Archived: St John of God Care Services Supported Living

St John of God Care Services Supported Living provides care and support to people living in supported living settings, so that they can live as independently as possible. The service supports people living within Richmond, Catterick Village and Leyburn and specialises in supporting people with a learning disability and / or autistic spectrum disorder. At the time of our inspection 25 people received support.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People and their relatives expressed their confidence that people were safe and received care that met their needs. Risks were effectively managed by a staff team that were familiar with people’s needs. People received their medication as required. Appropriate actions were taken when there were accidents or incidents. Staffing levels met people’s needs and people received support from a consistent team of staff.

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. People were asked for their consent to their care and staff supported them to make their own decisions.

There were good relationships with health and social care professionals to ensure people’s changing needs continued to be met. People were supported with their dietary needs and preferences. Staff felt well supported in their roles through a series of supervisions and appraisals. The provider had recently updated their training programme to ensure it encompassed the different types of support people needed.

Staff treated people with kindness and upheld their dignity and respect in how they supported them. People were comfortable with staff and relatives provided positive feedback about how they had been supported as families.

People had detailed, person-centred care plans which guided staff as to the support they required. People had full and active lives and were encouraged to partake in activities of their choosing and to be a part of their community. Complaints were addressed appropriately, and people and their representatives were confident in raising any issues. Staff were familiar with people’s individual communication needs.

The person registered to manage the service had left shortly prior to the inspection. In the absence of a registered manager, the service was being managed by the deputy manager with high levels of oversight from the provider team. People and staff provided positive feedback about the management of the service and talked positively about the improvements being made. The provider’s vision was shared with the staff team who were engaged with this. Staff and people’s views were listened to and acted upon. A series of checks were completed to monitor the quality and safety of the service and to drive improvements.

We made a recommendation about the systems of governance to ensure identified actions were followed up in a timely manner.

The service applied 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 requires improvement (published 14 November 2018).

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.

St John of God Care Services Supported Living provides care and support to people living in supported living settings, so that they can live 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 supports people living within Richmond, Catterick Village and Leyburn and specialises in supporting people with a learning disability or autistic spectrum disorder. At the time of our inspection 25 people received 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.

The service 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.

Whilst staff had completed some training essential to their role, training specific to the needs of the people who used the service had not been provided. This included epilepsy and positive behaviour support training. We have made a recommendation about the provider ensuring staff received the specialist training required. For one person who was responsible for assessing the competency of the staff with their medicines support, they themselves had not had their competency assessed since 2015. Whilst mental capacity assessments were completed around medicines support, people’s mental capacity in other areas of their lives had not been assessed, when the person was thought to lack capacity. Best interest decisions had not been recorded to demonstrate professionals and relatives had been included in discussions about the person’s care and the actions taken were in the person’s best interest and the least restrictive option. Staff received supervisions, however appraisals had not been completed.

The quality assurance checks completed had not identified some of the issues we highlighted during our inspection, including staff having not completed all necessary training, appraisals having not been completed and mental capacity assessments not in place. The registered manager and provider were responsive to the issues raised and were in the process of developing their quality assurance tools to ensure the safety of the people who used the service. The management team promoted a person-centred culture and demonstrated they wanted the service to continually improve.

People told us they felt safe. Staff understood the actions to take in the event of an accident or incident or if they had any safeguarding concerns for people. Risk assessments were in place when there was an identified risk, however we found for one person their risk assessment had not been updated following a fall. This was completed between day one and two of our inspection. There were sufficient staff in place to meet people’s needs and to simply spend time with another engaging in activities. People received their medicines as required. For one person, protocols for their as and when needed medicines were not all in place. Staff undertook their medicines training and had their competency assessed.

Although consent forms were not in place, staff did seek people’s consent and understood the importance of this. People were supported to eat a diet of their choosing and people’s weight was monitored if there were concerns about this. The staff and management team supported people to attend healthcare appointments and had formed closed links with healthcare professionals whose input was requested when there were concerns about an individual. People who used the service chose the furnishings and decoration for their bedrooms and had input into decisions about updates made to the decoration of communal areas.

People who used the service and their relatives told us staff were caring and promoted their privacy and dignity. Staff spoke about people with compassion and in a respectful manner. People were supported to maintain important relationships and visitors to the service told us they always felt welcome. Information was available about advocacy organisations to ensure people had the support they needed to speak up about matters that were important to them.

Staff were familiar with people’s needs and provided person-centred and responsive care. Care plans were detailed and provided information about people’s background, needs and strengths. We found one care plan had not been updated with important information which the registered manager agreed to update. People engaged in a variety of activities, according to their personal tastes, and engaged in volunteering and opportunities for further learning. The provider had a compliments and complaints policy in place and this was available in different formats dependent on people’s requirements. People told us they felt confident to raise any issues or concerns with the staff and management team.

People who used the service and their relatives were positive about the management team and expressed confidence in them. Tenants meetings were arranged for people who used the service and staff meetings were held to share important information. The registered manager and provider were a visible presence within the houses and were keen to provide people with person-centred care.

At the last comprehensive inspection in January 2016 the service was rated good in each domain. At this inspection we found the service had not maintained this standard and rated it requires improvement. This is the first time the service has been rated requires improvement.

Further information is in the detailed findings below.

St John of God Care Services Supported Living is coordinated from an office base located on the Aske Hall Estate, near Richmond. The service provides supported living services to people living in Scorton, Leyburn and Catterick Village. The service is registered as a supported living service and provides the regulated activity ‘personal care’ to people living with learning disabilities and autism.

At the time of this inspection the service supported 28 people and employed 47 staff who were involved in providing the regulated activity.

The service had a registered manager, who had been registered with us since October 2010. 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 the service and relatives told us that the service was safe. People were protected by staff who were aware of safeguarding procedures and could demonstrate how they had taken action to safeguard people when necessary. People who used the service, relatives and staff also told us that the registered manager and management team listened and acted on feedback.

Safe arrangements were in place for staff recruitment, with people who used the service being involved in the recruitment process. Staff rotas were organised in advance and ensured that enough staff were available to keep people safe. Where agency staff were used information about their qualifications and experience was obtained, they were introduced to the service and used regularly to help maintain continuity.

The service had health and safety related procedures, including emergency plans, in place. Systems for reporting and recording accidents and incidents, including detailed reviews and actions, were in place.

The care records we looked at included detailed individual risk assessments and management plans. Risk had been managed collaboratively and in a way that helped to maintain people’s independence.

Safe systems were in place for assisting people with medicines, where this was part of their agreed care plan. Detailed information was available about people’s medicines and the support they needed. Records and discussions with staff evidenced that that staff were trained and checks took place to ensure medicines were being given safely.

Staff had been provided with training and support to help them carry out their role. This included specialist training relevant to the needs of the people staff were supporting. Staff told us they were well supported and monitored by the registered manager and other staff.

The support people needed with eating and drinking was detailed in their care and support plan and professional advice had been sought if people had additional nutritional needs. People were involved in meal planning and food preparation where possible, and enjoyed regular ‘take away’ nights.

People’s care records included detailed information about their health and wellbeing, so that staff were aware of information that was relevant to their care. Relevant health care professionals had been involved when needed and people had been supported to make decisions about their health and treatment options.

People and their relatives told us that staff were caring and treated them well. Staff were able to describe how they worked to maintained people’s privacy and dignity. We saw examples of people being supported to maintain their privacy and independence.

People’s care records showed that their needs had been assessed and planned in a detailed and person centred way. People who used the service and their relatives told us that they were involved in planning and reviewing their support and that their views were listened too.

People had been provided with accessible information about making complaints or raising concerns. We saw examples of the service responding well when a person using it had raised concerns. People and their relatives told us that staff were approachable, listened and responded if they raised anything.

The registered manager was very experienced and a strong management structure was in place to support them. People who used the service, relatives and professionals all told us the service was well led, with an ethos of being open and providing good quality, person centred care to people. Staff told us they enjoyed their jobs and expressed how important it was to support people well.

Checks and audits took place to monitor and improve the quality of the service’s work. People who used the service, relatives and other professionals were routinely involved in meetings and reviews so that their feedback could be taken into account.

We carried out this inspection by visiting people in thier own supported living scheme and also by visiting the premises where the business is operating from. We saw that people experienced care, treatment and support that met their needs and protected their rights. People who were receiving a service told us they were happy with the care and support they received. Comments included "I get the help I want, when I want it" and " I like everything, I would not change a thing. I am always listened too and I know that everyone wants what's best for me."

People who used 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. Detailed policies for safeguarding and whistle blowing were in place for staff to follow and refer too. We saw appropriate referrals were made to the Local Authority Safeguarding Teams.

Staff received appropriate professional development. Staff told us they received a good level of support and training to enable them to carry out their role and were supported in their personal development.

The provider had an effective complaints system in place that was accessible to everyone and was available in different formats, such as pictorial and written.