4 September 2018
During a routine inspection
When we completed our previous inspection on 28 April 2015 we found concerns relating to the management of medicines. We made a requirement under Regulation 12 (2) (g) of the Health and Social care Act 2008. We received a suitable action plan shortly after this inspection in 2015. We saw that steps had been taken to improve matters. A pharmacist from the Lancashire Care NHS Foundation Trust (hereafter referred to as the Trust] had supported and trained staff. Suitable audits and improvement plans were in place. We judged that this breach had been met very soon after the requirement had been made in 2015.
This service provides care and support to people living in fifteen 'supported living' settings, so that they can live in their own home as independently as possible. Some people lived alone with support and others shared their home with up to three other people. 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. Everyone in the service received personal care 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. We saw that this service supported people in line with these guidelines.
This service did not require a named registered manager at this location as the service is part of a National Health Service provider. Lancashire Care NHS Foundation Trust 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 Trust employed a nurse manager who runs this service and one other 'supported living' service in the area.
Staff had received training on ensuring people were kept free from harm and abuse. They were confident in management dealing with any issues appropriately. The Trust had a confidential phone line and other means of contact for staff to report any concerns.
Good risk assessments and emergency planning were in place. Accidents and incidents were monitored and analysed by the Trust and action taken to reduce risks. Fire risk assessments and fire safety measures were in place. Suitable action was taken in relation to fire risk to ensure staff followed the risk management plans. We noted a possible issue around fire safety in one property but this was dealt with quickly after our visit.
We saw that staffing levels met the assessed needs of people in the service. There were some nurse vacancies in the service but this was being addressed by senior management. Staff recruitment was thorough with all checks completed before new staff had access to vulnerable people. The organisation had suitable disciplinary procedures in place.
Staff were trained in infection control and supported people in their own environment. Specialists in the Trust could be called on for advice, when necessary.
This staff team had been supported to develop appropriately. Staff were keen to learn and we saw that induction, training and supervision had helped them to give good levels of care and support. Nurses were given opportunities to keep their clinical practice up to date. Staff received good levels of training around principles of care in relation to people living with a learning disability and/ or autism. They were trained in specific techniques to support each person. They also had general training on supporting people with behaviours that challenge. Restraint had not been used in this service.
Consent was sought, where possible. The Trust and the local authority worked together to ensure the service operated within the Mental Capacity Act 2005. 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 access health care support from their own GP, the nurses in the location and specialist nurses and consultants. Staff worked with people to support and encourage them to visit dentists and other health care providers, like chiropodists and opticians.
Staff supported people to shop, budget and cook, where necessary. People were helped to take good nutrition and were encouraged to eat healthily. Some people had support to take nutrition by different means and staff were confident in how to manage this. We saw a very good nutritional plan for a person with a specific disorder.
Staff we spoke to displayed a caring attitude. People in the service responded warmly to staff on duty. Staff understood how to support people to maintain their dignity and privacy. Staff showed both empathy and respect for people living with the symptoms of autism and learning disability. People in the service had access to advocacy.
Everyone supported by the service had been appropriately assessed. People had positive behavioural support plans in place as well as person centred plans that staff followed closely. These had been regularly reviewed by nurses (and by other health and social care professionals) to ensure that people had the best care possible.
People were encouraged to go out and to engage, where possible, with sport, learning and social events. Staff were aware of how difficult this was for some people and planning for activities was done at an appropriate pace. We saw some good outcomes for people who had become more involved with activities in the community.
Complaint procedures were in place. There had been no complaints received about the service.
The service had a suitably trained, qualified and experienced manager. Each supported living service was managed by a nurse and a senior support worker. Staff told us they were easy to approach and aware of the needs of the service. The manager had created a culture of openness and we judged that staff worked in a non-discriminatory way. The atmosphere was one of enthusiasm and eagerness to give people the best care possible.
The Trust had a suitable quality monitoring system used in all their services. This service used the quality assurance system. This was evident in internal audits and records of visits by senior officers of the provider. Good monitoring and analysis of the service was in place.
We had positive comments from other professionals about how the service worked with them.
Staff and other people involved with the service were satisfied that the management arrangements were appropriate and that matters of governance were being followed to give good levels of care and support.