Archived: Gateshead Council Supported Living Domiciliary Care Service

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

People’s experience of using this service:

People received person-centred care which met all of their assessed needs. People had detailed and individual care plans which were regularly reviewed and updated as people’s needs changed. Risk assessments were in place to help keep people safe by mitigating identified risks people faced.

There was a governance framework in place to assess the quality and safety of care provided to people. We found this framework was not always effective as the registered manager had not notified the Commission of two incidents. The service was operating a supported living model of care and not a domiciliary service to people. We are dealing with this outside of the inspection process.

Staff were kind and caring with people and respected their privacy and dignity. People received safe care from a well established staff team who had received all mandatory training and on-going support.

Medicines were safely managed. Staff supported people with their medication appropriately and worked in partnership with GPs and other health care professionals to regularly review people’s medication and assess their needs.

Staff demonstrated a good knowledge of people and their relatives. People were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible.

People were supported to be independent, maintain social relationships and supported to attend activities that they had chosen in the community.

Staff worked in partnership with other health care professionals and used best practice guidance.

More information is in the detailed findings below.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 around the governance of the service and not displaying previous ratings of the provider’s services on their website and the registration of the service. We also found a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 due to the registered manager not notifying the Commission of a serious injury and a safeguarding incident. Details of action we have asked the provider to take can be found at the end of this report.

Rating at last inspection: At our last inspection the service was rated good. Our last inspection report was published on 8 September 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. At this inspection we found the service continued to be good in most areas. However, we also identified some areas which required improvement.

Follow up: We will continue to monitor the service through information we receive from the service, provider, the public and partnership agencies. We will re-visit the service in-line with our inspection programme. If we receive any concerning information we may inspect sooner.

We last inspected Gateshead Council Domiciliary Supported Living Service Newcastle in September 2014. At that inspection we found the service was meeting all of the legal requirements in force at the time.

Gateshead Council Supported Living Service is registered to provide personal care to adults with learning disabilities in the Gateshead area. People are supported by staff to live in small groups, referred to as independent supported living schemes. Different levels of support are provided over the 24 hour period dependent upon people’s requirements. People are tenants of their home and pay rent for their accommodation which is leased from housing associations.

The service did not have a registered manager. A manager was in place who was in the process of registering with the Care Quality Commission. 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 were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. Some people could tell us they felt safe. People appeared contented and relaxed with the staff who supported them.

A residential model of care was operating rather than independent supported living. An office had been created in tenants' own homes for the use of staff and the running of the business.

Staff knew the people they were supporting well and there were enough staff on duty to provide individual care to people. Care was provided with patience and kindness and people’s privacy and dignity were respected. People were supported to become more independent and maintain some control in their lives, whatever their level of need. Care plans detailed how people wished to be supported and people were involved in making decisions about their care. Records gave detailed instructions to staff about helping people to learn new skills and become more independent.

People received their medicines in a safe and timely way. People who were able, were supported to manage their own medicines. People who used the service had food and drink to meet their needs. Some people were assisted by staff to plan their menu, shop for the ingredients and cook their own food. Other people received meals that had been cooked by staff.

People were given information in a format that helped them to understand and encourage their involvement in every day decision making. A complaints procedure was available with information provided in a way to help people understand if they did not read.

People were supported to be part of the local community. They were provided with a range of opportunities to follow their interests and hobbies and were encouraged to try new activities. They were supported to holiday in this country or abroad and enjoyed outings to the town, coast and countryside.

Staff had received training and had a good understanding of the Mental Capacity Act 2005 and Best Interest Decision Making, when people were unable to make decisions for themselves. There were other opportunities for staff to receive training to meet people’s care needs.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed.

People had the opportunity to give their views about the service. There was regular consultation with people and family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

Training records held by the registered manager, were now accurate and up to date and showed when certain training had been completed, needed to be refreshed and when future training had been arranged.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found.

Is the service safe?

Records confirmed that the provider carried out effective recruitment and selection procedures to ensure that suitable staff were employed by the service.

People using the service told us they felt safe with staff who provided their care and support. One person told us, "I like the staff being here with me; I feel safe with them here." Relatives we spoke with told us they were confident that their family members were safe in their homes. One relative told us, 'He has a lovely life there and it's a relief knowing he is well looked after. There's been a lot of bad publicity recently about care, but we have no worries, or qualms whatsoever.'

People were cared for in an environment that was safe and clean. Equipment at the homes had been well maintained and serviced regularly, therefore not putting people at unnecessary risk. There were enough staff on duty to meet the needs of the people living at the homes and a member of the management team was available on call in case of emergencies. One relative told us, "I have no concerns regarding his safety or welfare. He is well looked after and in very capable hands."

Is the service effective?

People told us that they were happy with the care that was delivered and their needs were met. It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. We looked at how staff were supported to deliver care and treatment safely and to an appropriate standard. One relative told us, 'They encourage him and they get involved with everything; they really do try hard. They've got him doing domestic chores, like hoovering the living room, dusting and polishing, even making toast and coffee; he's come on a treat.'

However, we found that staff training was not up to date and the provider did not always monitor training requirements appropriately. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to staff training requirements.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One relative told us, 'They interact very well with him and they can spot the signs when things aren't right. They know the signs and fix things straight away and that comes from knowing him well,' and, 'It's brilliant support, help and care he gets. The council do a really good job with their staff selection; the staff are very caring.'

Is the service responsive?

People's needs had been assessed before they moved into the home. Care records for people at the service were reviewed regularly to make sure that the information was accurate and up to date. Where people's needs had changed, their care plans were updated more frequently. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people they supported were met. Records confirmed that people were registered with local GP's, dentists, opticians, chiropodists and other health care professionals.

People had access to activities that were important to them and were supported to maintain relationships with their friends and relatives.

People and their relatives knew how to make a complaint if they were unhappy. We saw that one complaint had been recorded, investigated and resolved to the satisfaction of the complainant within the last 12 months. We saw the service had policies and procedures in place in relation to the safeguarding of adults and responding to any allegations of abuse.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. People were able to complete a customer satisfaction survey. Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times. The provider undertook regular audits and risk assessments to monitor the quality of the services and there were effective systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. A relative told us, 'X (senior support worker) is very good and she's been there a long time ' she sorts everything and things are how they should be.'

Staff received regular supervision and appraisal and told us they felt supported by the management team. A support worker told us, 'I feel very supported by the management; It's a good well-run place where I work.'

People who used the service were positive about the care and support provided. Comments included 'It's lovely here. I like it' and 'I get on with everyone.'

People were cared for effectively and they were protected from the risk of abuse. There were good financial accounting systems in place to protect people from abuse.

Staff were given regular training and were given a professional appraisal of their work.

The provider had an effective complaints system in place. Complaints were taken seriously and responded to appropriately.