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

Reports


Inspection carried out on 9 January 2019

During a routine inspection

This was an announced inspection which took place on 9, 10 and 14 January 2019. We had previously carried out an inspection in November 2017 and found that service was good in the domains of caring and responsive but requires improvement in the safe, effective and well-led domains. The service was rated as requires improvement overall. At the last inspection we identified three breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014.

The breaches we identified at that time were in relation to failure to deploy sufficient numbers of suitably qualified, competent persons to deliver care; a failure to ensure staff received appropriate support, training, professional development, supervision and appraisal; and quality assurance systems were not effective in identifying and generating improvements in relation to the shortfalls we identified. We also made recommendations about staff awareness of safeguarding protocols and record keeping for mental capacity assessments. Following the inspection, we asked the provider to complete an improvement plan to show what they would do and by when to improve the key questions, is the service safe, effective and well-led to at least good.

At this inspection we found that improvements had been made and have rated the service good in all domains.

Zeno is registered to provide personal care to people in their own homes. The service specialises in providing support to people with a learning disability and complex needs. Support is provided both to individuals and to people living in small group settings. At the time of our inspection there were 46 people using the service.

The provider had a registered manager in place as required by the conditions of their registration with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 a manager who was registered with the Care Quality Commission and was qualified to undertake the role. They demonstrated a commitment to delivering quality care to people with complex support needs.

Staff had been safely recruited and there were enough staff to meet people's needs.

Staff received induction, training, supervision and appraisal to help ensure they were able to deliver effective care.

People told us they felt safe and there were appropriate safeguarding polices in place, and safeguarding concerns were fully investigated.

People’s records demonstrated that the service was working within the principles of the Mental Capacity Act. People had individual capacity assessments which were detailed and decision specific.

Quality assurance systems in place were used to drive improvements within the service. These included audits of care records, staff training and development, medicines and environmental checks.

Information from accidents, incidents, safeguarding and complaints were analysed for themes and trends and action taken to minimise future risks to people.

People received support from consistent staff teams who knew them well and worked creatively to support their needs.

People who used the service, depending on their ability, were responsible for household tasks in their own homes with support from staff as necessary. Independence and choice was promoted.

Systems were also in place to reduce the risk of cross infection, dependent on individual needs, and the homes we visited were clean.

People’s care records and risk assessments were person-centred and detailed and staff told us they provided them with all the guidance necessary to best support people.

People were supported to have daily access to a wide range of community activities.

People were supported to communicate according to their communi

Inspection carried out on 15 November 2017

During a routine inspection

The inspection visit took place on 15 November 2017 and was announced.

Zeno Limited is registered to provide personal care and support for people living with mental health needs and/or living with a learning disability or autistic spectrum disorder. This service provides care and support to people living in 12 ‘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. The Care Quality Commission does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the visit there were 37 people who used the service.

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.

This inspection was the first inspection since the service was registered with the Care Quality Commission in September 2017. The service was previously registered at a different address where we inspected on 15 April 2014. We found the service to be compliant with regulations at that time.

During this inspection in November 2017, we found the service to be in breach of three regulations under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to a failure to deploy sufficient numbers of suitably qualified, competent persons to deliver care, a failure to ensure staff received appropriate support, training, professional development, supervision and appraisal. The quality assurance systems were not effective in identifying and generating improvements in relation to the shortfalls in staff training, staffing levels and safeguarding processes. We also made recommendations about staff awareness of safeguarding protocols and record keeping for mental capacity assessments. You can see what action we told the registered provider to take at the back of the full version of the report.

The service had a registered manager as required. A registered manager is a person who has registered with the 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 registered manager was not present on the day of the inspection visit however; we spoke to them following the inspection visit. We were supported by the deputy manager and the nominated individual who is also one of the directors of the company.

The registered manager had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. During the inspection we received allegations of abuse from a former staff member. We informed the local safeguarding authority. They are undertaking enquiries. There was a lack of guidance and awareness on how to raise safeguarding concerns outside the organisation. We have made a recommendation about staff knowledge and awareness of safeguarding protocols.

People and their relatives confirmed people were encouraged and supported to maintain and increase their independence. Some people who used the service had limited ability to provide us with feedback on the service due to their needs. Feedback from relatives about care staff was positive.

Recruitment checks were carried out to ensure suitable people were employed to work at the service.

Feedback from staff demonstrated that there were concerns about staffing levels in three of the properties managed by the provider.

Staff had received induction, supervision and training. However we found a significant number of staff had not updated their training.

People are supported to h