Livability Somerset

About the service

Livability Somerset is a supported living service. It provides care and support to 20 people who have a learning disability across three locations in Bridgwater, Burnham on Sea and Bath.

People's experience of using this service and what we found.

The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.

Right Support

People were supported to have maximum possible choice and control of their lives and staff sought to support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. There was ongoing work to keep restrictive practices under review.

People were supported by staff to be involved in decisions about their care and support. Staff used individual communication methods to enable people to express themselves. There was work ongoing to ensure ongoing improvement to support with communication. People's families felt involved.

People received personalised care and support which was built around their needs and preferences. Care and support was provided by staff who knew people well.

Staff supported people with their medicines in a way that promoted their independence.

People’s needs were assessed and they were supported by staff who were trained and supported. This supported people to achieve their aspirations. Staff advocated strongly for people to ensure all appropriate agencies played their part in achieving good lives for people.

Staff enabled people to access health and social care support in their community.

Right Care

People received kind and compassionate care. Staff respected people’s privacy and dignity. They understood and responded to their individual needs.

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

The service faced staffing challenges but had sufficient appropriately skilled staff to meet people’s needs and keep them safe.

People's care and support plans reflected their needs and preferences, and this enhanced their wellbeing and enjoyment of life. Staff understood people's needs.

People could pursue interests of their choice. The service gave people opportunities to try new activities that enhanced and enriched their lives.

Right culture

The culture and practice of the organisation achieved positive outcomes for people. This had resulted in people being more content and a reduction in the times they experienced distress. The governance and oversight systems needed to be further embedded to ensure emerging issues were identified and outcomes continued to be good.

People had increased control over their lives because of the ethos, values, attitudes and behaviours of the management and staff.

People were supported by a management team who worked hard to promote a culture where people were valued and respected as individuals. This culture was reflected in the staff team’s commitment to the values of the organisation.

People and those important to them were involved in planning their care.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 23 December 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

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

Livability Somerset is a care at home service that currently supports 20 people with learning disabilities and autism who live in four shared supported living settings or their own flats. The people living in the supported living settings share communal areas and have their own bedrooms. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is 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 15 people were receiving support with personal care.

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

People were supported by staff who had been through changes in leadership and organisational structure. The registered manager had left in August 2021. Senior staff within the team had also left during this time and this had impacted on the oversight and support of staff across all the supported living settings.

People who lived in Bridgwater were supported by a team that was chronically short staffed. This had an impact on people’s support and staff morale. The senior team were aware of this and had been working to improve staffing.

Management tasks were not always completed: quality assurance actions; staff support and supervision and making statutory notifications had not been completed consistently.

We received mixed feedback from relatives and professionals about their confidence in the support provided to some people. Relatives and professionals highlighted issues around communication as a major challenge with numerous examples of the impact of this on people’s shared experiences .

There was mixed evidence regarding how well risks were managed. We identified examples of some risks being identified and managed, however, we also found examples where actions were not taken in a timely manner and risks were not responded to with consistency or sufficiently monitored. People’s rights were not always fully considered, and this meant that some risk management included restrictive practices that were not clearly identified and monitored.

People told us they mostly felt safe and we saw that they were relaxed in the company of staff. They were supported by staff who had been trained to identify and report abuse. Staff told us they were confident to report concerns. There was mixed evidence about external reporting of safeguarding concerns.

People were supported to prepare food either individually or with the people they lived with. Where people were at risk of not eating and drinking safely or were at risk of not eating and drinking enough, staff liaised with appropriate professionals.

People told us they had support to access health appointments. Some relatives flagged concerns about the oversight of health.

Prior to the pandemic people’s needs had been assessed before they started receiving support and most people had been receiving their support from the provider and its predecessor for many years. During the pandemic undertaking people’s assessments had been more challenging.

People were supported by staff who understood how to wear their PPE to reduce the risk of cross infection. There were enhanced cleaning measures in place as a response to the pandemic.

People were supported by staff who were committed to providing quality support but who did not always have the training and oversight they needed to do this effectively or consistently. People who spoke with us were happy with the way their support was provided.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The impact of staffing shortages and a lack of management oversight meant that the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. There was work ongoing to address this.

Right support:

• People lived in small groups with other people or in their own flats. Their support was designed to enable them to live the lives they chose. However, some decisions were made by staff without reference to people’s views about their own support or how they wished their tenancy rights to be manifested.

Right care:

• The support people received was mostly person centred. Staff aimed to promote people’s dignity and treat them respectfully, however, some practices were restrictive and people’s relationships beyond the organisation were not always fully valued.

Right culture:

• The provider organisation had recently restructured. Senior staff, and staff, were committed to ensuring people were leading more empowered lives. The demands on the time of senior staff meant that checks on culture and practices had been missed.

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 July 2018).

Why we inspected

We received concerns in relation to staffing and risk management and made the decision to undertake a direct monitoring assessment. We identified risks associated with staffing, risk management and oversight whilst undertaking this monitoring assessment. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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

We have found evidence that the provider needs to make improvements.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to risk management, safeguarding, staffing, the application of the MCA, person centred care and governance at this inspection.

We served a warning notice related to the governance of the service.

Please see the action we have told the provider to take at the end of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Livability Somerset 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

One year ago the provider for the service changed. At this inspection we found there had been a positive feeling about the changes this brought. There was a period of transition occurring whilst the systems changed.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and specialist housing. It provides a service to older and younger disabled adults including people on the autistic spectrum. At the time of the inspection,13 people were receiving support with intimate care. Others required guidance with medicine administration. There were options to have up to 24-hour support from staff because there were sleep-in facilities in some of the homes.

This service provides care and support to people living in three ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Each house had multiple occupation and two houses had the addition of some self-contained flats. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. The people in the flats were able to access support from staff and encouraged to work towards as much independence as possible.

Not everyone using Livability Somerset received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

“The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

At the time of the inspection there was 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.’

People using the service thought they were kept safe and were comfortable in the presence of staff. Most medicines were managed safely. Improvements could be made for guidance for ‘as required’ medicines to ensure consistency. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. One person with rapidly changing needs, had not always had guidance for staff updated and training in line with the changes.

The management had developed positive relationships with people. People and their relatives were happy with the support they received. There were enough staff to meet people’s needs and recruitment had resolved some recent staff shortages. Inconsistencies were found with staff recruitment. These were resolved during and following the inspection.

People were protected from potential abuse because staff understood how to recognise signs of abuse and knew who to report it to. When there had been accidents or incidents systems were in place to demonstrate lessons learnt and how improvements were made. Staff had been trained in areas to have skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to see other health professionals

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. When people lacked capacity decisions had been made on their behalf following current legislation. Some staff felt they required a little more guidance on more complex decisions. People were supported, when required, to eat a healthy, balanced diet. When specialist diets were required staff liaised with other health professionals.

Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. A range of ways to support people to communicate their wishes was used. Care plans reflected people’s needs and wishes and they had been involved where possible. People knew how to complain and were positive their concerns would be resolved in a fair way. There was a system in place to manage them.

People told us, and we observed, that staff were kind and patient. People’s privacy and dignity was respected by staff. Their cultural or religious needs were valued within the provider’s Christian ethos. People were involved in decisions about the care and support they received. The provider was developing systems to ensure people had a dignified death.

The service was well led and shortfalls identified during the inspection had mainly been identified by the management. There was a proactive approach from management and staff achievements were recognised. The provider had completed some statutory notifications in line with legislation to inform external agencies of significant events. Following the inspection the registered manager resolved any missed notifications.