Proactive Life Midlands

Proactive life is a supported living service with 36 self-contained flats people rent. The service offers personal care to adults of all ages with a learning disability/autism or mental health needs. Personal care was provided to three people at the time of the inspection. People's flats are within a complex of three attached houses. The service is on a main road in a residential area in Hockley.

Not everyone who used the service received personal care and 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

Systems and processes to keep people safe were in place, staff understood and knew how to use these. Risks to people were assessed and control measures to mitigate risks were detailed and known by staff. People’s medicines were safely managed and administered as prescribed.

There was a new management team who maintained and developed their oversight of the service delivery through robust audits and involvement of staff and people in the way care was provided.

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.

This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. People lived in their own homes and were supported and involved in all aspects of their care so far as was possible. People were supported to develop confidence and live as independently as possible. Staff did not wear anything that suggested they were care staff when supporting people.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 13 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety in relation to finances and medicines management. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Proactive Life Birmingham on our website at www.cqc.org.uk.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the Safe and Well-led sections of this full report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Proactive life is a supported living service with 36 self-contained flats people rent. The service offers personal care to adults of all ages with a learning disability/autism or mental health needs. Personal care was provided to three people at the time of the inspection. People's flats are within a complex of three attached houses. The service is on a main road in a residential area in Hockley.

Not everyone who used the service received personal care and 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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received in most instances planned and co-ordinated person-centred support that was appropriate and inclusive for them.

Because people lived in and were supported in their own homes this offered people better outcomes in respect of their self-autonomy and independence. Staff did not wear anything that suggested they were care staff when coming and going with people.

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

Quality monitoring systems had improved, although there were still areas where governance needed to be more robust to ensure people consistently received good outcomes. The provider was open and honest as to the need for further improvement and was making changes. Several quality tools had or were being introduced but these still needed to be fully embedded.

Overall, people were protected from potential risks as staff had a good awareness of what these were and how to mitigate them, However, some risk assessments were not always up to date and consistent with staff knowledge.

People had received their medicines as they wished although one person’s medicines had been out of stock for three days, this however had not caused them harm. There were improvements in monitoring arrangements for medicines although these needed to be embedded into day to day monitoring

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

The outcomes for people using the service reflected the principles and values of Registering the Right Support by recently developing more choice and control, independence and inclusion. People's support was focused on improving opportunities for them to gain new skills and become more independent.

People were supported by enough staff, who were caring and had developed good relationships with them. Staff showed respect for their rights, privacy, dignity and independence. Checks of staff when employed ensured they were safe to work with people who used the service.

The provider was developing systems to improve how people received care. This was to improve consistency and ensure people’s views were captured. Tools were being developed by recently employed clinical staff. Staff were knowledgeable about people’s needs and preferences and people told us they had good relationships with all staff.

People were supported by care staff who had the range of skills and knowledge to meet their needs although further training was needed for the provider to meet their own training targets. Staff understood their role, although not all of them felt well supported. Most staff said they received regular supervision.

People's health was supported as staff worked with other health care providers to ensure their health needs were met. Follow up from professional’s involvement had not always led to update of people’s care plans.

People were supported by staff to have choices, and the provider’s policies supported this practice. Recording of the decisions people made daily could have been better recorded. People’s likes and dislikes as well as diverse needs were well known and respected by staff.

People could raise concerns and the provider had systems in place to investigate, monitor and respond to these. Staff were confident they could identify when people were unhappy and look to resolve any matters.

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

Rating at last inspection. The last rating for this service was Requires Improvement (last report published 28 August 2019). There was a breach of regulation and a warning notice was issued to the provider stating governance arrangements needed to improve. 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, although improvements needed to continue and be embedded into the services’ routine practices.

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety, poor management of risk, issues with medicines management, concerns in respect of management, people having a lack of choice, and poor staff awareness of people’s needs. A decision was made for us to inspect and examine those risks.

We have found evidence the provider, despite addressing the breaches from our previous inspection, needs to make some further improvements. Please see the Safe, Effective, Responsive and Well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Proactive life – Birmingham on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Proactive Life provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. Care is provided in across three linked houses with individual flats. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the inspection four people were receiving personal care and support.

People’s experience of using this service:

We identified concerns about how risks were recorded and reviewed to keep people safe. We found that although staff were aware of the risks posed to people, these risks were not always formally reviewed and recorded to ensure that people were safe.

Systems to monitor the quality and safety of the service had identified the areas for improvement such as medicine management, care plans and staff training and supervision. However, systems had not been effective at improving the quality of the service.

There were enough staff to support people as required, however we found improvements could be made in staff recruitment to ensure robust recruitment processes.

Medicine management to ensure people received their medicines as required needed improvement. The provider had identified this, and further staff training had been arranged.

Staff felt support to the staff team could be improved but acknowledged that management changes had been made. Some staff we spoke with felt that recent changes had started to make improvements in the way the service was run.

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

Rating at last inspection:

The last rating for this service was Good (report published 27 March 2019)

Why we inspected:

We received concerns that indicated people were not receiving safe care and treatment. As a result, we undertook a focused inspection to review the Key Questions of Safe and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

After the Inspection:

We received information detailing further concerns around people’s safety, record keeping and staff training. We have asked the provider to investigate these concerns and we will continue to monitor the service.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

People’s experience of using this service:

¿ People were supported by staff who knew how to recognise potential abuse and who they should report any concerns to. People’s care considered their risks and reduced the risk of harm and where required, had access to equipment to support them. People's medicines were managed safely and there were enough staff to meet people’s social and care needs.

¿ People were supported to maintain a healthy diet in line with their needs and preferences. Staff were trained to meet people’s needs and acted promptly to refer people to healthcare professionals when required.

¿ People enjoyed positive relationships with the staff team and were treated with kindness and respect. People’s independence was promoted by staff who encouraged them.

¿ People’s needs and routines were know and supported by staff who ensured these were met and respected. People knew how to complain if needed, and were confident any comments or concerns were listened and acted on.

¿ People and staff were happy with the way the service was led and managed and the provider worked well with external professionals to ensure people’s needs were met.

¿ Service management and leadership was consistent and areas for improvements were identified. The manager gathered people’s views and experiences and made any necessary improvements.

¿ We found the service met the characteristics of a “Good” rating; More information is available in the full report

Rating at last inspection: Good (report published May 2018)

Why we inspected: This inspection was brought forward due to information of risk or concern in relation to an increase in safeguarding notifications. During the inspection the provider and manager demonstrated they had acted to promote and protect people’s safety.

Follow up: There will be ongoing monitoring

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

This service provides care and support for up to 24 people in ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support in their own flats. The flats are in three purpose built blocks on one site. The provider’s office is also on this site. At the time of our inspection the service was supporting 24 people. Some people were receiving up to 24 hour support each day, according to their assessed needs and level of independence. Most of the people who used the service had the mental capacity to decide how they wanted to be supported.

At the time of the inspection the service had a registered manager who was present during our visit. 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 found the provider had taken or had on-going processes which addressed recent concerns about people’s safety and leadership at the service. However processes to monitor people’s calls did not identify if people had received support in line with their care plans. Records did not always identify if people had been supported appropriately to resolve long-standing maintenance issues with their flats which were relevant to their personal care.

People told us they felt safe in their flats, and the provider had worked with the landlord to prevent uninvited people from entering the buildings. Staff knew how to keep the people they supported and themselves safe from physical and emotional abuse. The registered manager had taken action to reduce and prevent the reoccurrence of incidences or behaviours which could cause people distress or harm.

Staff were aware of the action to take should they suspect that someone was being abused or the factors which may make someone more vulnerable to abuse. Processes were in place to minimise the risk of people experiencing financial abuse. Staff said the registered manager was approachable and would take appropriate action to keep people safe.

There were processes in place to prevent and control the spread of infection. Staff conducted regular health and safety audits to ensure communal areas and people’s flats were clean and safe environments to live and work in. Fire detection and prevention systems had been approved by the fire brigade.

People were supported by staff who knew their latest care needs. The provider had taken action after our last inspection and appropriate checks were undertaken to ensure staff were suitable to support the people who used the service. There were sufficient numbers of suitably trained staff to meet people’s needs. People received their medicines safely and as prescribed.

There were systems in place to monitor and promote staff development. Staff had regular meetings with senior staff to review and identify how they could improve their performance. Staff were provided with opportunities to express their views about the service and how it could be improved. The registered manager had taken action in response to feedback from staff.

People who used the service and staff we spoke with expressed confidence in the leadership of the service. Staff told us they could access senior staff out of hours when they required advice and guidance. The registered manager understood their regulatory responsibilities to the commission and could explain how they promoted an open and honest culture in line with their duty of candour.

The service worked in partnership with other agencies to improve people’s lives. People were regularly supported to attend appointments with health care providers and local authorities to maintain their well-being.

At the last inspection in April 2015, the service was rated Good. At this inspection we found the service remained Good. The service remained Good in all the key questions we look at except, “Is the service Safe?” We rated this key question Requires Improvement.

People felt safe when they received support from staff. Staff demonstrated that they were aware of the action to take should they suspect that someone was being abused. There were enough staff on each shift to meet people’s care and support needs promptly. People who needed support received their medication as prescribed. Written assessments and systems in place were not all being used effectively when helping people to stay safe and reduce the risks associated with their care and support.

Staff received appropriate training and supervision in order to carry out their role. People were supported to have the maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

When necessary staff encouraged people to prepare and eat a healthy diet and supported people to attend medical appointments.

People told us staff were friendly, caring and helpful. People received person-centred care from staff that treated them with dignity and respect.

People were involved in the planning and review of their care needs. Staff were aware of people’s individual needs and supported them according to their preferences. People were aware of how to raise issues or concerns and these were responded to.

People and staff were complimentary about the registered manager. Staff were aware of their roles and responsibilities. Systems were in place to assess and monitor the quality of service people received.

Further information is in the detailed findings below.