Together for Mental Wellbeing Supported Living Branch

Some people living at Together for Mental Wellbeing Supported Living Service did not receive a regulated activity from the service. The Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’, which includes help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection, the service supported 31 people living in three locations and they only provided regulated activity of personal care to nine people.

Together for Mental Wellbeing Supported Living Service provided support for people living with mental health conditions.

At the last inspection, carried out on 4 December 2017, the service was rated Requires Improvement, with Requires Improvement in well-led. We found that the Care Quality Commission was not notified about the important events taking place at the service as required by law.

At this inspection we found that improvements had been made and we rated the service Good.

The service had a registered manager. A registered manager is a person who has registered with the CQC 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 registered manager was managing one of the supported living sites and they were supported by two project managers who managed the other two sites of the service.

Staff followed the service’s procedures to provide immediate support to people should they notice them being at risk to abuse or when incidents and accidents took place. Staff provided references and carried out criminal records checks before they started working with people. People were enabled to manage their medicines independently as necessary. Risks to people's social care needs were appropriately identified and assessed which provided staff with guidance on how to mitigate the potential risks to people. However, it was noticed that risks related to sharps were not recently assessed and that information was missing regarding the severity and likelihood of the identified risks which the registered manager agreed to review as necessary.

People had their care needs identified and the support plans put in place to meet their chosen life styles. People’s health needs were adhered to when they needed medical attention. Staff were provided with effective support and training to help them to carry out their responsibilities as required. The staff team were trained to support people in the decision-making process as required by the Mental Capacity Act 2005 (MCA). However, some staff were not up-to-date with the required training courses but the service took immediate action to address this.

People spoke positively about the staff team that supported them and noted that staff knew what was important to them. Staff attended to people’s needs with care and kindness. People felt they were respected and had their personal information kept securely. Staff supported people to learn new skills in all areas of their daily lives to increase their independence as much as possible.

Care records were detailed and held information related to the support people required to go out in the community and meet their personal care needs. People were encouraged to share their experiences and provide feedback about the services they received. Staff helped people to gather information about the external resources available for them to use which supported their social inclusion.

People felt that the service was well led and the management team was available for support when they needed it. The culture of the service promoted team working and staff’s involvement in making decisions about the care delivery. Regular audits were carried out to review the quality of the services provided for people and to ensure ongoing monitoring and improvement of the service.

Together for Mental Wellbeing Supported Living Branch provides care and support to people living in a ‘supported living’ setting, so that they could live in their own home as independently as possible. People’s care and housing were provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service provided support for people living with mental health conditions. Not everyone receiving support from Together for Mental Wellbeing received the regulated activity. CQC only inspects the service being received by people provided with the regulated activity ‘Personal Care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection, the service supported 35 people in two locations in Surrey and one in East Sussex. At the time of our visit, they provided regulated activity of personal care to 13 people

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 registered manager was managing one of the sites within the Together for Mental Health Living Branch. They were supported by two service managers managing other two sites of the service. All of the three managers had appropriate training and experience to manage the regulated activity of personal care.

The service helped to protect people from avoidable harm. Staff received training in safeguarding people and they knew how to recognise and report safeguarding concerns.

Risk to people’s health and safety had been assessed and staff had sufficient guidelines on how to support people safely and reduce identified risks. The provider’s robust recruitment systems ensured people were protected from unsuitable staff. Sufficient staffing levels ensured that people’s needs were met promptly. Appropriate arrangements around medicines management supported people in taking their medicines safely and as intended by a prescriber. However, the registered manager had not notified the CQC about incidents as required by regulations.

People had their needs and choices assessed prior to moving into the service and there was an additional settling in period following their admission which aimed to help make the moving in process more comfortable.

New staff received an in-depth induction and other staff received regular refresher training that the provider considered mandatory. Staff had regular support from their line managers, which was in the form of one to one supervision meetings, team meetings and day-to-day conversations.

Staff supported people to have a nutritious diet that was in line with their dietary needs and personal preferences. When people’s health deteriorated, staff took appropriate action to ensure people had access to respective health professionals and services.

The service worked within the principles of the Mental Capacity Act 2005 (MCA) and staff sought people’s consent before providing any care and support.

Staff who supported people were considerate and compassionate. Staff and the management team placed people who used the service at the centre of the care and support provided to them. People were encouraged to express themselves and stay in touch with their personal needs and cultures. Staff supported people in protecting their privacy and dignity at all times.

Care provided to people was individual and reflected people’s care needs and personal preferences. People were involved in planning and reviewing of their care, which was discussed with them regularly throughout their stay at the service. Consequently, staff had sufficient information and guidelines on how to support people effectively and in line with their preferences.

The provider had a complaints policy in place and staff supported people in using the complaints process when required.

Staff thought the service was well led and they spoke positively about the management team. Staff felt informed about the matters related to the service provision. Staff were involved in the development of the service and, they said, their suggestion and ideas were taken into consideration.

The service sought people’s opinion about the service and people said they could speak to staff and the management any time if they had any problems or concerns. The management team had systems in place to ensure on-going monitoring and improvement of the service. Appropriate policies and procedures provided staff with guidance to help them to carry out their roles safely and effectively.

The service received positive feedback from external health and social care professionals.

We found one breach of the Health and Social Care Act 2008 (Registration) Regulations 2009.

People were enabled to carry on living in a home environment because staff managed their care safely and encouraged people to be as independent as they wished and carry on with activities with assistance. People were involved in drawing up and reviewing their own care and support plans. Staff had been trained to meet individual people's needs and told us they were well supported by the management team. Staff were supervised and received annual appraisals which included discussions of training needs.

We spoke with one person receiving personal care who described the staff as "very helpful and kind'. We saw one recent survey of the service from another person who rated the care and support as 'very good'. People using the service were encouraged to give their feedback and discuss any concerns. Appropriate information about people's medical and social needs was taken when they first started using the service and risk assessments were undertaken and updated to ensure people's safety. There were plans in place for what to do in an emergency which staff were aware of.

Staff had been trained in safeguarding. They knew how to recognise signs of possible abuse and how to report any concerns (including to the local authority).

People who use the service had opportunities to feed back information and the service was responsive to changes on the basis of feedback received.