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Archived: St Anne's Community Services- Doncaster Good

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Reports


Inspection carried out on 27 March 2018

During a routine inspection

The inspection took place on 27 March 2018. The inspection was unannounced.

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.

Inspection carried out on 17 January 2017

During a routine inspection

We inspected St Anne's Community Services- Doncaster over two days. The first visit was on 17 January 2017 and was unannounced. We returned to complete the inspection on 18 January 2017.

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 f

Inspection carried out on 4 May 2016

During a routine inspection

This inspection took place on 4, 5 and 8 May 2016 and was unannounced. This inspection was carried out to review the progress on meeting the regulations and shortfalls identified at previous inspections .

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 simila

Inspection carried out on 4,5,6 November 2015

During a routine inspection

We inspected St Anne's Community Services- Doncaster on 4,5,6 November 2015. The inspection was unannounced. St Anne's Community Services- Doncaster was last inspected in February 2014. At that inspection we identified breaches of the HSCA (RA) Regulations 2010 regarding medication and governance. Following this inspection the provider produced an action plan to address the shortcomings identified.

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 and is divided into four separate teams. On the day of the inspection 55 people were receiving accommodation based care services from the provider. St Anne's Community Services- Doncaster had 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 who used this service were not always safe. Medicines administered were not always signed for on the Medication Administration Records (MAR). Medication in the form of liquids and creams did not always have an ‘opened on’ date. The provider’s monitoring processes did not always identify recording errors had been entered on medicine administration records. You can see what action we told the provider to take at the back of the full version of the report.

Staff knew how to reduce the risk of harm to people from abuse and unsafe practice. The risk of harm to people receiving the service was assessed.

Most staff felt there was sufficient numbers of staff available to meet people’s needs although some staff and people who used the service believed that staffing was not always adequate and support had not been delivered as a consequence. The provider had procedures in place to recruit staff safely.

Care plans did not always reflect the current needs of people who used the service. Not all care plan documents were updated regularly.

People felt safe and secure with staff coming into their homes and that staff had the skills and knowledge to care and support them. Staff felt trained and supported to care for people.

Where appropriate, people were supported by staff to access other health and social care professionals when needed. The provider was taking the appropriate action to ensure people who used the service, was not unlawfully restricted and had processes in place to protect people’s rights.

People felt that the staff were caring and treated people with dignity and respect. They felt staff promoted their independence and staff responded to their support needs.

People felt they could speak with the provider about their worries or concerns and most felt that they would be listened to and have their issues addressed.

The provider had internal quality assurance systems in place to monitor the care and support people received. However, the systems were not always used  with the frequency expected by the provider, nor were they always effective in identifying issues or areas requiring improvement.  You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 12, 13 February 2015

During a routine inspection

We inspected St Anne's Community Services- Doncaster on 12 and 13 February 2015. The inspection was unannounced. St Anne's Community Services- Doncaster was last inspected in January 2014, no concerns were identified at that inspection.

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 community based accommodation in Doncaster. On the day of the inspection 13 people were receiving accommodation based care services from the provider. St Anne's Community Services- Doncaster had 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 who used this service were not always safe. Medicines stored did not always tally with the number recorded on the Medication Administration Records (MAR). There had been more than 10 reported medication errors by St Annes – Doncaster in the last year. The care staff knew how to identify if a person may be at risk of harm and the action to take if they had concerns about a person’s safety. The care staff knew the people they were supporting and the choices they had made about their care and their lives. People who used the service, and those who were important to them, were included in planning and agreeing to the care provided.

The decisions people made were respected. People were supported to maintain their independence and control over their lives. People received care from a team of staff who they knew and who knew them.

People were treated with kindness and respect. One person told us, “My support is the best thing that has happened to me. I want it to continue so I can make plans and do things with my life.”

The registered manager used safe recruitment systems to ensure that new staff were only employed if they were suitable to work in people’s homes. The staff employed by the service were aware of their responsibility to protect people from harm or abuse. They told us they would be confident reporting any concerns to a senior person in the service or to the local authority or CQC.

There were sufficient staff, with appropriate experience, training and skills to meet people’s needs. This ensured people received a service that promoted their rights and independence.

Staff were well supported through a system of induction, training, supervision, appraisal and professional development. There was a positive culture within the service which was demonstrated by the attitudes of staff when we spoke with them and their approach to supporting people to maintain their independence.

The service was not consistently well-led. There was a comprehensive, formal quality assurance process in place however it was not robustly applied. This meant there was a risk that not all aspects of the service were appropriately monitored to ensure good care is provided and planned improvements and changes may not be implemented in a timely manner.

You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 22 January 2014

During a routine inspection

People�s privacy, dignity and independence were respected. One person who used the service told us: �The staff who visit me are always respectful and nice, they never rush me.�

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.