All inspections: Prospects Supported Living Limited

We carried out an inspection of Prospects Supported Living on 13 and 14 May 2015. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to risk management and the skills of the staff team in order to ensure adequate support of people during critical times in their mental health recovery.

We undertook this focused inspection to check that they had followed their action plan and to confirm that they now met legal requirements. This report only covers our findings in relation to these topics and additional areas of concern noted during the inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Prospects Supported Living Limited on our website at www.cqc.org.uk

The home provides accommodation for four adults with mental health needs. The property at (Wessex Close) provides single occupancy bedrooms and is located on the outskirts of Accrington in Lancashire. At the time of this inspection there was one person living at the home.

At the time of our inspection the service did not have 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. An acting manager was however in post and we saw that they had submitted their application to register with the Commission.

Whilst it was evident that some work had been undertaken to progress areas requiring improvement identified on the last inspection, on this inspection we found additional issues of concern. During this inspection we found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service provider was providing nursing care at the home which was contrary to their conditions of registration. Following the inspection the service provider has submitted applications to address this matter and these are currently being considered by the Commission.

There had been a significant number of incidents occurring at the home which had not been notified to the Commission.

The service provider had not displayed their inspection rating in the home as they are required to do.

Medication items given to service users for use on home leave were not managed effectively. Policies needed enhancing to ensure that a record was maintained of medication handed in to staff and to ensure that there was direction for the staff on how to mange this medication going forward.

Risk assessments had been updated since the last inspection and provided greater detail about self-harming behaviours. Information was available to direct staff when they should intervene and offer support.

Evidence of completed environmental risk assessments and audits were noted in the home however these did not include specific risks such as ligature risks. We recommend the provider access best practice guidance relating to risk assessing and making adjustments to the environment where people are at risk of ligaturing.

Staff had access to the safeguarding policy and procedures in the home and we saw evidence of safeguarding of vulnerable adults training in the training matrix we looked at.

We saw that some training had taken place and that more was planned in order to ensure that all staff had received training to equip them with the skills and knowledge to care for individuals with complex mental health needs. It was noted however that the training in self-harming behaviours was only delivered over a short period of time but was regularly refreshed through internal practices such as staff supervison and core group meetings.

A number of policies were available for staff reference such as accident and incident reporting (RIDDOR) policy, dealing with accidents and emergencies policy and a first aid policy. However these policies need to be enhanced to reflect a mental health care focus.

Risk assessments had been enhanced to include details of how to support and monitor people with an eating disorder and how to monitor any health related matters.

Evidence of a supervision matrix of staff was seen and there were copies of supervision records in place for staff member.

We carried out an inspection of Prospects Supported Living on 13 and 14 May 2015. The first day of inspection was unannounced. We last visited the service on 4 April 2013 to check whether the service was meeting requirements we made at the previous inspection on 14 February 2013 and found the service was meeting the regulations in force at the time.

The home provides accommodation for four adults with mental health needs. The property at (Wessex Close) provides four bedrooms for single occupancy and is located on the outskirts of Accrington in Lancashire.

The home was managed by 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 told us they were all right and were supported by staff to take control over their lives. People had confidence in staff and said they were treated well.

Care plans were linked to people’s assessments and were risk based. However we found action was not taken to minimise risk identified in two people’s assessments at the early stage of their mental health recovery. You can see what action we have asked the provider to take at the back of the full version of this report.

People were cared for by staff that were recruited safely. However the level of experience and skill mix of staff during critical periods, such as when people first arrived at the home was variable. People were cared for and supported by staff with limited experience and training. This meant staff would not necessarily have the right skills to support people safely. You can see what action we have asked the provider to take at the back of the full version of this report.

Before this inspection CQC had received concerning information that professional boundaries had been breached. This had been dealt with by the provider; however we did not see a lone worker policy and staff had not confirmed they had read and understood the service professional boundaries policy. We have made a recommendation about this.

Staff told us they were confident to take action if they witnessed or suspected any abusive or neglectful practice and had received training about the Mental Capacity Act 2005 (MCA 2005) and

Deprivation of Liberty Safeguards (DoLS). The MCA 2005 and DoLS provide legal safeguards for people who may be unable to make decisions about their care.

We found positive relationships were encouraged and people were being supported as appropriate, to maintain contact with relatives and friends.

We found medicines were managed well and appropriate arrangements were in place in relation to the safe storage, receipt, administration and disposal of medicines.

We found the premises to be clean and hygienic. People using the service took some responsibility in keeping their rooms clean.

Where people’s assessment had indicated the benefit of health therapists this was arranged. This meant professionals actively involved in people’s care should receive essential information to support a streamlined service. We have made a recommendation about this.

People using the service were involved in staff recruitment and gave staff training in mental health issues such as eating disorders. Staff said this training was invaluable. Staff had supervision and appraisal of their work. This meant staff training needs and additional support requirements could be identified.

People were encouraged to take control in meeting their nutritional needs. People were encouraged to shop for food and support was provided with cooking and baking lessons. However monitoring people's nutritional intake needed to improve and we have made a recommendation about this.

Staff interacted and related to people using the service in an empathetic and compassionate manner. We also observed staff providing support in a positive way by involving people in routine decisions and consulting with them on their individual needs and choices.

People had a key worker to support them during their recovery, and staff described this support as building good relationships with people and gaining their trust. Staff worked with people on a one to one basis. The activity co-ordinator shared her view on the benefit of this level of support in building people’s self-esteem.

Staff induction covered principles of care such as privacy, dignity, independence, choice and rights. Confidentiality was a key feature in staff training and in their contractual arrangements. This helped to make sure information about people was shared on a need to know basis and people’s right to privacy was respected.

Records showed people were involved in discussions and decisions about meaningful activities, developing skills and accessing community resources. Links had been made with the RSPCA and one person enjoyed taking part in dog walking sessions.

People’s care plans and other related records showed how people took into account their mental health needs when mapping their care and support. Staff described how they delivered support in response to people’s individual needs and we were told of the progress people had made in their recovery and rehabilitation programme.

The complaints procedure was displayed in the home and we found processes were in place to record, investigate and respond to complaints. This supported people have confidence their concerns would be taken seriously. People could access advocacy services if they wanted support and advice from someone other than staff.

People using the service did not express any concerns about the management and leadership arrangements. The registered manager operated an ‘open door policy’, which meant arrangements were in place to promote on-going communication, discussion and openness.

There were systems and processes in place to consult with people who used the service, other stakeholders and staff. Regular meetings and consultation surveys meant people had the opportunity to develop the service.

The organisation was described by staff as ‘forward thinking’. Staff were clear about their roles and responsibilities.

The registered manager expressed commitment to the on-going improvement of the service. Audits of the various processes including, medication systems, care plans, incident reporting, staff training, health and safety and the control and prevention of infection were being completed.

We spoke with a person who used the service who indicated the support workers provided sensitive and flexible support and they were well cared for. They made positive comments about the service such as, 'The staff are really good to us' and 'We're like a family here'.

Staff spoken with told us they had received training in safeguarding vulnerable adults and knew what to do if they suspected abuse. We examined seven staff training records which confirmed that the training had been undertaken.

We looked at the homes medicines policy which ensured that risks to people who used the service had been managed through effective medicines procedures.

We looked at seven staff records and saw evidence that support workers had been appropriately recruited and provided with training relevant to their role. Staff spoken with confirmed they had undergone the necessary pre employment checks to ensure they were suitable for their role.

We looked at the staff records which confirmed that staff training and development appropriate to their role had taken place and was ongoing.

Staff spoken with told us that they were happy with the level and standard of training provided and felt well supported by the managers. They made positive comments such as, 'The managers are always there to help us at whatever time'.

People told us they were happy living in the home and were able to have a choice about what to do each day, such as going to college and leisure activities. One person said, "I really like it here it's the best place I have been to". This person also said, "The staff are really nice".

However whilst people told us they were happy in the home and staff treated them well, we had concerns about the way the home was run and which could affect people's well being and safety. We were concerned people with complex needs were living in the home for which an effective recruitment procedure had not been implemented.

We were also concerned that suitable arrangements had not been made to safeguard service users against the risk of abuse. Staff had not received training to protect people under 'safeguarding' procedures.

We found that service users were not always protected against the risks associated with the management of medicines at the home.

Archived: Prospects Supported Living Limited

All Inspections

27th Ocotber and 18th November 2015

During an inspection looking at part of the service

13, 14 May 2015

During a routine inspection

4 April 2013

During an inspection looking at part of the service

14 February 2013

During an inspection in response to concerns