Creative Support - Hartlepool Service

This service provides care and support to four people living in three ‘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. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service had a registered manager in post. 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.

At the last inspection in December 2015, the service was rated Good. At this inspection we found the service remained Good.

Risks were well managed. People were encouraged to be independent and to take everyday risks. Risk assessments were in place to cover various aspects of people’s daily lives, which included guidance for staff on how to manage identified risks.

Relatives told us they were happy with the service provided. Sufficient experienced and trained staff were deployed to ensure people’s needs were met. The provider was in the process of recruiting new staff to maintain this. People were supported by staff that were trained to carry out their roles effectively. Staff received mandatory training as well as training which was tailored to the needs of those they supported. All staff received an induction and an on-going programme of supervision and appraisal. Staff felt supported.

Staff were knowledgeable about the people they supported, their likes and dislikes and interests.

Appropriate arrangements were in place for the safe administration and storage of medicines. We have made a recommendation about the recording of when required (PRN) medicines.

Systems were in place, and had been followed to reduce any risks of abuse and harm. Staff told us they would be confident to raise any concerns they had and they would be acted upon. An effective recruitment and selection process was in place. The provider carried out monthly health and safety checks to ensure people lived in a safe environment.

Accidents and incidents, although very few, were accurately recorded and reported and any lessons learned were shared with staff.

People were supported to have 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.

People's rights were protected by staff who under stood the Mental Capacity Act and how this applied to their role.

Relatives and people were involved in the planning of their care. Information was provided in easy read format to assist people in understanding the care available to them. The provider had an effective complaints procedure in place and relatives were aware of how to make a complaint.

People were supported in maintaining a healthy and balanced diet. People were involved in the preparation of meals. People were supported to maintain good health and had access to health and social external professionals.

Activities were developed around people’s interests. People were supported to maintain relationships and access the local community.

Although staff felt supported by colleagues they said they felt undervalued be higher management and morale was just okay.

The provider understood the importance of monitoring the quality of the service and reviewing systems to identify any lessons learnt. The service consulted with people, relatives and staff to capture their views about the service.

During this inspection we visited the services registered office. We also visited two of the supported living schemes where personal care was being provided. We spent time meeting with four people who used the service, spoke with five staff and we looked at records. Some of the people who used the service had complex communication needs, making it difficult for us to speak with them about their care and support. To help us better understand people's experiences we spent time in the supported living services, so that we could observe how people were supported by staff. We also spoke with a relative of someone who used the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Creative support had arrangements in place to assess and plan people's care and support needs. This included risk assessments and arrangement to manage behaviour that challenges in a safe and consistent way. For example, staff who worked in services where people experienced behaviour that challenges had received appropriate training and people had detailed personal behaviour support plans in place. This helped to ensure that staff responded in safe, consistent ways, which were safe and effective for the individuals involved.

The service had systems in place for the management and administration of medication. However, we found examples where people had not received their medication in accordance with their prescription. This meant that people hadn't always received their prescribed medication when they needed it. A compliance action has been set for this and the provider must tell us how they plan to improve.

Staff told us that they received good training at the service, with access to regular training refreshers and updates. The training records we were provided with showed that staff had completed a variety of training relevant to their roles. However, the training records provided to us did not demonstrate that staff had completed all of the training listed on the services 'Mandatory Training Matrix' or the training update frequencies suggested by the services training calendar. This meant we could not evidence that staff had completed all of the training the service said they required.

We found that the services quality assurance systems included checks and audits related to health and safety. For example, regular checks of the arrangements for fire safety and maintenance in the supported living services.

Is the service effective?

People who used the service and their relatives told us that they were happy with their care and support. During our visits we saw that people looked well cared for and appeared comfortable and at ease with the staff in their homes. Records showed that people's care and support needs had been assessed, planned and reviewed. Staff knew people well and said that the service provided people with good quality support.

Is the service caring?

We observed staff treating people kindly and with respect. People who used the service appeared comfortable with their staff, conversing and interacting with them in a friendly and relaxed way. People we spoke with told us that they liked their staff and were happy with their service. The staff we spoke with knew the people they supported well and could explain people's individual preferences and how they liked to be supported.

Is the service responsive?

People's needs had been assessed and planned. Reviews took place regularly and included people who used the service, relatives and other professionals. Records showed that people's suggestions and wishes were listened too. For example, one person had wanted to make some improvements to their garden and staff had supported them to do this.

Is the service well-led?

The person who was registered with CQC as manager of the Creative Support Limited ' Hartlepool service did not currently have management oversight of any of these services. However, Creative Support had recently recruited a new regional service director and was in the process of reviewing the management structure, which included looking at the arrangements for registered managers.

Quality assurance systems were in place, including arrangements for staff supervision and support, local maintenance checks and audits at both local and corporate level. However, we highlighted some inconsistencies in quality assurance systems across different Creative Support registered services. For example, we saw that good practice in one area had not been recognised and implemented in others and found some variations in quality across the different services. We discussed this with the service director who was already aware of these inconsistencies and was looking at how QA processes could be improved and strengthened across the organisation.

What people told us about the service:

Because people who used the service had complex communication needs and couldn't all talk with us about their care we spent time observing how they were supported. During our visits we observed that staff treated people with respect, speaking to people politely and supporting people in kind and dignified ways. Staff offered people choices and were aware of people's different preferences. People appeared comfortable and at ease with the staff. One relative told us how they had seen staff involving people who used the service in discussions and signing paperwork. They thought that this was really positive and were pleased that their relative was being involved as much as possible. The people we spoke with told us that they were happy with their support. One person commented 'I like it here.' Comments made by one person's relative included 'They are good, really good' and 'I'm really satisfied.'

During the inspection we went to both the office base and people's homes. Many of the people had limited communication skills so we also spent time observing interactions between the staff and them. The places we visited had set up 24 hour care packages and each person had their own core team of staff. We found the staff teams had received the necessary training they needed to ensure they delivered effective care for each individual.

The people we spoke with who could share their opinions told us that they found the care packages met their needs; thought the staff were excellent at their jobs; and felt their lifestyle was enhanced because they received individualised care. People told us that they liked having tailor made care packages and felt this enhanced their lives.

We found that the provider had effectively monitored the service and when issues were raised, successfully implemented and sustained a range of improvements that made sure the service met the needs of the people.