Background to this inspection
Updated
8 September 2016
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 3, 9 and 10 August 2016. It was carried out by one inspector. We told the registered manager the day before our first visit that we would be coming to ensure the people we needed to talk to would be available. We last inspected the service in June and July 2013 and identified no concerns.
Before the inspection we reviewed the information we held about the service. This included incidents they had notified us about and the completed Provider Information Return (PIR) we had received from the service. A PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also contacted commissioners and health and social care professionals to obtain their views of the service.
During the inspection, we visited three people in their homes and spoke with seven staff. People had their own personal ways of communicating as they could not easily talk; they could not tell us about their experience of the service. We observed how staff interacted with them. In addition, we spoke with the registered manager, and looked at three people’s care and support records in the office, including their medicines records and daily recordings. We also reviewed three staff recruitment and support records and a range of records relating to the management of the service, such as quality assurance records, accident and incident records and the on call log.
Updated
8 September 2016
This comprehensive inspection took place on 3, 9 and 10 August 2016. We told the registered manager the day before our first visit that we would be coming to ensure the people we needed to talk to would be available. We last inspected the service in June and July 2013 and identified no concerns.
The service is a supported living service that provides personal care and support to people with a learning disability in their own homes. At the time of our inspection, there were 15 people who received personal care, most of whom received a service 24 hours a day seven days a week.
The registered manager had been in post since November 2015. 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 we met had their own personal ways of communicating as they could not easily talk and they could not tell us about their experience of the service. We therefore observed how staff interacted with them and looked at the records of care and support they received.
People benefited from a safe service where staff understood their responsibilities for safeguarding people. As staff handled money on people’s behalf, measures were taken to protect people from financial abuse. Staff had confidence that the registered manager would listen to their concerns, which would be received openly and dealt with appropriately.
Risks to people’s personal safety, including risks posed by health conditions such as epilepsy, were assessed and were addressed through people’s support plans. When people had accidents, incidents or near misses these were recorded and monitored to look for developing trends. Where necessary practice was changed to help prevent a repeat occurrence.
People’s rights were protected because staff acted in accordance with the requirements of the Mental Capacity Act 2005. Wherever possible, people were supported to make choices about their care and support. The service had identified where people might be considered to have been deprived of their liberty and had requested service commissioners to apply to the Court of Protection to authorise this.
People received the care and support they needed and appeared happy and settled in their homes. They were supported to take part in activities that were meaningful for them, both in the wider community and at home. Staff had a good understanding of people’s support plans, which were holistic and personalised to reflect people’s individual needs. They were also aware of people’s dietary needs and preferences. Professional advice was obtained from the appropriate healthcare professionals when there were concerns about people’s weight changes or swallowing difficulties. Where people needed food and drink through a special tube, staff were trained in how to support this and their competence was assessed before they began to provide the support.
People’s healthcare needs were monitored and advice and support from healthcare professionals sought where necessary. A healthcare professional commented that they had noted some delays in appointments being arranged and did not receive updates from the service unless they requested this. A different healthcare professional reported improved communication with the service in recent months.
People’s medicines were managed safely. Medicines administration records for topical medicines, such as creams and gels, did not always contain clear instructions for the administration of these medicines. The registered manager said the service would liaise with prescribers so that topical medicines administration records contained the necessary information.
Staff told us how morale had improved during the year, since the registered manager had been in post and with a full complement of supervisory staff now working. They confirmed they were well supported through training, supervision and appraisal to perform their roles. They also said the service’s out of hours on call system was responsive and supportive.
Quality assurance systems operated to monitor and improve the quality of service being delivered. The registered manager operated an ‘open door’ policy, valuing feedback from people, their representatives and staff and acted on their suggestions. Complaints and compliments were monitored, with complaints investigated and used as an opportunity for learning. A service improvement plan had been developed from findings from the provider’s internal audit team and monitoring visits by local commissioners. Issues raised had been or were being addressed. Supervisory staff undertook regular audits of people’s support, finances and medication, and also made spot checks at people’s services.