We carried out a review of the data available to us about HF Trust - London DCA on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about HF Trust - London DCA, you can give feedback on this service.
About the service
HF Trust – London DCA provides personal care and support to people living in their own home as part of a supported living scheme. The service comprises several purpose-built flats (supported living units) where people either have their own self-occupied flats or bedrooms with access to shared kitchen, bathroom and communal living areas.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Out of 29 people, 22 people who received personal care were using the service at the time of the inspection.
People’s experience of using this service and what we found
Right Support:
Systems were in place to monitor and ensure people received their medicines safely. However, we identified some shortfalls which the provider was addressing.
Risks in relation to people's care and welfare were thoroughly assessed. This meant staff had the right guidance to support people safely.
The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
Staff supported people to make decisions following best practice in decision-making.
Staff enabled people to access specialist health and social care support in the community.
Right Care:
The service had enough appropriately skilled staff to meet people's needs and keep them safe.
Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and knew how to apply it.
Staff promoted equality and diversity in their support for people. They understood people's cultural needs and provided culturally appropriate care.
People's care and support plans reflected their range of needs and this promoted their wellbeing and independence.
Right Culture:
The service evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Quality assurance systems helped the staff team to monitor the service they provided and promote ongoing learning.
Staff knew and understood people well and were responsive to their individual needs. This meant people received compassionate and empowering care that was tailored to their needs.
People and those important to them were involved in planning their care.
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 7 December 2018).
Why we inspected
This focused inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
Recommendations
We made a recommendation around the safe management of medicines.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
This inspection took place on the 17 and 19 October 2018. The inspection was announced to ensure someone would be in to help facilitate the inspection. At The Old Print Works last inspection on 3, 7 and 9 December 2015, the service was rated good overall with a rating of “requires improvement” in the key question Safe. The service had made improvements to bring this key question to “Good”. There were no breaches of the regulations found during their last inspection.
At the time of our inspection 37 people were receiving personal care.
This service provides care and support to people living in ‘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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
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.
This registration had three sites and each site had its own registered manager at the time of the inspection.
People were kept safe at the service as there were staff on site 24 hours a day. People told us they felt safe. Staff understood their safeguarding responsibilities and could explain how they would escalate their concerns further or whistleblow if no action was taken.
Risk assessments were robust and staff knew how to mitigate against risk. People were supported to live in a less restrictive way and to take positive risks. Staff followed people’s positive behaviour support plan where risks presented themselves.
Staff were recruited safely and the provider performed a number of checks to ensure suitability and safety to work with people at the service. Medicines were managed safely and staff received thorough training before being able to administer medicine. People had detailed medicine profiles which outlined side effects and reasons for prescribed medicines.
The risk of infection was minimised as staff followed safe hygiene practices and wore personal protective equipment.
People received an assessment of need to ensure the needs could be met by the service. Staff received an induction, and mandatory and specialist training to support them in their role. Supervisions took place regularly and time was protected for this and staff received an annual appraisal where applicable.
People were encouraged to make their own decisions and be as independent as they could with staff there for support. Staff understood the principles of the Mental Capacity Act 2005. Appropriate referrals had been submitted to the local authority for Court of Protection applications where people’s liberty was being deprived.
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 to eat and drink well and staff were vigilant to people’s dietary requirements where it may impact their health.
Staff were observed to be kind and caring towards the people they supported. People had personalised flats with decorations of their choice. Staff knew people’s likes and dislikes and people were supported to develop romantic relationships.
Support plans were personalised as were people’s reviews. Relatives were invited to reviews of care. Staff met people’s needs and used their initiative to give people the best outcome when they travelled in the community or identifying concerns with medicines.
People participated in a number of activities of their choice with staff support and the service found ways to ensure people were not restricted in doing an activity.
The service was well led. Staff felt well supported by the registered manager and received praise for doing a good job. Quality assurance was robust and helped to identify where the service needed to improve or to acknowledge where people were receiving quality care.
The service sought feedback from people, their relatives and professionals.
This inspection took place on 3, 7 and 9 December 2015. We told the service about this two days before the inspection to ensure that management were available.
The Old Print Works is registered to provide personal care services to people living at supported living services and in their own homes. Services are provided to people with learning disabilities, physical disabilities, and mental health needs. At the time of our inspection 45 people were using the service. At our last inspections in April and July 2014 the service failed to meet regulations relating to care planning, records, supporting workers, nutrition, quality assurance, and notifications. However we found significant improvements in all these areas during the current visit.
The service did not have a registered manager, however an operations manager was in place covering this role since September 2014. They advised of the service’s intention to split into three separate services with a registered manager for each. 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 and associated Regulations about how the service is run.
We found that people lived in a safe and clean environment. They felt well supported by the staff at the service, and had developed positive relationships with them. However improvements were needed in procedures to further protect people using the service from financial abuse..
Staff received appropriate training, supervision and support for their roles, including training in the Mental Capacity Act 2005, and there were systems in place to ensure that this was followed.
Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported. People spoke highly of the support staff provided including support to meet their cultural needs.
Staff supported people with eating and drinking and to attend health care appointments. Safe systems were in place for staff to support people to take their prescribed medicines.
People told us that the management were accessible and approachable, and that they felt able to speak up about any areas for improvement. There were regular checks in place to review the quality of the service provided to people and to seek their views.
There were financial procedures in place to keep peoples’ money safe. However we made a recommendation about reviewing the way staff supported two people when using their cash cards to ensure that all parties were protected as far as possible.
We spent the majority of the inspection visit at two adjacent supported living schemes at which the service supports 24 people. We met with seven people using the service although many were not able to speak with us due to communication needs. We spoke with the staff supporting them, and looked at records available at the office of these schemes and in some people's homes in these schemes. We also spoke with two community healthcare professionals following our visit.
People using the service that we spoke with indicated that they were happy with the service. 'I like it here,' one person said. Most staff we spoke with indicated that they were supported in their work and to meet people's needs. We saw records of ongoing training and supervision of permanent staff. We found that there was an overall focus on supporting people to access the community and be involved in activities and occupations that they enjoyed, and for many people this support was being provided.
However, we found that the service was not effective at identifying, assessing and managing risks relating to the health, safety and welfare of people using the service. Where incidents affecting the safety and welfare of people using the service had taken place since our last inspection, many had no record of action in response to the incident. Therefore we could not be assured of effective risk management. These included incidents of someone repeatedly activating the fire alarm, and a person using the service attending hospital as a result of the actions of another person using the service. We also found cases where action had been taken but had not been effective at minimising risk. For example, an allegation of financial abuse that had not been acted on promptly which allowed a repeated incident to occur the following week. The provider's risk management processes, particularly around incidents, was failing to protect people against the risk of inappropriate or unsafe care, and so we were not assured of a well-led service.
We found three occasions when the service had not promptly notified us of important events that affected people's health, safety and welfare. As a result, we could not be confident that people using the service were being protected from risks and safeguarded when needed.
We tracked the support being provided to five people with higher care needs and found that for one person, the planning and delivery of support with drinking was not protecting them from the risks of dehydration. Their support plan had not been kept up-to-date in this respect despite community healthcare input, and records of fluid intake were not consistently recorded or used. The support provided to them was not consistently enabling them to drink enough to protect them from the risks of dehydration, and so we were not assured of the effectiveness of the service in this respect.
We found that some care and support records about people using the service were not kept securely in the office of the two adjacent supported living schemes. We also found pages torn out of the communication book in that office. These matters failed to protect people using the service against the risks of inappropriate or unsafe care.
The Old Print Works provides a supported living service to people in their own homes. Its services are primarily for adults with a learning disability. At the time of our visit, the service was providing personal care for 47 people across a number of supported living schemes and people’s own homes.
During the inspection we talked with the registered manager who had been in post since the service was registered. They were well-known to many people using the service.
Most people using the service informed us that nothing needed changing about the service and that that they would recommend it to others. Comments included, "It's very nice" and "They’re good at what they do." We found that people were safely supported with their medicines and meals, and that staff listened to them and promoted their independence.
However, a few people indicated that they did not feel safe using the service. We found that the service did need to improve in terms of keeping people safe. Although staff had received a lot of training, they did not have enough training on safely supporting people whose behaviour challenged the service. There was not enough effective care planning on working with new people and those with complex communication needs, and so people’s safety may have been put at risk.
Some records kept by the agency were disorganised or missing, and some people’s support plans failed to demonstrate how they had been involved in making decisions about their care and support. We were not assured of a well-led service.
We found that most people had positive relationships with small groups of established staff who knew them well. However, some people were supported by too many agency staff, which put them at unnecessary risk of inappropriate or unsafe support. We were not assured of the service being effective at meeting people’s needs.
The problems we found breached three health and social care regulations. You can see what action we told the provider to take at the back of the full version of the report.