. They ensured they included the views of people and their families in the support they provided.

Plans of care focussed on people’s abilities. People were supported to pursue their hobbies and interests. People made good use of the Wellington Centre which provided employment opportunities for some as well as social and therapeutic activities. The agency responded appropriately to complaints and worked cooperatively with health and social care professionals to continue to develop the service.

The agency had clear vision and values and there was a positive culture which was open and inclusive. Staff felt valued and supported. There were clear governance arrangements in place to drive improvement within the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (March 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Opportunities for Adults and Children provides personal care and support to people in their own homes. At the time of our inspection the agency was providing a service for 36 people with a variety of care needs, including people living with a learning disability or who have autism spectrum disorder. The agency was managed from a centrally located office base in Andover.

The service had a registered manager. 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 service was currently in the process of registering the manager for the regulated activity of personal care.

The manager oversaw the running of the service and was supported by five support managers who were allocated a geographical area to manage. Support managers were responsible for individual parts of the service, for example support to people in a supported living unit or support to people living in their own home.

Some family members felt staffing levels needed to be improved. The manager was aware of our concerns and actions to address them had already been put in place. The agency was actively recruiting to fill staff vacancies and agency staff had been used appropriately to ensure all planned shifts were covered.

People and their families told us they felt safe and secure when receiving care. Relevant recruitment checks were conducted before staff started working at Opportunities for Adults and Children to make sure they were of good character and had the necessary skills.

Staff received training in safeguarding adults and children. They completed a wide range of training and felt it supported them in their job role. New staff completed an induction designed to ensure staff understood their new role before being permitted to work unsupervised. Staff told us they felt supported and received regular supervision and support to discuss areas of development. Staff meetings were held every other month.

The risks to people were minimized through risk assessments and staff were aware of how to keep people safe and the information provided staff with clear guidelines to follow. There were plans in place for foreseeable emergencies.

People who used the service felt they were treated with kindness and said their privacy and dignity was respected. People received their medicines safely. Staff had an understanding of legislation designed to protect people’s rights and were clear that people had the right to make their own choices.

Staff knew what was important to people and encouraged them to be as independent as possible. People were supported to lead full and varied lives and encouraged to make choices.

Staff were responsive to people’s needs which were detailed in people’s care plans. Care plans provided comprehensive information which helped ensure people received personalised care. People felt listened to and a complaints procedure was in place.

Staff felt supported by the manager and could visit the office to discuss any concerns. There were systems in place to monitor the quality and safety of the service provided. Accidents and incidents were monitored, analysed and remedial actions identified to reduce the risk of reoccurrence.

We used this inspection to answer five key questions; is the service safe, effective, caring, responsive and well led?

Is the service safe?

People told us they felt safe. Safeguarding policies and procedures were kept up to date and under regular review. Staff knew how and when to report any concerns.

We saw people's rights and dignity were respected and they were included in the decision making process.

Systems were in place to make sure managers and staff learned from events such as accidents, incidents and complaints.This reduces the risk to people and helps the service to continually improve.

Staff knew about risk management plans and we observed elements of risk management being carried out. This demonstrated to us people using the service and staff were not put at unnecessary risk. People had access to choice and remained in control of their care and lives.

Staff were well supported by their line managers and received regular training, supervisions and meetings.

Is the service effective?

People's health and care needs were assessed by a suitably qualified person and people were involved as much as possible in the decision making process. Care plans we looked at were up to date and reflected people's current care needs.

We saw people had access to an advocacy service and on the day of our inspection an advocacy meeting was being held with a person who used the service. Information about advocacy services was clearly displayed on notice boards and easily accessible to people.

Is the service caring?

We spoke with five people being supported by the service. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; "The staff are lovely", "They are my friend" and "We always have fun".

Staff we spoke with knew the needs and wishes of people and it was clear they genuinely cared for the people they supported.

People using the service and their relatives completed an annual satisfaction survey. We saw that issues raised were dealt with in a timely manner and actioned appropriately.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Complaints procedures were available in written and pictorial representation so that everyone could understand them. We saw complaints had been dealt with in an appropriate manner and were recorded in detail. There had been no complaints since the last inspection.

Is the service well led?

Quality assurance systems were in place which enabled the service to continually learn from and improve the quality of service provided.

Staff told us they were clear about their roles and responsibilities and understood the quality assurance processes. This helped ensure people received a good quality service at all times.

We found that all staff who had worked for the provider for more than 12 months had received an appraisal. We looked at the Continuing Professional Development records for a selection of staff. We saw that there was a clear record of the formal supervisions they had received. These meetings between staff and their line manager gave both people the opportunity to discuss any issues relating to their role or day to day duties.

The people we spoke with said that communication between themselves and the office was very good. One of the relatives we spoke with said:'I have had excellent service; I know there is somebody at the end of the line 24 hours. I am never made to feel I am bothering them.'

People we spoke with all spoke very highly of the support workers who visited their homes. One relative said that when the support worker was with their relative: 'All I can hear is laughing.'

Staff felt that due to their knowledge of people they hoped they would be able to detect any changes in their personality which could indicate a concern. The staff we spoke with explained the procedure they would follow if they suspected any type of abuse was occurring.

Generally staff felt supported by their coordinators, the level of contact they had with other members of their team and the communication with the office. However we had concerns that staff had not had the opportunity to take part in a formal appraisal. This meant that staff had not received support through a formal appraisal system to further their professional development.

Each staff team had regular meetings were any concerns or worries were discussed. One member of staff told us: 'It is nice to get together and be able to discuss what is working and what isn't.'