Archived: Consensus Community Support South

Consensus Community Support Limited- East Hill Place is a supported living service providing personal care to people living in their own homes. The provider supported people with a learning disability and/or mental health need. At the time of our inspection they were supporting 14 people who lived in two separate supported living settings. One of the supported living settings is a specialist service supporting people who live with Prader-Willi Syndrome. Prader-Willi syndrome is a rare genetic condition that causes a wide range of physical symptoms, learning difficulties and behavioural problems.

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.

People’s experience of using this service and what we found

People told us they were happy with their care. They were comfortable in staff’s presence and felt secure in raising issues or concerns. People were safeguarded from the risk of suffering abuse or coming to avoidable harm. The provider had an open and transparent approach where people, relatives and professionals were kept informed about key events related to care.

The registered manager had overseen sustained improvements since our last inspection. They had ensured that the service was no longer in breach of regulations and had put in place systems to promote good quality care.

The provider had systems in place to monitor and improve the quality of care. The provider had met regulatory requirements around submitting statutory notifications and the registered manager understood their regulatory responsibilities.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were supported to have choice and control around their care. Staff encouraged people to weigh up decisions, whilst respecting their right to make unwise choices if they had the capacity to do so. Staff were focussed on supporting people to work towards positive outcomes in relation to their health, wellbeing and independence. People were comfortable and settled in their homes and with their care arrangements.

Risks related to people’s health, medical conditions and behaviour were assessed and reduced. Staff had a good understanding of people’s needs and had received appropriate training and support in their role.

There were systems in place to gain feedback about the quality of care and ensure complaints were handled in line with the provider’s policy.

People’s care plans were detailed, containing information about their health, personal care routines and medicines. There were safe systems in place to support people to manage their medicines and good examples of how people were supported to become more independent in this area.

There were enough staff in place who had gone through appropriate recruitment checks to help ensure they were suitable in their role. Staff were caring and responsive to people’s needs.

The provider worked well with external stakeholders to meet people’s changing needs and ensure people had smooth transitions when moving between different services.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update:

The last rating for this service was requires improvement (published 23 October 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Consensus Community Supported Living is a domiciliary care agency providing personal care to 12 people in their own homes at the time of the inspection. Some of whom lived in flats in a ‘supported living’ environment. It provides a service to adults who have a learning disability or autistic spectrum disorder and younger adults. Consensus Community Supported Living is a specialist service supporting people who live with Prader-Willi Syndrome. Prader-Willi syndrome is a rare genetic condition that causes a wide range of physical symptoms, learning difficulties and behavioural problems. 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.

People’s experience of using this service and what we found

People were not sufficiently protected against the risk of avoidable harm because potential risks to people’s health, safety and welfare were not managed safely all the time.

Despite this, people were happy being supported by Consensus Community Support Limited and told us they felt safe. There were enough staff to meet people’s needs on the day of inspection.

The provider had not fully considered the Equalities Act 2010. We have made a recommendation about this.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

People could not be assured that safe recruitment practices had been followed. We made a recommendation about this.

People were supported by staff who were kind and caring. People had access to a range of activities and were supported to maintain links with the community and people who were important to them.

Staff felt valued and listened to and told us they liked working at Consensus Community Support Limited.

End of life care plans were not always in place. We have made a recommendation about this.

The provider lacked effective governance systems to effectively monitor the service and drive the

necessary improvement. At times, there was a lack of detailed records regarding medicines, recruitment and complaints management.

The provider demonstrated a willingness to make improvements and during the inspection began reviewing some of their systems and processes to ensure the service started to make improvements.

The service didn’t always consistently apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, lack of choice and control and limited independence. For example, people did not always have choice in the amount of drinks they could have or at what times they could have hot or cold drinks. However, menus were developed by staff with input from people who lived at the supported living settings.

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 23 February 2017).

Why we inspected

The inspection was prompted in part due to concerns received about risk management, failure to report safeguarding incidents and management of the Mental Capacity Act (MCA). A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has acted to mitigate some of the risks and is working with the local authority to continue to make improvements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Consensus Community Support Limited – East Hill Place on our website at www.cqc.org.uk.

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.

We told the provider they needed to take action and we received a report setting out the action they would take to meet the regulation. At this inspection we reviewed whether or not these actions had been taken and found the provider was now meeting the requirements of the HSCA 2014. We found improvements had been made regarding the management of risk relating to peoples finances and documentation was in place to support this work.

East Hill Place is a supported living service situated within a number of residential flats located on the outskirts of Liss Village Centre. The service provides care and support for up to seven younger adults with learning disabilities. People using the service also live with a number of complex emotional and behavioural needs including autism as well as other health needs such as epilepsy. East Hill Place is comprised of seven self-contained individual one or two bedroomed flats within the grounds of a residential home owned by the same provider.

A supported living service is where people are provided with personalised care and support in their own home which is situated within a purpose built residential area. At the time of the inspection the service was providing personal care and support to six people.

East Hill Place has a registered manager in post. 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 using the service told us they felt safe. Staff understood and followed guidance to enable them to recognise and address any safeguarding concerns about people.

People’s safety was promoted because risks that may cause them harm in their own flats had been identified and guidance provided to staff on how to manage these appropriately. People were assisted by staff who encouraged them to remain independent. Appropriate risk assessments were in place to keep people safe.

Recruitment procedures were completed to ensure people were protected from the employment of unsuitable staff. New staff induction training was followed by a period of time working with experienced colleagues. This ensured staff had the skills and confidence required to support people safely. There were sufficient staff employed to ensure that people’s individual needs were met.

Contingency plans were in place to ensure the safe delivery of care and support in the event of adverse situations such as large scale staff sickness or fire and floods. The registered manager was also able to deliver care if staff were ill and unable to work.

People were protected from unsafe administration of their medicines because staff were trained effectively. Staff had completed mandatory training to ensure they could prompt people to take their medicines where required. Where staff administered people’s medicines this was carried out safely. Staff followed guidance to ensure people safely stored and disposed of medicines which were kept in their own flats or in the staff office when required. Staff skills in medicines administration were reviewed on a regular basis by an experienced and suitably trained member of staff to ensure they remained competent to continue.

People were supported by staff to make their own decisions. Staff were knowledgeable about the actions to take to ensure they met the requirements of the Mental Capacity Act (MCA) 2005. The registered manager identified they would work with health care professionals when required to assess people’s capacity to make specific decisions for themselves. Staff sought people’s consent before delivering their care and support.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to all care settings. The registered manager showed an understanding of what constituted a deprivation of person’s liberty. An appropriate application had been submitted which was awaiting action by the commissioning body to ensure people were not being unlawfully restricted.

Where required people were supported to eat and drink enough to maintain a balanced diet. People were encouraged to participate in preparing their meals and to ensure they met their individual nutritional and hydration requirements. Staff followed guidance in people’s support plans which identified their preferred meals and assisted people to make alternative options and choices when they expressed a wish to eat more healthily.

People’s health needs were met as the staff and the registered manager had a detailed knowledge of the people they were supporting. Staff promptly engaged with healthcare agencies and professionals when required. This was to ensure people’s identified health care needs were met and to maintain people’s safety and welfare.

Staff had taken time to develop close relationships with the people they were supporting. Staff understood people’s communication needs and used non-verbal communication methods where required to interact with people. These skills were practically demonstrated both by the registered manager and staff during their interactions with people.

People received personalised and respectful care and support from staff who understood their needs. Staff delivered care following guidance contained in people’s support plans. Support plans contained detailed information to assist staff to provide care in a manner that respected each person’s individual needs and wishes. People were encouraged and supported by staff to make choices about their care including how they spent their day within their flats or in the local community.

People and a relative told us they knew how to complain and told us they would do so if required. Procedures were in place for the registered manager to monitor, investigate and respond to complaints in an effective way. People, relatives and staff were encouraged to provide feedback on the quality of the service during regular support plan reviews. People were also asked to complete an annual quality assurance questionnaire to provide their views on the quality of the care and support provided.

People were supported to participate in activities to enable them to live meaningful lives and prevent them experiencing social isolation. A range of activities were promoted to people to enrich their daily lives which included visiting local nature park areas and supporting people with the aim of wishing to experience a foreign holiday. Staff were motivated to ensure that people were able to participate in a wide range of external activities and encouraged them to participate in external day trips they knew people would enjoy.

The provider’s values included the right for people to be provided with choice and respect, supporting people to achieve great things in their lives and staff being honest and working with integrity. Whilst staff were not always able to discuss all the provider’s values they demonstrated they knew how to deliver high quality care in a way which promoted people’s dignity, respect and independence. People and a relative told us these standards were evidenced in the way that care was delivered.

People and a relative told us East Hill Place had a confident registered manager and staff told us they felt supported by them. The registered manager provided strong positive leadership and fulfilled their legal requirements by informing the Care Quality Commission (CQC) of notifiable incidents which occurred at the service. Notifiable incidents are those where significant events happened. This allowed the CQC to monitor that appropriate action was taken to keep people safe.

Quality assurance processes were in place to for the provider to routinely and regularly monitor the quality of the service being provided in order to drive continuous improvement.