Independent Living Centre

At our comprehensive inspection on 30 November and 02 December 2016 we found breaches of legal requirements as risks to people had not always been identified, assessed adequately, or steps taken to mitigate them. Recruitment checks were not always robust and did not always demonstrate that staff were of good character. Records relating to people’s medicines were not always properly completed and staff had not always taken action in good time to ensure people had sufficient stocks of their prescribed medicines at home. Staff had not always completed training or refresher training in line with the provider’s requirements and staff had not received supervision in line with the provider’s policy. The provider’s systems to assess and monitor the quality of the service provided were not always effective. Records relating to people’s care records were not always accurate and up to date and the provider had not always sought feedback from people using the service to help drive improvements.

The provider wrote to tell us the actions they would take to address these concerns by 28 February 2017. We undertook an announced focussed inspection on 25 April 2017 in relation to the warning notices we served on Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that action had been taken and improvements made but the systems and processes that had been implemented had not been operational for a significant amount of time for us to be sure of consistent and sustained good practice.

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.

At this inspection, we found that the issues we had identified had been addressed, in line with the provider’s action plan. Risks to people had been assessed, identified and with appropriate management plans in areas such as moving and handling, medicines management, eating and drinking and falls. Appropriate recruitment checks took place before staff started working with the provider to and were vetted to be of good character and suitable for the role they had applied for in social care. People were supported with their medicines safely and staff ensured there was sufficient stock of medicines for people and records relating to people’s medicines were completed properly.

The provider had training courses that were mandatory and all staff training were up to date. Staff had also completed training relevant to people’s needs and had completed an induction when they first started working with the service. Staff were supported with regular supervision and appraisals in line with the provider’s requirement.

Appropriate systems had been put in place to assess and monitor the quality of the service. People’s care records were up to date and reflective of their care needs. People’s views were sought through telephone monitoring calls, home visits and annual satisfaction surveys and staff views were sought through regular team meetings.

People told us that adequate numbers of staff were deployed to support them; however we had mixed feedback on staff punctuality. Staff said the current staffing numbers in place were appropriate to support the number of people using the service. The provider had safeguarding policies and procedures in place and staff knew of their responsibility to report and records any concerns of abuse to their manager. People were protected from the risk of infection because staff were aware of the provider’s infection control practices.

Before people started using the service their needs were assessed to ensure the service would be suitable and their needs met. People were supported to eat sufficient amounts for their well-being. The provider worked well within and across organisations such as the local authority to plan and deliver an effective service. People said they made their own arrangements for healthcare appointments but where required, staff supported them to access healthcare services. Staff were aware of the need to seek consent from people and work in line with the requirement of the Mental Capacity Act 2005 (MCA).

People were involved in planning their care and support needs. Staff demonstrated a good understanding on supporting people under the Equality Act. People’s privacy and dignity was respected and their independence promoted. Staff demonstrated a good knowledge of the people they supported including their support needs and preferences.

Each person using the service had a care plan which was reviewed regularly to ensure their needs were met. People were supported to be engaged in activities that interest them. The provider had a complaints policy and procedure in place which provided guidance on how to raise a complaint. People were provided information about the service so they know the level of support to expect. The provider had arrangements in place to support people with end of life care; however, no one using the service at the time of this inspection required such support.

People told us the service was well-led and staff said their manager was open and addressed issues quickly. Staff teams were aware of the provider’s values and visions. The provider worked in partnership with key organisations to drive improvement. The provider kept records of accidents and incidents and continuously learned to improve on the quality of the service.

We undertook this focused inspection to check that the provider met our legal requirements. This report only covers our findings in relation to the breaches identified in the warning notices. We will follow up on the other breaches of legal requirements at our next inspection. You can read the report from our last comprehensive inspection, by selecting the link for The Independent Living Centre on our website at www.cqc.org.uk.

The Independent Living Centre provides care and support for people in their own homes. Most people using the service have a physical disability or a sensory impairment. At the time of this inspection ten people were using the service.

At this focused inspection on the 25 April 2017 we found that the provider had addressed the breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were compliant with the warning notices we served. Risks to people had been identified, assessed and steps were being taken to mitigate them. The provider's systems for assessing and monitoring the quality and safety of the services provided had improved and the provider had sought feedback from people using the service to help drive improvements.

However the ratings for the key questions safe and well led at this inspection remain ‘Requires Improvement’ at this time as systems and processes that have been implemented have not been operational for a sufficient amount of time for us to be sure of consistent and sustained good practice.

The Independent Living Centre provides care and support for approximately 40 people, many of whom have a physical disability or sensory impairment.

The current manager was in the process of applying to become the 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.

At this inspection we identified breaches of regulations because risks to be people had not always been fully assessed and guidance was not always in place for staff on how to manage risks. There were sufficient staff deployed by the service to meet people's needs but recruitment checks did not always demonstrate that staff were of good character. People told us they received their medicines as prescribed but records relating to the administration of people's medicines were not always properly completed and staff had not always taken action in good time to ensure people had sufficient stocks of their prescribed medicines at home.

Staff received an induction when they started work at the service but had not always completed training or refresher training in line with provider's requirements. Staff told us they were supported through supervision but records showed that staff had not always received regular supervision in line with the provider's policy. The providers systems for monitoring the quality and safety of the service, and for seeking feedback from people using the service were not always effective and did not always drive improvements. Records relating to people's support were not always accurate and up to date. The provider had not always submitted notifications to the Commission as required.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We also found that improvement was required to ensure the service had systems in place to comply with the Mental Capacity Act 2005 (MCA).

People told us that staff were kind and caring, and that they were involved in decisions about their care and treatment. Staff treated people with dignity and respected their privacy. People told us they had been consulted about their care needs and that the service was flexible and able to meet their individual needs and preferences. They were aware of how to raise a complaint and expressed confidence in the management of the service.

Staff had received training in safeguarding adults and were aware of report any concerns they had if they suspected someone had been abused. They told us they were well supported by the manager and senior staff and were aware of the importance of seeking consent from the people they supported. People told us they were supported to maintain a balanced diet, where this was part of their care plan and that staff helped them to access healthcare services if required in support of their well-being.

The family of the person who used the service told us the service had recently commenced and the staff had a good beginning in the process of getting to know them, and already understood how to provide for their needs safely and competently. They said: 'the staff are friendly and respectful and always take their time and don't rush the support'. The person said they were given choices about how care was delivered and that they felt their relative was safe and well cared for. The person told us that the agency manager had also visited them to introduce the staff who would work with them.

The staff understood how to keep people safe and understood their responsibilities for reporting concerns if necessary. The provider ensured that the staff were trained and supervised so that they were up to date in their practice and supported people safely. There was a system in place to effectively monitor the quality of care provided, including monitoring concerns and complaints where necessary.