Background to this inspection
Updated
24 September 2021
The inspection
This was a targeted inspection to check staffing levels, safe use of medicines, whether the risks to people were safely managed, and governance systems.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
Two inspectors carried out the inspection.
Service and service type
This service provides support to people living in 13 'supported living' locations, so that they can live 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 manager registered with the Care Quality Commission. This means that they and the
provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We visited two of the provider's 'supported living' locations. We spoke with seven people who used the service about their experience of the support provided. We spoke with 14 members of staff including the provider, registered manager, clinical leads, occupational therapists, registered nurses, team leaders, training co-ordinator and support workers.
We reviewed a range of records. This included five people’s support plans and multiple medication records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
24 September 2021
About the service
Northern Healthcare is a 'supported living' service that provides care and support for people with a recognised diagnosis relating to mental health, learning disabilities, autism or acquired a brain injury, which includes support and recovery programmes. Each person has their own individual lease agreement with the housing association and a separate contractual agreement for their care.
The provider has 13 'supported living' locations nationwide and other locations currently under development. Each location contains a number of individual bedrooms or flats and shared or communal gardens, lounges, kitchens and dining areas. The service provides 24-hour support from mental health professionals, including registered mental health nurses, occupational therapists, and a cognitive behavioural therapist.
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.
This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People’s privacy was not always maintained. In some of the locations microphone recording was used in communal areas without consent from people. Some people told us this had a negative impact on their privacy as they could not have a private conversation with their families and friends in the communal areas. The provider deactivated the microphones across locations during the inspection process.
We received mixed feedback from staff and people regarding staffing levels. We have made a recommendation about the provider reviewing their staffing levels across locations.
There was a lack of training for specific conditions. We have made a recommendation about the provider reviewing their training programmes for specific conditions.
Staff had administered prescribed creams for one person without the appropriate training or competency checks. We have made a recommendation about the provider using a reputable source to review their medicine training, policies and processes.
Medicine audits were not robust. We have made a recommendation about the provider using a reputable source to review their medicine auditing systems.
After the inspection we received concerns in relation to staffing levels, training, medicine management, oversight of the service and meeting people’s care needs in one of the provider’s locations that was not visited as part of the inspection. This is being investigated outside the inspection process in partnership with the local systems, including contract monitoring and safeguarding teams.
People and staff members were involved with the service through regular team meetings and surveys. We received mixed feedback from staff in relation to the management of the service.
People's care needs were risk assessed and care plans provided staff with the information they needed to manage the identified risk. People’s ongoing risk assessments were reviewed on a regular basis and when needs changed. People’s views and decisions about care were incorporated in their care plans. This helped staff to support people in a way that allowed people to have control over their lives.
Staff received training in infection control and told us personal protective equipment (PPE) was readily available to them.
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 16 September 2019).
Why we inspected
We received concerns in relation to staff training and management of the service. 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.
The provider has taken some action to mitigate the risks. Staff have been provided further training to meet the needs of the people they support. Microphone recording has been deactivated across locations.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Northern Healthcare Head Office on our website at www.cqc.org.uk.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to maintain people’s privacy at this inspection.
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.