Liaise (London) Supported Living

Sequence Care Supported living provides care and support to 32 people living in five supported living settings. CQC does not regulate premises for supported living; this inspection looked at people’s care and support.

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

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.

Based on our review of the key questions of Safe and Well-Led. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture

Right Support

People were supported to promote and maintain their independence. People were able to choose how they wanted to spend their day and things they wanted to do in the community. Staff supported people to achieve this and maintain their relationships with relatives.

Right Care

People received care based on their preferences and treated with respect. We observed positive interactions between people and staff. People were comfortable approaching staff when they needed support and we observed staff respected people’s choices.

Right culture

Some features in individual schemes were similar to a ‘care home’ setting and communal areas encouraged potential closed cultures.

We found safeguarding procedures were not effectively established in relation to safeguarding people’s finances, there was limited learning in relation to managing accidents and incidents and identifying lessons learnt, risks to people were not effectively assessed or managed, medicines administration for ‘as and when required medicines’ (PRN) and people’s allergy status were not recorded properly. There was a number of audits in place to monitor the quality of service, however these were not robust enough to identify the issues we found during this inspection. Joint working with other healthcare professionals including an internal multidisciplinary team was not always effective.

Relatives told us they felt people were safe and staff knew their needs well. Appropriate recruitment checks had taken place before staff started work. There were enough staff available to meet people’s support needs, this included the use of agency staff. Staff followed appropriate infection control practices.

The service took the views of people and their relatives into account through surveys and meetings. Staff meetings were held so staff had the opportunity to share good practice. Staff told us they felt supported by management.

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 (published 27 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received from the local authority in relation to safeguarding in relation to physical and financial abuse and whistleblowing concerns. A decision was made for us to inspect and examine those risks.

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.

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 Sequence Care Supported Living on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safeguarding, risk, accidents and incidents and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

In line with Registering the Right Support guidance, people were placed at the heart of the service, their views, opinions and wishes were sought and acted on to deliver person centred care tailored to their needs and aspirations. People had achieved excellent outcomes based on a robust care planning approach to meet their changed needs. People's independence was promoted and valued enabling people to maintain and develop skills and abilities to meet their desired outcomes.

•People using the service told us they felt safe. One person said, “Yes I do feel safe here.”

•There were appropriate adult safeguarding procedures in place to protect people from the risk of abuse.

•Risks were identified, and risk management plans were in place to manage these safely.

•Medicines were safely managed and staff followed appropriate infection control practices to prevent the spread of infections.

Accidents and incidents were appropriately managed and learning from this was disseminated to staff. •Sufficient numbers of suitably skilled staff were deployed to meet people's needs.

•Assessments were carried prior to people joining the service to ensure their needs could be met.

•Staff completed an induction when they started work and were supported through regular training and supervisions to ensure they performed their role effectively.

•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 were supported and encouraged to eat a healthy and well-balanced diet.

•People had access to healthcare professionals when required to maintain good health.

•The environment had been adapted to meet people's needs.

•People told us staff were caring and respected their privacy, dignity and promoted their independence.

•People were involved in making decisions about their daily care and support needs.

•Staff understood the Equality Act and supported people’s individual diverse needs if required.

•People were provided with information about the service when they joined in the form of a 'service user guide' so they were aware of the services and facilities on offer.

•Staff were knowledgeable about people's individual support needs to support recovery.

•People were involved in planning their care and support needs.

•People’s needs were regularly reviewed and updated following a change in care or support needs

•There was a variety of activities on for people to take part in if they chose to do so. Information was available to people in a range of formats to meet their communication needs if required.

•People were aware of the home’s complaints procedures and knew how to raise a complaint

•The service was not currently supporting people who were considered end of life, if they did this would be recorded in their support plans.

•There were effective systems in place to assess and monitor the quality of the service provided.

•Regular feedback was sought from people and staff about the service and acted upon if necessary.

•The provider worked in partnership with key organisations to ensure people's needs were planned and met and deliver an effective service.

•People were complimentary about the registered manager and said the service was managed well.

Rating at last inspection: This was the first inspection of this service.

Why we inspected: This was a planned inspection in line with CQC regulations. We found the

service met the characteristics of Good in all areas.

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