Support for Living Limited - 37 Barlby Road

We found the following examples of good practice.

The provider had put in place and adapted the visitors’ protocol when risk factors and government guidance changed. There was a clear process in place to ensure all visits to the service were managed safely.

There were systems in place to ensure stocks of personal protective equipment (PPE) were maintained. The provider had assessed the risks and put in in place risk management plans for people who were unable to adhere to self-isolation guidelines.

The registered manager completed regular health and safety audits of the service to ensure infection prevention control procedures were being followed. Staff followed cleaning schedules to ensure levels of cleanliness were maintained and the service was clean and hygienic when we visited.

Staff received Infection Prevention and Control (IPC) training and enhanced COVID-19 training. The registered manager had a contingency plan in place which contained plans for acute staff shortages. The service was taking part in ‘whole service’ testing in line with current government guidance to help protect all people using the service and staff.

Support for Living - 37 Barlby Road provides care and support for up to four people living with complex learning disabilities and physical disabilities. People have their own rooms and share bathroom facilities. People shared bathroom facilities and hoisting equipment was available when needed. At the time of this inspection four adults were receiving care and support from the service.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way.

Staff had received training on (DoLS) and the (MCA) and in theory understood what to do if people could not make decisions about their care needs in line with the MCA.

Staff developed caring relationships with people using the service. However, staff were not always adopting a creative and meaningful approach to maximising people’s quality of life in terms of the range of activities people were able to access.

People's cultural preferences were documented in their care and support plans. However, we saw little evidence that these preferences were being promoted and provided for in relation to meal choices.

Safeguarding training was completed by all staff and refreshed when needed. Staff were trained to protect people from abuse and harm and knew how to refer to the local authority and others if they had any concerns.

Risk assessments were centred on the needs of the individual and were up to date and being reviewed in line with the provider’s policies and procedures. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow and to make sure people were protected from harm.

Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There were enough appropriately skilled and experienced staff deployed to the service. Staff had completed the necessary training to equip them with the skills and knowledge to carry out their duties.

There were suitable arrangements in place for the safe storage and disposal of medicines and all medicines were administered by staff who had received the appropriate training to be assessed as competent to carry out these duties.

Staff supported people to attend healthcare appointments as required and liaised with people’s family members, GPs and other healthcare professionals to ensure people’s needs were met appropriately. Advocates and family members (where appropriate) were involved in reviews of people’s care and support.

The provider had implemented and was operating effective systems to audit different aspects of the service; these included the administration of medicines, care records and reviews, fire safety procedures and health and safety checks.

During our visit we were unable to review people’s proof of identity, right to work status and references as this information was not held at the service. We requested and received information from the provider relating to staff recruitment demonstrating that criminal record checks and other relevant checks were undertaken before staff commenced working with people.

We have made two recommendations in relation to the development of people's activity programmes and meal planning and preparation.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ’Support for Living Limited - 37 Barlby Road’ on our website at www.cqc.org.uk’

Following the inspection in November 2015, we asked the registered provider to undertake weekly audits of all service users’ needs, care plans and risk assessments and send us a monthly report stating the action taken or to be taken as a result of these audits. We received these reports promptly along with an action plan setting out what the provider would do to meet legal requirements in relation to the above breaches.

We carried out a follow up comprehensive inspection on the 29 July 2016 to check that the provider had followed their action plan and to confirm that they now met legal requirements.

Support for Living - 37 Barlby Road provides care and support for up to four people living with complex learning disabilities and physical disabilities. At the time of this inspection three adults were receiving care and support from the service.

The recently appointed manager had submitted an application to become the registered manager of the service and this was being processed at the time of our visit. 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 time of our inspection, the manager was employed on a full time basis and was supported by an acting deputy manager. There were enough appropriately skilled and experienced staff deployed to the service and staff had completed the necessary training to equip them with the skills and knowledge to carry out their duties effectively.

There were suitable arrangements in place for the safe storage and disposal of medicines and all medicines were administered by staff who had received the appropriate training to be assessed as competent to carry out these duties.

People were protected from risks to their health and wellbeing because written risk assessments were up to date and were being reviewed in line with the provider’s policies and procedures.

There were systems in place to protect people from abuse and keep people free from harm. The provider had policies and procedures in place for safeguarding adults which were available and accessible to members of staff. Staff were able to demonstrate a good understanding of these policies and procedures and how they related to their roles and responsibilities.

Staff supported people to attend healthcare appointments as required and liaised with people’s family members, GPs and other healthcare professionals to ensure people’s needs were met appropriately. Advocates and family members (where appropriate) were involved in reviews of people’s care and support.

CQC is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005, Deprivation of Liberty Safeguards (DoLS) and to report upon our findings. DoLS are in place to protect people where they do not have capacity to make decisions and where it is regarded as necessary to restrict their freedom in some way, to protect themselves or others. These safeguards are there to make sure that people receiving support are looked after in a way that does not inappropriately restrict their freedom. Services should only deprive someone of their liberty when it is in the best interests of the person and there is no other way to look after them, and it should be done in a safe and correct way. Staff had received training on the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA) and understood what to do if people could not make decisions about their care needs in line with the MCA.

The provider had implemented and was operating effective systems to audit different aspects of the service; these included the administration of medicines, care records and reviews, fire, health and safety checks.

During our visit we were unable to review people’s proof of identity, right to work status and references as this information was not held at the service. We requested and received information from the provider relating to staff recruitment demonstrating that criminal record checks and other relevant checks were undertaken before staff commenced working with people.

Staff developed caring relationships with people using the service and supported them to maintain their hobbies and interests. People's cultural preferences were respected.

Following our last inspection in November 2015 we judged the service was Inadequate and we placed it in special measures. At this inspection we found the providers had addressed the concerns we raised with them and had made improvements to the quality of care and support people received. We have judged the service as Requires Improvement and it is no longer in special measures.

Staff understood the importance of ascertaining capacity and getting a person's permission before delivering care. People's families were involved in developing their care plan and person centred documentation. People's views were ascertained over time and their care plan was adjusted accordingly.

All people's risk assessments and care plans were up to date. Person Centred documentation was regularly updated and in place for all residents.

Staff had been trained on how to recognise abuse and the service had procedures in place to prevent abuse from happening.

People were cared by staff who had been through a recruitment process and subjected to the appropriate pre-employment checks.

There was a complaints policy in place and people were given information and assistance in making a complaint.

We were unable to speak with people using the service at 37 Barlby Road because they were not able to communicate verbally with us. However, we saw that each person had constant care, support and interactions with staff. We saw that staff communicated with people in a positive way. People had up to date care plans and risk assessments which included what they liked and disliked. We saw no evidence that people who did not have family involvement had access to an advocate in recent months. An advocate is a person who speaks on behalf of another person.

On the day of our visit we saw that there were sufficient staff to meet the day to day needs of people using the service. We saw that some people were going out to activities and appointments.

We saw that action plans were in place for the improvement of the home's facilities, such as the kitchen and one of the bathrooms. Plans also included review of staffing levels and activities for people using the service. The provider was meeting monthly with the local authority's representatives to monitor the contract.