Archived: Community Living & Support Services Limited

Community Living and Support Services Limited is domiciliary care agency which is registered to provide personal care and support to people in their own homes including supported living settings. The service can be provided to adults with learning disabilities, dementia, mental health conditions, physical disabilities and sensory impairments.

At the time of our inspection the service was supporting 43 people across eight supported living settings. Five of those people were in receipt of 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.

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

People, their relatives and staff told us the service was safe. Risks had been assessed and detailed guidance helped staff to provide safe care. Staff and the management team understood their responsibilities to keep people safe. The management of people’s medicines continued to be safe and people received their medicines when they needed them.

Staff were recruited safely, and people told us staff followed safe infection control practice in their homes. The providers systems reduced the risk of infections spreading. People were supported to eat and drink in line with their wishes if this was part of their planned care. Staff worked in partnership with health and social care professionals to support people to achieve positive outcomes.

People received effective care from trained and skilled staff who knew them well. Staff completed an induction when they started work at the service followed by an ongoing training programme.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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.

Based on our review of the safe, effective and well-led key questions the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: People had choice and control over their lives and were supported to live their lives as independently as possible. People's support focused on them having as many opportunities as possible for them to gain new skills and access specialist support to remain healthy and well.

Right care: People received personalised care and support from staff they knew and trusted. People’s human rights were promoted, and people spoke positively about the care and support they received. They felt listened to and were fully involved in planning and reviewing their care.

Right culture: Feedback without exception confirmed a positive and inclusive culture was embedded, managers led by example. Staff felt supported by their managers and understood the provider's vision and values. The whole staff team demonstrated commitment to continually learning and improving the service to benefit people. A range of effective audits and checks took place to monitor the quality and safety of the service provided.

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 July 2019) and there was a breach of the regulations. 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 prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Community Living and Support Services Limited is a service which provides care for 42 people living in the community in a supported living environment. These are mainly young people with mental health needs and learning disabilities. Care ranges from a small number of hours per week to 24 hour care.

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.

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

There was a registered manager in post who was also the provider. A new manager had been in post for around five months. They were in the process of applying for registration with us.

Quality checks were carried out to monitor the service, however these did not always identify the concerns we found during our visit. These were in relation to training records, employment processes, changes in people’s care needs and action taken following some concerns being raised. Action taken was not always documented to demonstrate processes were followed correctly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, systems did not always support this practice.

There were enough staff to ensure people were safe. Where risks associated with people's health and wellbeing had been identified, plans were in place to manage those risks while ensuring people could remain independent.

People received care which was responsive to their individual needs. Staff had a good understanding of how to support them well.

Care records provided information in relation to people’s backgrounds, interests and care needs and this information was in the process of being updated.

Staff understood their responsibility to safeguard people from harm and knew how to report concerns.

The provider ensured care was based upon good practice guidance to help ensure people received an effective service.

Staff were caring in their approach and had good relationships with people. Promoting independence was a part of the ethos of the service and people were supported to improve their daily life skills.

Staff encouraged people to maintain a balanced diet and respected their individual choices. The provider and staff team worked closely with external healthcare professionals to ensure people's health and wellbeing was maintained.

Positive feedback was received in relation to the management of the service. People, relatives and staff had opportunities to feedback about the running of the service. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The service was rated as Good in April 2017.

Why we inspected

The inspection was prompted by some concerns received about staff practices when supporting people. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm, however we did find improvement was required in some other areas.

We have found evidence that the provider needs to make improvements. Please see the Effective and Well – Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified a breach in relation to ‘Good governance’ at this inspection. Systems and processes were not operated effectively.

Follow up

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Community Living and Support Services Limited are registered to provide personal care. The service provides care and support to two people who live in their own homes and to 36 people living in their own homes within 'supported living' accommodation. People's care and housing are provided under separate agreements; this inspection looked at their personal care and support arrangements.

There was a registered manager in post who was present throughout the inspection. 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 told us that the service provided to them was safe. Staff followed the appropriate safeguarding procedures to ensure the risk of harm to people was minimised. Sufficient staff had been employed following robust recruitment checks. We found that overall medicines management within the service were effective and people received their medicines as prescribed.

Staff received regular supervision and support. Training was provided to staff so they could meet people’s care needs. People’s rights were protected and they had choices in their daily lives. People received support to plan, make and prepare their meals. Staff worked with other healthcare professionals to ensure people’s healthcare needs were met.

People told us they were happy with the service provided. People described staff as kind and lovely. People were involved in making decisions about their own care needs. People were supported by a staff team who understood the importance of treating people with dignity and respect and promoting people's independence.

People’s support plans demonstrated that they were supported to have maximum choice and control of their lives. People were involved in developing and reviewing their support plans and individual needs. People were supported to choose and access activities which were of interest to them. People told us they were engaged and supported in day to day living skills. People were able to raise their concerns and processes were in place to ensure complaints were investigated and responded to.

The registered manager provided staff with appropriate leadership and support. The service sought people’s feedback through questionnaires, reviews and telephone contacts about the quality of the service. The registered manager assessed and monitored the quality of care consistently. However, some training records were incomplete and it was not possible to identify if all staff had the appropriate up to date knowledge and skills.

Care was planned and designed to meet the individual health and welfare needs of the people who used the service. A person we spoke to expressed confidence that their care was planned, managed and delivered in a way to respect their dignity in the way that had been promised.

We saw that the provider had made suitable arrangements to ensure that people who used the service were safeguarded against the risk of abuse. A member of staff told us, 'I would raise concerns with the manager and then we would notify the authorities'.

We found that there were enough skilled, qualified and competent staff to provide people with the care they required to meet their individual needs.

The providers systems for monitoring safety and quality of the service were not robust enough and people were at risk of having unsafe care and treatment. There was no evidence that action had been taken when staff had not followed the providers own policies in relation to access to peoples own accommodation or in respect of the timings of calls and support provided.

People who used the service were involved in planning their care. They were supported to make choices about the care they received. Where decisions were made on a person's behalf they were done so with their agreement and in their best interest.

Care was planned and designed to meet the individual health and welfare needs of the people who used the service. A person we spoke to expressed confidence that their care was planned, managed and delivered with dignity in the way that was promised. They told us, 'They know my needs and what I like'.

We saw that the provider had made suitable arrangements to ensure that people who used the service were safeguarded against the risk of abuse.

We found that people were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. A member of staff told us, 'I can discuss anything at my supervision and don't feel I have to say what they want to hear'.

The provider was able to protect people from unsafe care and treatment by regularly assessing and monitoring the quality of the service provided.

People told us that the workers caring for their relatives had a good manner, respected people's dignity and spoke to them as adults. One person who used the service told us, 'The staff are very helpful, they seem to understand me'.

Care was planned and designed to meet the individual health and welfare needs of the people who used the service. A person we spoke to expressed confidence that their relative's care was planned, managed and delivered with dignity in the way that was promised.

We saw that the provider had made suitable arrangements to ensure that people who used the service were safeguarded against the risk of abuse.

We found that the provider had robust recruitment processes in place to ensure people were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider was able to protect people from unsafe care and treatment by regularly assessing and monitoring the quality of the service provided.