Archived: St Anne's Community Services- Doncaster

This service provides care and support to people living in 35 '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 is divided into five separate geographical teams. Each geographical area has 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.

The service can support a maximum of 80 people. On the day of our inspection 75 people were receiving support from St Anne’s Doncaster.

At the last inspection in January 2017 the service was rated Requires Improvement. We found the service had improved in the areas of medicines, care planning and quality assurance. However, these improvements needed to be continued and sustained. At this inspection, we found the service had sustained the improvements and embedded them into everyday practice. We have rated the service as Good.

Processes were in place to keep people safe and free from harm. Staff were knowledgeable in safeguarding adults' procedures and any concerns were discussed with the registered manager and local authority safeguarding team. Plans were in place to manage and mitigate risks to people. The registered manager regularly reviewed any incidents that occurred. There were sufficient staff to meet people's needs. People received their medicines as prescribed. Infection control procedures were adhered to.

People were supported by staff that had the knowledge and skills to undertake their duties. Staff completed a programme of training and received regular supervision. Staff supported people to eat and drink sufficient amounts and met their dietary requirements. Healthcare professionals were liaised with by staff and visited the service as required to ensure people had their health needs met. Staff adhered to the Mental Capacity Act 2005 and conditions specified in people's Deprivation of Liberty Safeguards authorisations.

Kind and respectful relationships had been developed at the service. Staff were polite and friendly when engaging people. Staff supported people to make choices and communicated with people in a way they understood. People's privacy and dignity was maintained.

People's care and support needs were met. Care plans were regularly reviewed and held sufficient and appropriate detail about how people were to be supported. A full activities programme was in place, this included individual and group activities. People said they would be comfortable to make a complaint and were confident action would be taken to address their concerns. The registered managers and provider treated complaints as an opportunity to learn and improve.

Staff felt well supported by the registered managers and area manager and felt they were approachable. Staff and people's feedback was obtained through informal conversations, organised meetings and regular surveys. A programme of audits was in place to review and monitor the quality of service delivery. The registered manager adhered to the requirements of the CQC registration and submitted notifications about key events that occurred at the service.

Further information is in the detailed findings below.

St Anne's Community Services- Doncaster provides personal care for adults with a learning disability in a supported living setting. The service is delivered in 23 shared or self-contained community based properties in Doncaster. The service is divided into five separate geographical teams. Each geographical area has either, a registered manager or a manager who has begun the process of registration with 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.

The service was previously inspected in May 2016 and we identified the service was not meeting six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches were in respect of notifying us of incidents, involving people in planning their care, gaining consent, meeting people’s needs and preferences, planning for risks and keeping people safe, and keeping appropriate records.

Following the inspection, the provider sent us an action plan, which detailed how improvements would be made. During this inspection, we saw the provider had made considerable progress in relation to the action plan to address previous areas of concern. Whilst improvements had been made we will check at our next inspection to determine if the improvements have been sustained and embedded into everyday practice.

There were enough staff with the right skills and knowledge to support people. Staffing was sufficient and flexible to meet people's needs and staff had time to respond to people's needs in an unrushed way. People were given the time to communicate at a pace that suited them. Staff had good support and supervision to fulfil their role effectively and felt confident in approaching the registered manager if they needed extra guidance. People were protected by the service using safe and robust recruitment processes.

Staff understood that although they had a duty of care to help keep people safe, people were also free to make their own choices even if this could increase the level of risk to that person. The risk of harm to people was reduced as robust risk assessments had been implemented. Staff were trained in safeguarding and understood the processes for reporting abuse or suspected abuse.

Staff assessed people's nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

People and their relatives, where appropriate, were involved in the assessment, planning and review of their care. Staff considered people's choices, health and social care needs, and their general wellbeing.

Staff supported people in a way which was kind, respectful and encouraged them to maintain their independence. Staff also protected people's privacy and dignity.

People received their medicines on time and according to their preferences, from staff with the necessary training and who had their competence assessed. There were systems in place for the storage, administration and disposal of medicines. The improvements in recording and auditing of medicines needed to be continued and sustained.

People had opportunity to participate in a wide choice of activities. People were involved in a range of activities on the day we visited. People were able to attend day centres if they so wished. There were several community based activities which people enjoyed, such as, dog walking for a local greyhound rescue centre.

People we spoke with said if they had any concerns or complaints they would feel confident discussing these with staff members or management. They were sure the correct action would be taken if they made a complaint.

Whilst we found some need for further improvement, care plans had improved from our previous inspection. People's care files were written in an easy read format which included pictures to help people understand its content. Documents gave a good level of detailed guidance to inform staff of how to deliver person specific care. The improvements in care plans and recording needed to be continued and sustained.

There were quality assurance processes in place to enable the registered manager to have oversight of the home and to ensure that people were receiving the quality of service they had a right to expect. The improvements in auditing needed to be continued and sustained.

We inspected St Anne's Community Services - Doncaster in February 2015 when we found two breaches of Regulations. These were regarding the safe management of medicines and lack of effective governance. The service received an overall rating of Requires Improvement following the inspection. We inspected the service again in November 2015. We did not find significant improvements at this inspection nor did we have evidence that where improvement had been made, they had been sustained or embedded to enable us to change the ratings given at the February inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘St Anne's Community Services - Doncaster' on our website at www.cqc.org.uk'

St Anne's Community Services- Doncaster provides personal care for adults with a learning disability in a supported living setting. The service is delivered in shared or self-contained community based accommodation in Doncaster. The service is divided into five separate teams each with a service manager. One of these service managers is also the 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.

At this inspection we identified continued shortfalls and repeated breaches of the regulations. The arrangements in place for protecting people from abuse or the risk of abuse were not sufficient to protect people, particularly from financial abuse.

Previous inspections in February and November 2015 had identified concerns in relation to medication which have not been addressed sufficiently. For example, we found two instances where prescribed creams were in use, yet did not have a medication administration record to capture the frequency or detail of application.

We saw that people’s risk assessments and support plans in relation to keeping people safe were generic and did not name the person they related to.

We spoke with staff about how they raised concerns to the provider. One told us that out of hours management was sometimes difficult to contact when incidents occurred. Another told us that they had raised concerns and did not feel the provider had responded.

We found the service was not meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). We spoke with the registered manager and other managers within the service about this. They believed that they could lawfully deprive people of their liberty, and spoke about making applications to do so. The Registered Manager lacked understanding of the legal requirements of the Deprivation of Liberty Safeguards in relation to support living services.

We found that the provider did not appropriately seek people’s consent, and on occasion obtained consent from other people on people’s behalf, despite them having the mental capacity to give or withhold consent themselves.

We checked records of staff training and found that the training programme was comprehensive, and enabled staff to undertake training in specialist areas that would enable them to better understand the needs of people using the service. Our observations during the inspection indicated that the training was not always put into practice or effective.

Staff meetings had not taken place at the provider’s required frequency, and topics discussed were limited.

We observed staff interacting with people and saw that they spoke with people respectfully and kindly.

Care plans lacked personalisation. In one part of the service, all the care plans were extremely similar, and did not contain individualised information and showed little evidence that people had been involved in their care.

There was a system in place for people to have a monthly meeting with their keyworker where their care plan and support was discussed. We found that such reviews had not always taken place in the three months preceding the inspection and in one instance the last recorded meeting was in October 2014.

Activities appeared to be plentiful, and people we spoke with described that they went out often.

A complaints policy and procedure was in place. People told us that they would be happy to raise concerns and would speak to staff or management if they needed to.

The arrangements in place for monitoring the quality of the service provided were poor. The service had a registered manager, however, the registered manager was only responsible for around 20 percent of the service; their role within the organisation meant they had no control or influence over the rest of the service.

The registered manager told us they carried out audits of care plans, audits of medication and checks of people’s finances. They were unable to describe any other areas they monitored. We found that care plan audits were inaccurate and did not reflect the records that we had checked.

We looked at statutory notifications submitted to CQC by the provider, and compared them to records of incidents that had happened within the service that the provider was legally required to notify CQC about. We found there were numerous incidents that the provider had failed to submit notifications for.

Some medication did not have dates recorded showing when it had been opened, and stock records were inadequate as staff had not recorded any medication carried forward from one month to another. This meant that the provider had failed to act when CQC found shortfalls in medicines management in November 2015.

In the months preceding the inspection, incidents had occurred within the service where money belonging to people using the service had gone missing. We found there were insufficient systems in place to protect people from financial abuse.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration the service will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. A questionnaire returned by a relative read: 'We are more than delighted with the care our family member receives.' One person who used the service told us: "I like the support I get here. I have been on lots of trips and staff support me to arrange holidays."

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.