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UK Supported Living Services Good

Reports


Inspection carried out on 23 July 2019

During a routine inspection

About the service:

UK Supported Living Services Limited is registered to provide personal care to people in their own homes. At the time of our inspection six people living with a learning disability were receiving 24 hour support with personal care in their own supported living accommodation.

Not everyone using UK Supported Living Services Limited receives regulated activity; CQC only inspects the service being received by people provided with 'personal care', help with tasks related to personal hygiene and eating. Where they do we also take into account 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 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:

People were supported by caring, motivated staff who knew everyone very well and treated people as individuals and with dignity and respect. People were cared for by a consistent staff team who had received appropriate training to carry out their roles. The provider had robust recruitment systems to ensure staff were safely recruited. Staff spoke knowledgably about the systems in place to safeguard people from abuse.

The provider showed innovative and unique use of technology. The provider had developed and implemented a bespoke real time digital recording database system which enabled them to record, review and monitor all care and support records accurately and instantly. The introduction of the database had greatly improved the service delivery for people and had impacted positively on people’s health, wellbeing and daily lives.

The service was working within the principles of the Mental Capacity Act 2005. People were supported to have maximum choice and control over 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 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. The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent .

Since the previous inspection the provider had made improvements to how they managed people’s medicines. People’s medicines were managed safely, stored securely and administered by trained staff. People received assistance to take their medicines as prescribed and were supported to access health care services.

People's care was tailored to their individual needs and maintained their independence as much as possible. Care plans were comprehensive, person centred, respectful, and reviewed regularly to ensure they reflected people’s needs.

Staff received regular supervision and annual appraisals to ensure they were fully supported in their role. There was an effective training programme that staff felt was interesting and well delivered.

People were supported to lead active lives and took part in a range of different activities if they wished. People who preferred to spend time on a one to one basis were supported with appropriate activities they enjoyed, to ensure their wellbeing was maintained and to prevent social isolation.

There was a robu

Inspection carried out on 9 December 2016

During a routine inspection

The inspection took place on the 9 and 13 December 2016 and was announced. When we last inspected the service in June 2015 we found that the service was not deploying sufficient numbers of suitably skilled and experienced staff to meet people’s needs. We asked the provider to take action which they had completed.

The service is registered to provide personal care. At the time of our inspection seven people living with a learning disability were receiving 24 hour support with personal care in their own supported living accommodation.

The service had a registered manager. 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’s medicine was not stored and administered in line with best practice guidance which increased the risk of people not receiving their medicines safely. Best practice was not being followed for storage of medicines that needed to be kept in a fridge, safekeeping of medicine cupboard keys and protocols for the administration of medicines prescribed as and when required. Staff had completed medicine administration training and were aware of the actions they needed to take should an error occur.

People were supported by staff who had received training in how to recognise abuse and the actions they would need to take if they felt a person was at risk. Some staff were not aware of agencies outside the service that they could report concerns too. Staff had been recruited safely which included checks with the disclosure and baring service to ensure they were suitable to work with vulnerable people. There were enough staff with the right skill mix to meet people’s needs. Staff received regular supervision and were supported to carry out their roles effectively. The service provided a 24 hour on-call facility for staff, people and their families.

Risks to people were assessed and staff understood their role in minimising risk whilst ensuring people’s choices and freedoms were respected. Risks were regularly reviewed and when changes happened actions were carried out in a timely way. When appropriate this had involved the expertise of other professionals such as physiotherapists, occupational therapists and dieticians.

People were involved in decisions about their care. When they were unable to do this the principles of the mental capacity act were being followed. Advocacy services were available to people if needed. People had access to healthcare which included GP’s, specialist learning disability nurses, dieticians and dentists.

Staff were caring and had warm friendly relationships with the people they supported. Staff attitudes were positive and they were described as respectful, patient and friendly. People’s communication needs were understood by staff and this enabled people to be involved in decisions about their day. Staff had a good understanding of people’s interests, likes and dislikes which meant they could interact in a meaningful way with people. People’s dignity and privacy was respected and staff encouraged and supported people to be as independent as possible.

People experienced care that was responsive to their needs and regularly reviewed. Staff understood peoples care needs and how they liked to be supported. How people spent their time was linked to their interests and included activities both at home and in the community. Daily records were completed by staff that reflected the care and support plans. Communication passports were in place to for occasions when the person needed to be supported by another service such as a hospital admission.

The service had an open, friendly atmosphere and staff were positive about the organisation, their roles and the teamwork

Inspection carried out on 17, 19, 22, 25 June 2015

During a routine inspection

The inspection took place from 17 June 2015 with home visits being completed by 22 June. Further phone calls were completed by 7 July 2015. The inspection was announced as we wished to ensure there was someone at the office when we visited.

The service specialises in social support and care for people with complex needs related to learning disabilities or mental health diagnoses including people with Autistic Spectrum Disorders. The service is provided to people in their own home and currently supports around 40 people living in Dorset, Bournemouth and Hampshire. Currently eight people are supported with personal care, as defined in the Health and Social Care Act 2008 regulations. The inspection only looked at the service in relation to people receiving personal care as part of their overall support. This is because personal care is a regulated activity.

The service is required to have a registered manager. 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 service had a registered manager in place.

The people receiving personal care had need for support and care on a mostly continuous basis to ensure their safety and participation in everyday life. This was due to people’s learning disability, including some people who had additional physical or mental health needs. Staffing was tailored to each person with small groups of staff providing the service on a rotational basis. Staffing arranged in one geographical area was insufficient which meant one person did not get the care they needed on two occasions during the inspection. These issues were being addressed by the management, however due to the impact on the person we judged the service was not meeting the standard for having sufficient staff available when needed. This was raised with the local authority as a safeguarding issue by another agency who was involved with the person.

Most people could not tell us about their experience so we used observation, speaking with staff and people who knew the person. People were relaxed and happy when we visited. Two people told us they were happy in their home and felt supported to do what they wanted. The service supported people to have regular involvement with their families and friends, depending on individual circumstances. Feedback was recorded from three relatives as part of a recent survey which described their satisfaction with the standard of the service. We spoke with one relative who told us they were happy with the service provided.

People were relaxed and responsive in the presence of the staff providing the service and we observed that positive relationship had been developed. People were supported in a person centred way by staff who were enthusiastic and worked with people to enable them to positive outcomes. They understood their roles in relation to encouraging people’s independence while protecting and safeguarding people from harm.

The service aimed to provide continuity and familiarity between people in the way the service was planned. The service was not responsible for people’s accommodation however we found they had ensured people’s homes were safe and comfortable, through effective liaison with the landlords and other relevant agencies.

The service demonstrated a culture which promoted people’s rights. Risk assessments were used to promote a balance of autonomy and safety for each individual in relation to their day to day care and support. People were supported to visit friends, family and their chosen activities in the wider communities where they lived, however any risks associated with this had been considered and staffing arranged accordingly.

Staff received an induction into the service before starting work on their own, including opportunities for shadowing more experienced members of staff. There was a plan of ongoing training and supervision to ensure they had the necessary skills and knowledge to provide an effective and safe service. The needs of people were taken into account when making decisions about the qualifications, skills and experience required when appointing new staff and in the delivery of on-going training. Plans were in place to make recruitment safer by improving the quality of checking employment history.

Staff received supervision and told us they felt well supported by their supervisors however some staff told us they were worried about pressure on staff on occasions due to staffing shortages.

People’s rights were protected because the management team understood where people did not have mental capacity to consent to their care that decisions had to be made within the framework of the Mental Capacity Act 2005 (MCA). Procedures had been followed appropriately in this area.

People received their medicines safely and staff understood the importance of safe practice in this area including their role in monitoring any symptoms or side effects.

People were supported to have a balanced diet through one to one support in their own home. Some people were supported to be involved in shopping for their food. Written care plans reflected individual preferences and any special dietary requirements.

Staff and managers ensured people had access to healthcare services when needed and worked with a range of health professionals to implement a health action plan for each person.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced risk to people who used the service and helped the service to continually improve. The service had addressed a number of issues raised through safeguarding procedures over the last six months. Action had also been taken by the service in response to recommendations made by two of the local authorities which commission the service, following a contract review in January 2015. From speaking with the management of the service and a number of external professionals, it was evident that each party wished to improve the relationship between the service and the commissioning authorities, particularly communication, and a plan was in place to address this.

New systems, policies and procedures had been developed to make sure that any unsafe practice was identified and people were protected. The workforce had been restructured and was in transition at the time of inspection. Recruitment for new roles was in progress and additional training had been delivered and arranged for the future. This was designed to develop the enabling ethos of the service and ensure people's needs were always met.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to how staff were deployed.

Inspection carried out on 5, 7, 10, 12 March 2014

During an inspection to make sure that the improvements required had been made

We completed this inspection to follow up compliance actions from our inspection in July 2013. These related to care and welfare, medicines, supporting staff and managing risks. The provider's action plan stated how they would ensure they complied with the regulations.

There was no registered manager in post. However, we were aware the recently appointed manager had applied to register.

The provider supported 36 people in their own homes. We met and spoke with four people and a relative. We also spoke with nine staff, including the manager. We looked at five people's care records and four staff files.

We found the provider had addressed the compliance actions from our inspection in July 2013.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. One person told us, "The support workers take me out and help with different things. They are pretty alright". Another individual said they were "looked after much better now".

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Most staff told us they felt well supported.

The provider had an effective system to manage risks to people's health, safety and welfare. They notified us of important events that affected people�s wellbeing and safety.

Inspection carried out on 28 November 2013

During an inspection in response to concerns

We visited the offices of UK Supported Living Services unannounced on 28 November 2013. On this occasion, we did not speak with people using the service because we were discussing the provider�s management of a safeguarding concern. During this inspection we spoke with the nominated individual and two managers.

There was no registered manager in post. The nominated individual told us they were in the process of appointing someone who they anticipated would apply to be the registered manager.

The provider had responded appropriately to an allegation of abuse and had taken action to protect people from the risk of harm. During the inspection the nominated individual expressed concerns about the Dorset multi-agency policy and procedures for safeguarding vulnerable adults.

The provider had not notified the Commission of all abuse or alleged abuse in relation to people using its services.

The provider had not notified the Commission of all incidents that had been reported to, or investigated by, the police.

Inspection carried out on 15, 16, 17, 19, 23, 24 July 2013

During an inspection to make sure that the improvements required had been made

There was no registered manager in post. A recently appointed manager told us they were applying to the Care Quality Commission to register as manager.

We met seven people who used the provider�s services, spoke with three of them, and with nine staff and three managers. We looked at four people�s care records and four staff files.

The provider had addressed the compliance action from our inspection in February 2013. This related to safeguarding people from abuse. Staff had clear guidance about how to report concerns about abuse. People told us they felt safe with their workers.

Some people did not always experience care and support that met their needs and protected their rights. People told us they were happy with their support. However, some people�s care plans did not reflect all their needs. Some care records were incomplete.

People were not fully protected against the risks associated with medicines. Some people�s medication records had not been completed properly. The provider did not check staff competence in administering medicines.

There were enough qualified, skilled and experienced staff to meet people�s needs.

Staff were not all fully supported to deliver care safely and to an appropriate standard. Staff had not all received regular supervision or appraisals.

The provider monitored service quality. However, there was no wholly effective system to manage risks to health, safety and welfare.

Inspection carried out on 25, 27, 28 February and 1 March 2013

During a routine inspection

During our inspection we spoke with four people who use the services of UK Supported Living Services, one of their relatives, four care workers and clinical staff, and two managers.

People�s privacy, dignity and independence were respected. Their views and experiences were taken into account in the way the service was provided and delivered in relation to their care. For example, people told us they had a regular team of care workers.

People experienced care, treatment and support that met their needs. They expressed satisfaction with the care they received. For example, people told us that they were supported to do activities they enjoyed.

People using the service were not protected from the risk of abuse, because the provider had taken not reasonable steps to identify the possibility of abuse and prevent abuse from happening. We found that a safeguarding incident had not been identified and reported.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had effective systems in place to assess and monitor regularly the quality of service that people receive, and to identify, assess and manage risks to the health, safety and welfare of people who use the service and others.