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 have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service supported this practice.
Risk assessments had been developed to minimise the potential risk of harm to people who used the service. These had been kept under review and were relevant to the care and support people required.
Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care. People’s independence and choice was promoted. However, mental capacity assessment records were not always provided to staff who provided care. We made a recommendation about following best practice in record keeping for mental capacity records.
Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required.
People’s care needs were discussed with care commissioners before they started using the service to ensure the service was able to meet their assessed needs. Care plans showed how people and their relatives were involved in discussion around their care. People were encouraged to share their opinions on the quality of care and service being provided.
Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed. People’s nutritional needs were met.
There was a variety of meaningful activities to keep people occupied and to promote social inclusion.
People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.
There was a policy to support people at the end of their life to have a comfortable, dignified and pain-free death.
We received mixed feedback from staff regarding the management and culture in the service. The registered manager understood their responsibilities, and were supported by the provider and other managers to deliver what was required. They used a variety of methods to assess and monitor the quality of service provided to people. These included regular internal audits of the service, surveys and staff and relatives meetings to seek the views of people about the quality of care being provided. The quality assurance systems were not always effective to identify the shortfalls we found during the inspection.