Archived: Shine Supported Living - South East

Shine Supported Living - South East is a supported living service registered to provide personal care. The service provided care and support to seven people with a learning disability or other complex needs living in supported living' settings, so that they can live in their own home as independently as possible. 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. Two people were in receipt of personal care when we visited.

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

People were not being protected against abuse. There were instances of harm taking place at the service where appropriate action had not been taken by the provider to mitigate the risk of harm occurring again. The local authority were not always being informed when safeguarding incidents occurred.

The behaviour that challenged people was not being managed in a safe way. Behaviour charts were not being completed for people where required to do so. Staff had not always received appropriate training to ensure they could meet people’s needs. There were not always sufficient staff to safely support people.

The leadership at the service was not robust and there was not sufficient auditing by the provider to review the quality of care provided. Notifications were not always being sent to the CQC when it was appropriate to do so.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were not always supported with their independence. Staff did not always have an understanding of the support and care people needed to enable them to have a fulfilled life.

Right support:

• Model of care and setting did not maximise people's choice, control and Independence

Right care:

• Care was not person-centred and did not promotes people's dignity, privacy and human rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives

Following this inspection, we worked closely with local authorities to ensure people were safeguarded from ongoing harm. Two people were supported to move out of the service.

Rating at last inspection (and update)

The last rating for this service was Requires Improvement (published 10 January 2020) and there were multiple breaches of regulation. 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 sufficient improvements had not been made and the provider remained in breach of regulations.

The service is rated as inadequate in the key questions Safe and Well Led.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We received concerns in relation to people being safeguarding from the risk of abuse. 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. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the Safe, 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Shine Supported Living - South East on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people not being protected from the risk of neglect and abuse, risks related to the care being provided to people, the lack of suitably qualified staff and the lack of robust provider and management oversight at this inspection.

We took action against the provider and cancelled their registration at Shine Supported Living. Everyone who received a regulated activity has moved out of the service, and we have de-registered Shine Supported Living with the Care Quality Commission.

Shine Supported Living - South East is a supported living service registered to provide personal care. The service provided care and support to four people with a learning disability or other complex needs living in supported living' settings, so that they can live in their own home as independently as possible. 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. Two people were in receipt of personal care when we visited.

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 receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The management of risk around people’s health was not consistently safe. Management of constipation and risks associated with choking and falls were not well managed. The service relied on a high number of agency staff who may not support people for a number of days. Information was not robustly handed over and documentation did not record important information to share with staff. Although accidents and incidents were recorded and analysed for trends and patterns, action was not always taken to prevent repeated incidents. Lessons were not always learnt or embedded.

Staff did not always have reliable information to refer to when supporting people. Support plans contained duplicated information, staff found them difficult to navigate through and some important information was missing. Recommendations from healthcare professionals were not always acted on, meaning people did not always receive effective person-centred care.

Communication between staff needed to improve so important information relating to people was not missed. The provider and registered manager had failed to identify the concerns we found at this inspection around management of constipation, choking, and falls. The provider had failed to ensure ratings were conspicuously displayed on their website. Although some agency staff worked frequently at the service, they did not receive any formal supervision and were not engaged in meetings or other ways to provide feedback.

People received their commissioned hours of support. There was a safeguarding policy in place and staff said they were confident any concerns would be dealt with if raised. Medicines were managed safely. Before people were offered a service, the registered manager conducted assessments to ensure needs could be met and staff had the right training. People were supported to eat and drink and maintain a healthy weight. People were supported to visit health apportionments with healthcare professionals.

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; the policies and systems in the service supported this practice. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

We observed staff talking to people in a kind and respectful way. People diversities were assessed and supported. People were supported to go on outings and participate in activities they enjoyed. Consideration had been given to how information was presented to people in the way they could understand. A policy was in place which outlined the process for dealing with complaints. An easy read version was available for people who required this.

Staff were positive about the support they received. Staff were positive about the registered manager and direction of the service. People, relatives and staff were asked for feedback about the service and information was used to make improvements.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 28 November 2018) and there were six breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made or sustained and there were four breaches of regulation. This service has been rated Requires Improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to Safe care and treatment, Person-centred care, Good governance and Requirement as to display of performance assessments at this inspection. Please see the action we have told the provider to take at the end of this 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.

Shine Supported Living - South East is a supported living service registered to provide personal care. The service provided care and support to 5 people with a learning disability living in ‘supported living’ settings, so that they can live in their own home as independently as possible.

In supported living services 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.

The service is based in Herne Bay. Two people live in one bungalow and three people live in the bungalow next door. The manager’s office is based in a separate building behind one of the houses.

This is the first inspection since the service registered with CQC in November 2017. At this inspection we rated this service is rated as ‘Requires Improvement’ as we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 and the Care Quality Commission (Registration) Regulations 2009.

At the time of the inspection the registered manager had not de-registered with CQC but had left the service the week before. There was a new manager in place who had not yet registered with CQC and had not had time to make an impact on the running of the service. 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.

The care service has not 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.

Risks to people’s health and well-being were not consistently assessed and fully mitigated. Some risks had been assessed but others had not. Support plans were long and complex, the service used agency staff who did not always know people well and care and support was not always consistent.

Medicines were not consistently managed safely. There were restrictions to people that were not the least restrictive option to keep people safe. The service was not delivered in line with the Mental Capacity Act 2005 (MCA) legal framework as some people were deprived on their liberty and the provider had failed to seek lawful authority.

Staff had not undertaken all of the relevant training needed to support people with their assessed needs. Support was not always available to assist people to develop their communication skills as staff did not have access to the appropriate training. Staff had not had supervision with a line manager for some time. Previously the service had senior support workers in place, however there were none in post at the time of the inspection. Staff did not always feel supported or informed by the provider.

People were not always supported to express their views about their care. Some people were non-verbal and needed support to communicate. We made a recommendation about this.

The support provided did not consistently meet peoples assessed needs and preferences. Support was not always personalised.

Notifications of important events were not always sent to CQC when they should have been. The providers checks on the quality of the service did not always identify concerns and where concerns were identified these were not always acted upon. Relatives were involved in planning peoples care but were not always informed by the provider about important changes to the service such as regular staff leaving.

There was a complaints process in place and people and their relatives knew how to complain. The complaints policy needed updating as it contained details about the manager who had left the service. We made a recommendation about this.

Incidents were recorded and acted upon but there was evidence that some known risks had re-occurred when people were supported by staff who did not know them well. Incidents had not been reviewed for trends since January 2018, so there was no oversight of recent incidents. We made a recommendation about this.

People were protected from the risk of infection. There were safe recruitment systems in place and enough staff to cover shifts with support from agency staff. New staff underwent and induction and attended appropriate training.

Prior to people receiving a service their needs were assessed to ensure that the service could meet their needs. Assessments were used to plan staffing levels and plan peoples care. Where people wanted support with their religion, sexuality, sexual or gender identity this support was provided.

People were treated with dignity. Staff knew how to maintain people’s privacy and treated people with kindness and compassion. Staff has undertaken training in safeguarding and new how to report concerns about abuse. People were provided with support to maintain and increase their independence.

People were supported to access food and drink when this was needed and to maintain their weight. People had access to health care service and were provided the support they needed to access these.

We found five breaches of the Health & Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

You can see what action we told the provider to take at the back of the full version of the report.