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Community Living & Support Services Limited Requires improvement

This service was previously registered at a different address - see old profile

Reports


Inspection carried out on 26 June 2019

During a routine inspection

About the service

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.

Inspection carried out on 26 April 2017

During a routine inspection

This inspection took place on 26 April 2017 and was announced. We gave the provider 48 hours’ notice of our visit because the location provides a domiciliary care service [care at home]; we needed to make sure that there would be someone in the office at the time of our visit. The service was last inspected in December 2014 and at that time was meeting all the regulations.

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.

Inspection carried out on 5 December 2014, 12 December 2014

During a routine inspection

This inspection took place on 5 and 12 December 2014 and was announced. The provider was given 48 hours’ notice of the first date of our office visit. This was because the location provides a domiciliary care service and we needed to be sure that we could speak to someone who co-ordinates the staff providing personal care. At our last inspection in March 2014 the service needed to make improvements to support people with the management of their diet, monitor that staff complied with the policies of the service and ensured that people received the service at the times it was commissioned. They responded to the actions and told us what they us were going to do. We found that improvements had been made in these areas.

At the time of the inspection the service was providing a personal care and support service to 11 people in their own homes and 21 people who lived in supported living flats.

The service had 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.

We spoke to some people who used the service on the telephone and some people came into the service’s office to speak with us. People we spoke with told us they liked the staff supporting them and felt safe when they were being supported. Staff understood what signs to look for that may indicate that a person was unhappy or being abused and were confident any concerns they had would be taken seriously.

People were being supported by enough suitably qualified and trained staff. Staff we spoke with were knowledgeable about the care that people needed. Staff had received suitable induction and training to meet the needs of people living in their own homes.

The Mental Capacity Act 2005 (MCA) states what must be done to ensure that the rights of people who may lack mental capacity to make decisions are protected, including when balancing autonomy and protection in relation to consent or refusal of care. The MCA Deprivation of Liberty Safeguards (DoLS) requires providers to submit applications to the Court of Protection for authority to deprive someone of their liberty. We did not find anyone being deprived of their liberty and people were being assisted to consider any choices that may be unsafe for them.

People were supported and encouraged to eat healthily and sufficient amounts to maintain their health and received their prescribed medicines safely. They had access to appropriate health care when needed and were supported to maintain and develop daily living skills. Professionals from social care and health backgrounds that we spoke with were happy with the support provided by the staff and management of the service.

Where the service was commissioned to support people with their leisure time we found that people were encouraged to look at work, educational courses and pursue their personal interests.

People who used the service told us that they could speak to staff and management about their concerns and told us that they would be listened to. The provider obtained feedback from people and involved relatives and professionals about the service to identify where improvements could be made.

Inspection carried out on 20, 21 March 2014

During an inspection in response to concerns

When we visited 36 people were receiving support with personal care from this service. We spoke with three people who used the service and five staff who were supporting them. We also looked at office records and spoke to a person who commissioned the service. A person who used the service told us, �I am very happy, they support me to attend appointments�.

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.

Inspection carried out on 24 May 2013

During a routine inspection

When we visited, the service was providing personal care to 26 people, some of whom were not able to give us their views because of their complex needs and conditions. We used a number of methods to understand the experiences of the people who used the service including speaking with the people, looking at care records and speaking with staff.

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.

Inspection carried out on 4 March 2013

During a routine inspection

When we visited, the service was providing personal care to 21 people some of whom were not able to give us their views because of their complex needs and conditions. We used a number of methods to understand the experiences of the people who used the service including speaking with the people, their relatives, looking at care records and speaking with staff and other care workers.

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.