Archived: Creative Support - Wigan Service

The 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.

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. The registered manager is currently off work temporarily, their role has been covered by another registered manager from within the organisation. Staff we spoke with reported this had been effective and they felt they had enough support from the management team.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People continued to be protected from the risk of harm and abuse. The service had clear safeguarding policies and procedures in place which had been followed when required. Staff knew how to recognise and raise any concerns.

Risk assessments identified the support people needed to manage the specific risks in their daily lives. Though some of the paperwork could have been clearer to follow, everything had been considered. The service continued to consider the impact on people's liberty and rights when supporting them to manage risks.

Staffing had been maintained at a safe level. The service reviewed the level of staffing regularly in response to changes in people's needs.

Medicines continued to be managed safely.

Emergency plans were in place and ensured staff knew how to respond to events including fires. Everyone living in the service had a Personal Emergency Evacuation Plan. (PEEP)

Infection control policies continued to protect people from the risk of infection and cross contamination.

Assessments identified people's needs prior to admission to the service. This ensured the service could be confident they were able to meet people's needs.

Staff training remained up to date which ensured staff had the appropriate skills and knowledge to support people effectively.

People continued to receive support with their nutrition and hydration. Advice and guidance from related professionals had been included in the support plans.

In addition to information about health needs and diagnoses people had hospital passports and health action plans, which ensured they were supported effectively should they need to access health services.

The two properties we visited had been adapted to ensure they were accessible. Further development had been undertaken to respond to the specific needs of individuals. Eg, sensory area in one of the properties.

The service continued to work within the principles of the Mental Capacity Act (2005) and associated Deprivation of Liberty Safeguards (DOLS). Staff understood the importance of achieving consent prior to providing care and support.

Staff were observed to interact with people and each other in kind and caring ways. The service had clear values in relation to supporting people to maintain their privacy, dignity and respect. Staff were skilled in ensuring these were achieved.

Communication guides were detailed and ensured people were supported to express their views and wishes. People living in the service were encouraged to be involved in decisions and had support from advocacy services when required.

People continued to receive person centred care which was responsive to their individual needs and preferences. Details about the individual, their background and cultural identity had been recorded together with details of the support people needed to maintain these needs.

People had access to a broad range of activities which reflected their recorded preferences. In addition shared social activities were arranged including parties and trips out.

The service had a complaints policy had been followed when required. People were supported to share their views about the quality of the service they received. Compliments were recorded and shared with the staff.

The service continued to promote values based on achieving high quality support and positive outcomes for people who used the service. Staff were aware of the standards expected of them and spoke about their commitment to achieving them.

There was a clear management structure which identified the roles and responsibilities of each member of the team. Senior staff were supported to manage delegated responsibilities in the individual properties.

Regular audits continued to ensure good governance. Quality assurance visits were completed with local commissioners. Regular checks of care records ensured information was up to date. Any concerns had been identified and addressed to prevent reoccurrence.

Team meetings were held regularly, including large meetings of the whole team and individual meetings in the separate properties. The management team also met regularly. This ensured people had the opportunity to share knowledge and keep up to date with any changes.

The service continued to work closely with their partners and stakeholders to share skills and knowledge and maintain the quality of the service.

We last inspected this location on 14 January 2014 and found the service to be compliant with all regulations we assessed at that time.

At the time of our inspection visit 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 service had appropriate systems and procedures in place which sought to protect people who used the service from abuse. The service maintained a corporate safeguarding policy and associated procedures which were complimented by ‘easy read’ safeguarding documentation with pictorial representations. This meant people who used the service were able to access safeguarding information in a format which was accessible and easy to understand.

We looked at recruitment and selection procedures and found safe recruitment practices were in place. This was evidenced through our examination of employment application forms, job descriptions, people’s proof of identity, two written references, and Disclosure and Barring Service (DBS) checks. These helped ensure potential employees were suitable to work with vulnerable people.

Accidents and incidents were recorded and monitored appropriately. Where necessary, we found preventative measures had been put in place to minimise identified risks. A variety of individual risk assessments had been

Health and safety records relating to buildings and premises were complete and up to date. Fire equipment was maintained and checked monthly and weekly fire alarm tests and means of escape were undertaken. Emergency lighting was checked monthly, as was the first aid kit. Fire drills were undertaken on a six monthly basis. Gas certificates were up to date in each of the properties we visited. The service had a business continuity plan to be implemented in the event of an emergency such as flood, fire or loss of power. This included guidance for staff and emergency contact numbers.

Financial management records were maintained for each of the supported houses and we found these to be up to date. External audits of financial records were also completed on a regular basis

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate Medicines were checked according to need. Some individuals were able to self-medicate and their medicines were checked on a weekly basis. Others were checked daily, as administered.

People’s care plans included a range of up to date and relevant health and personal information. Risk assessments were complete and up to date. A holistic assessment was in place for each individual. A hospital passport was included in each file, which contained health and other relevant information to help provide consistency of care.

The induction programme was robust and included mandatory training, orientation and direct observations of practice before new employees were deemed competent to work alone. New workers were given an employee handbook and information on policies and procedures and health and safety. There was a probation period with regular reviews and supervisors were required to ‘sign off’ new starters once they were deemed competent.

Staff supervision sessions were undertaken on a regular basis and issues discussed included personal development and training, person-centred planning, communication, equality and diversity and safeguarding.

Training was on-going for all employees and staff we spoke with told us they were able to access training courses relating to specific subjects as well as the general training. For example, one person told us they had been on a course regarding a specific, quite rare physical health condition and this training had been accessed from an outside source as the company had no provision for this particular subject.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We checked whether the service was working within the principles of the MCA and found the service had an appropriate MCA policy and associated procedures which included an assessment flow chart, example capacity test and guidance for staff.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care settings are called the Deprivation of Liberty Safeguards (DoLS) and can be legally authorised by the local authority. However, people who used the service at Creative Support – Wigan are considered ‘tenants’ within supported living accommodation. This means any decision to deprive a person of their liberty within supported living accommodation must be legally authorised by the Court of Protection.

Where people who used the service were the subject of a DoLS, or other forms of restrictive practice, we found the service had discussed matters relating to restrictive practices with the local authority and had completed all the paperwork required by law. This included the completion of the local authorities own ‘restrictive practice screening tool’ and a ‘restrictive practice monitoring tool.’ Both of these restrictive practice tools had been developed by the local authority using a number of key indicators as set out by the Supreme Court to ensure best practice in DoLS and restrictive practice assessments.

We looked at the how service supported people with their nutritional and hydration needs and found that staff demonstrated a good understanding of people’s likes and dislikes, dietary preferences and personal requirements. Staff we spoke with also clearly understood the importance of encouraging people who used the service to maintain a healthy balanced nutritious diet whilst acknowledging that some individuals were able to make their own choices.

People who used the service told us staff were kind and caring. Some had lived in supported accommodation with Creative Support for many years and knew the staff members well and considered them friends. Three people proudly showed us their rooms and told us they had been involved with choosing the decorations and furnishings.

Information within the individual care records was produced in easy read format, with pictorial representations. This made it more accessible to the people who used the service and helped them participate fully in reviews of their support if they wished to.

We saw that the service sent out service user satisfaction surveys on a twice yearly basis. Not many had been returned, but those that had were positive about the experience of the people who used the service.

The registered manager told us that tenants meetings did not take place at all the properties in the service. This was dependant on whether the people who lived there were able to participate and whether they wished to do so. The properties we visited did have regular tenants meetings on a monthly basis and we saw notes of discussions. These included activities and outings, service user issues, falls and finances. Key worker meetings, between the key worker and the person who used the service also took place on a monthly basis and any issues or changes in support needs were discussed in these forums.

People who used the service told us they enjoyed a variety of activities and were taken out regularly by staff, this included going out for pub lunches, daytrips to local attractions and trips out to do clothes shopping. We also saw a social calendar of events which included a trip to the imperial war museum north, a film and pizza night and social meeting for members Creative Support’s own ‘breakthrough’ group which met regularly in Manchester city centre.

People’s care and support plans were well written, organised and easy to read. Support plans were highly person-centred and individualised with information about what was important to people, what they liked to do, what people liked about them and important people in their lives. There was information about what support workers would need to know to support people best and the best communication methods to use, including guidance for staff on how to understand facial expressions, gestures and body language.

Regular staff meetings took place which were evidenced by meeting minutes and records of agenda items. There were also regular seniors meetings where staffing issues, rotas and supervisions were discussed and at one of the properties we visited staff told us they also had regular Monday morning catch up meetings with all the staff.

Staff and people who used the service, along with their relatives, all agreed the service was well-led and that the registered manager was friendly and approachable.

We also spoke with three support staff, two people using the service and three relatives on the telephone. Likewise, we visited a supported living property and spoke with two staff, two relatives and three people who lived there.

People using the service provided by Creative Support ' Wigan Service confirmed that they were treated with respect and their dignity was maintained. People also spoken with reported that they were happy with the standard of care provided and confirmed that their needs were met.

Comments received from people using the service included: 'I like living here'; 'I'm very happy and the staff are lovely'; 'I am looked after and I prefer it to where I used to live as I don't get lonely anymore'; 'I couldn't get better care anywhere'; It's a brilliant place where I live' and 'The staff are perfect angels.'

Likewise, comments received from relatives included: 'The standard of care is excellent'; 'The staff deal with issues promptly' and "We are very happy with everything.'

We spoke with five people who used the service. One person told us 'They look after us great, they ask what we think.' All felt they were supported to be as independent as possible and were positive about staff attitudes and their care delivery. We spoke with the relative of one person who used the service. They told us "I've not a bad word to say about them, this really is a care company."

We looked at policies and procedures and saw that all relevant ones were in place. We saw evidence that people who used the service were safeguarded from the risk of abuse and that safeguarding concerns were followed up appropriately.

We saw evidence of robust recruitment procedures and that efforts were made to ensure that staff were equipped with knowledge and information needed in order to deliver care safely and appropriately. We saw that training and development of staff was ongoing.

We saw that there were systems in place to allow the people who used the service to be involved in all aspects of the service and they were encouraged to give feedback about their care delivery. Continual monitoring of the service was undertaken to facilitate ongoing improvement.