Archived: Craegmoor Supporting you in Kent

This service provides personal care and support to adults 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 only looked at people’s personal care. This supported living service meets the needs of people with learning disabilities, autism or people with more complex health needs such as epilepsy. At the time of this inspection there were 24 people receiving personal care. The service is run from an office in New Romney.

A registered manager was not employed at the service. However, the provider’s regional manager had applied to register as the manager and was available to support the inspection process. 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.

Craegmoor Supporting You in the South East Services was placed in special measures in December 2016. [Services that are in special measures are kept under review and inspected again within six months.] We expect services to make significant improvements within this timeframe. The last inspection report for Craegmoor Supporting You in the South East was published on 05 September 2017, with an 'Inadequate' rating following a comprehensive inspection, which took place on 28, 29 and 30 June 2017 and 03 July 2017. At that inspection, although we found improvements, we found six breaches of the legal requirements set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to Regulation 9, Person centred care; Regulation 12, Safe care and treatment; Regulation 13, Safeguarding service users; Regulation 16, Receiving and acting on complaints; Regulation 17, Good governance; Regulation 18, Staffing. Due to these breaches we used our regulatory powers by imposing conditions on the provider’s registration and this service remained in special measures.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The provider had restructured the management of this supported living service from a centralised model to a localised model. This had facilitated improved operational and quality management oversight by the deployment of an experienced regional manager to take day-to-day charge of this service. The regional manager had been supported to make significant improvements in the last six months by an experienced senior quality improvement manager. These changes had assisted the provider to meet the Regulations set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The regional manager and the provider had demonstrated a desire to improve the quality of the service for people with a learning disability by listening to feedback, asking people their views and improving how the service was delivered. People, their relatives and staff felt that the service was now well led. They told us that the management understood people’s needs, were approachable and listened to their views. The service commissioners told us that the service had improved. The provider and regional manager continued to develop business plans to further improve the quality of the service.

The regional manager had involved people in planning their care by re-assessing their needs based on a person centred approach. Care management reviews had taken place and in some cases, people were now receiving higher levels of staff support. For others, the regional manager was working with other agencies to find placements better suited to people’s needs and choices.

New systems were now in use to monitor people’s one-to-one hours and shared hours. Systems were audited on a weekly basis to check for effectiveness and quality.

More robust processes were now in place to manage medicines safely. There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely. Staffs continued competence in this area was checked at least annually.

An open and honest culture had been developed within staff teams. People could involve relatives or others who were important to them when they chose the care they wanted. The care plans had been developed to assist staff to meet people’s needs, told people’s life story, recorded who the important relatives and friends were in people’s lives and explained what lifestyle choices people had made. Care planning told staff what people could do independently, what skills people wanted to develop and what staff needed to help people to do.

The regional manager had delivered training about the principals of supported living to all staff. This training was based on nationally recognised practice. This had given staff a better understanding of how they assessed and treated people as individuals so that they understood how they planned and delivered people’s care to maintain their safety, health and wellbeing and personal choices. Risks were assessed within the service, both to individual people and for the wider risk from the environment people lived in. Actions to minimise risks were recorded. Staff understood the steps they should take to minimise risks when they were identified.

People’s care was being reviewed in line with the requirements of the Mental Capacity Act 2005 (MCA 2005). The regional manager understood their responsibility to comply with the MCA 2005, to assess people’s capacity and work in people’s best interest. Staff received training about this.

The provider’s health and safety policies and management plans were implemented by staff to protect people from harm. The provider trained staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have.

Incidents and accidents were recorded and checked or investigated by the regional manager to see what steps could be taken to prevent these happening again. Staff followed the provider’s policy for recording and responding to safeguarding incidents. When required these had been reported to the local authority for further investigation and notifications had been sent to the commission.

People were often asked if they were happy with the care they received. The provider offered an inclusive service. They had policies about Equality, Diversity and Human Rights. People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face, by telephone, or by using formal feedback forms. Complaints made by people or their relatives were taken seriously and thoroughly investigated.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The provider recruited staff with relevant experience and the right attitude to work with people who had learning disabilities.

New staff and existing staff were given an induction and on-going training which included information specific to the people’s needs in the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

Staff received supervision and attended meetings that assisted them in maintaining their skills and knowledge of social care. Staff consistently fed back to us that the culture and attitude to the quality of care in the services had been changing for the better. Staff had a better understanding of the balance between positive risk taking and safety. People were supported to maintain their health by healthy lifestyle planning and advice. Dietary support had been provided through healthy eating plans put in place by dieticians. Staff supported people to maintain a balanced diet and monitor their nutritional health. People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health.

The quality outcomes promoted in the providers policies and procedures were monitored by the management in the service. Audits undertaken were based on cause and effect learning analysis, to improve quality. All staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice.

Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and accessed personal protective equipment like disposable gloves and apron’s.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

The provider met their legal obligations by displaying their last inspection rating in their offices and on their website. The provider had been meeting the five additional conditions of their registration we placed on the service in October 2017.

Craegmoor Supporting You in The South East provides personal care and support to adults in their own homes. It provides care in five separate locations where people share a home together; and an outreach services to people that live alone. The service provides care and support for people living with a learning disability; it is registered to provide personal care. At the time of this inspection 23 people were receiving the regulated activity of personal care from the service.

The service did not have 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. There had been several changes of management over the past year, a new manager had been appointed in May 2017 and was present throughout the inspection, they were in the process of applying for their registration with The Commission. They were being supported by a senior manager who had provided support to the service since May 2017.

The service was last inspected in November 2016 where five breaches of our regulations were identified. The safe and well led domains were rated as inadequate and an overall rating of inadequate was given at that inspection. The breaches of regulation related to person centred care, risk assessments, reporting of accidents and incidents, safeguarding, staffing and training. We took enforcement action and required the provider to make improvements. This service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us regular information and records about actions taken to make improvements following our inspection. At this inspection we found that although improvements had been made in some areas, other significant problems had emerged and some new breaches were identified.

People had not been protected from harm, concerns about their safety had not always been listened to and incidents had gone unreported. One person told us they were frequently bullied by another person. The provider's processes for recording and responding to safeguarding incidents were not robust. Some incidents had not been reported to the correct professional bodies for further investigation and the provider had been unaware about some of the incidents we found during our visit.

There were not enough staff to protect people from harm or support them in a way which met their needs. During the inspection a person was asked to keep an eye on another person who was distressed so the staff member could seek guidance from another member of staff. People did not always receive all of their one to one hours of support; this meant they had been restricted in going out to pursue their outside interests.

People’s health had been placed at risk. Staff did not have a good understanding of how risk should be minimised and the provider had been unaware about the assistive technology a person should use to monitor their seizures. Peoples health needs had not always been well monitored of responded to.

Concerns and complaints had not always been responded to or recorded well. A relative said they had raised concerns but had not received a response from the provider.

Staff had not received all of the necessary training to support people with their individual needs. Since the new manager had been appointed staff fedback supervisions and the support they received had improved.

People had choice around their meals. Staff demonstrated they respected people's individual likes and preferences, they understood people's preferences well. Staff engaged with people in a caring manner. People's privacy was respected; staff knocked on doors before entering people's homes and asked people if it was okay if we looked in their bedrooms.

Care plan documentation had been updated and improved to provide staff with more person centred informative which reflected people’s individual needs.

Since the new manager had taken up post feedback from staff had been more positive. Prior to their appointment in May 2017 the provider had taken little action to improve the service and respond to the concerns we had raised during the previous inspection. People had continued to receive poor care and had been exposed to harm. People’s individual needs had not been met.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Craegmoor Supporting You in The South East provides personal care and support to adults in their own homes. It provides care in six separate locations where people share a home together; and an outreach services to people that live alone. The service provides care and support for people living with a learning disability; it is registered to provide personal care. At the time of this inspection 31 people were using the service. 25 people lived in shared accommodation and six people lived alone in their own home. The number of people using the service had increased since the last inspection. Two of the shared homes were formally residential services within the providers group; they had de-registered in July 2016. People from these homes now received support with their personal care from Craegmoor Supporting You in the South East.

The service had a registered manager; however they no longer worked at the service and were in the process of de-registering. 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 regional manager was managing the service until a new manager was employed.

The service was last inspected in February 2016 where eight breaches of our regulations were identified. The safe domain was rated as inadequate and an overall rating of requires improvement was given at that inspection. The breaches of regulation related to notifications of incidents, person centred care, obtaining peoples consent, medicines, risk assessments, safeguarding, recruitment, leadership and staffing. The provider had made minor improvements, but more were needed in a number of areas, and not enough improvement had been made regarding keeping people safe and the management and leadership of the service. We found some new breaches of our regulations at this inspection.

The provider could not demonstrate that when risks had been identified measures had been put in place to reduce the likelihood of repeating incidents. Risk assessments had not been updated or implemented when people had been put at risk or suffered harm.

The provider’s processes for recording and responding to safeguarding incidents were not robust. Some incidents had not been reported to the correct professional bodies for further investigation.

People did not always receive all of their one to one hours of support; this meant they had been restricted in going out to pursue their outside interests.

The provider had not always appropriately checked new staff were competent to complete their roles effectively before allowing them to work alone. Agency staff worked alone with people and had not been given enough information to understand their individual needs which impacted on the care that was provided. Staff did not have clear guidance to support people with their individual behaviour needs, this left people and staff at risk of harm.

Some staff training had lapsed or had not been completed. This meant people were not supported by staff who had the most up to date knowledge and skills to meet their needs. Staff had not received regular supervision to support their roles. The provider could not be assured that people were being supported well by staff as competency checks had not been conducted to assess this.

Peoples care plans did not always contain up to date information regarding their health needs, people had not been supported well with their weight management. People had been supported with the management of their other health needs such as attending outside health care appointments.

Staff were unable to deliver support to people in a person centred way because they had not been given up to date guidance or information. People were not always supported by staff who understood their interests or personal preferences well. During the inspection some people were not engaged in any activity and staff were not engaging or communicating with people.

Care plans were not up to date and lacked important information to help staff understand how to support people. Not all care plans had been reviewed and updated to reflect people’s current needs. Some documentation gave good detail about how staff could help support people with their basic needs and situations. Some people were consulted about their care plans and how they wished their care needs to be met.

Communication between staff was inconsistent, there was little handover between staff at one shared house unless staff arrived early for shifts. This was of a greater impact if the staff member taking over a shift was a new agency worker, lone working with unfamiliar people.

The provider lacked oversight of the service, some of the concerns found at the previous inspection continued to be areas of concern at this visit. Record keeping was poor in areas such as complaints, care planning, and continuous improvement of the service. Whilst some improvements had been made there continued to be breaches of regulations that should have been identified by the provider.

Staff did not understand the ethos of supporting people in their own homes rather than in a residential service or how independence could be promoted. Staff had not been well consulted by the provider. Staff lacked understanding about the support they provided people and asked us for advice about how they should support people with specific areas of their life.

Recruitment processes were in place to ensure only suitable staff were employed. Checks made prior to new staff beginning work included references, health and appropriate identification checks to ensure staff were suitable and of good character.

People were supported to take their medicines safely; medicines were administered by trained staff.

Staff demonstrated they respected people's individual likes and preferences, they understood people’s preferences and communication needs well. Staff engaged with people in a caring manner. People’s privacy was respected; staff knocked on doors before entering people’s homes and asked people if it was okay if we looked in their bedrooms.

The provider had a system for managing complaints. Although the provider had responded to complaints, the outcomes to these complaints had not always been recorded so it was not possible to see how complaints had been resolved to the complainant’s satisfaction.

The regional manager had restructured the management of the service appointing three locality co-ordinators. This new structure had been in place for three weeks at the time of the inspection and staff reported positively about the change although it was too early to analyse how successful this was.

The regional manager had conducted some of their own internal audits since their appointment and had improved some areas. This included obtaining additional hours for locality co-ordinators to do paperwork, more staff being deployed to meet the needs of people in some of the shared houses and booking training for some staff in a specialised area.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is 'Inadequate' and the service is therefore in 'Special measures'.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time frame. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service.

This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Craegmoor Supporting You in The South East provides personal care and support to adults in their own homes. It provides care in four separate locations where people share a home together; and an outreach services to people that live alone. The service provides care and support for people living with a learning disability; it is registered to provide personal care. The service was last inspected in November 2013 and had met our standards of compliance. At the time of the inspection 22 people were using the service. 15 people lived in shared accommodation and seven people lived alone in their own home.

The service had a registered manager; however they no longer worked at the service and were in the process of de-registering. 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. A new manager was in the process of registering with the Commission and was present on all three days of the inspection.

The service had not safeguarded people from abuse. Several incidents had not been reported to the local authority for investigation or notified to the Commission. The provider had been unaware about the incidents until raised by the inspectors. Since the new acting manager had been in post safeguarding incidents had been reported following the correct processes to protect people from further harm.

Risk assessments had not been updated or introduced when people or others had been put at risk or suffered harm. The provider could not demonstrate that when risks had been identified additional measures had been put in place to reduce the likelihood of repeating incidents.

The provider’s systems for reporting, recording and responding to accidents and incidents were ineffective. The provider had been unaware about numerous incidents where people had been placed at risk. When staff had reported incidents they had not been acted on appropriately by the management team.

People were not benefiting from staffing, which was flexible to their preferences and support needs, but were dependent on the availability of staff. At a location where people shared an environment insufficient staff numbers were deployed from Monday to Friday after 2:00pm. This impacted on the freedom people had to leave the service and when they could receive support with their personal care.

Staff had not completed their essential training before working alone. The provider had not checked staff’s competency in their ability to work alone safely. Not all staff had received specialised training to support people with their individual needs. Staff lacked understanding and knowledge around fundamental areas, which were necessary to keep people safe, for example, safeguarding, diabetes and epilepsy.

Staff recruitment files lacked some information, which is a requirement of the regulations and needs to be obtained to ensure people are kept safe. This included photographs, exploration into employment gaps, reasons for the termination of previous employment and suitable references.

The provider was not fully complying with The Mental Capacity Act 2005. Restrictions had been placed on people, which had not been assessed as the least restrictive option available and best interest meetings had not taken place in line with the Act. Understanding around this important area was lacking.

The service was inconstant in meeting people’s health needs. Some people had been supported well when they required specialist help with their health needs; other people had not been supported when deterioration in their health had been identified.

Some reports about people were not written in a respectful or dignified way. People’s information was not always stored confidentially.

There were inconsistencies across the service with supporting people to access activities and social stimulation. At one of the shared locations the lack of staff meant people could not freely leave their home between specific times.

Care plans and daily notes about people were lacking in detailed information and were not personalised. Some documentation gave good information about how staff could support a person in specific areas.

The provider did not have good oversight of the service. Internal audits had failed to identify the areas of concern identified at this inspection and the provider was unaware about the incidents which had gone unreported. Staff felt the service was making improvements since the new manager had taken up post. They told us previously to this they did not feel well led or managed and had been given conflicting advice by different managers, which made their jobs difficult. The provider recognised they had areas to improve and had made an action plan with the acting manager to work towards. Since the acting manager had been in post most staff had received a supervision and appraisal, they said they felt better supported then previously and the service was turning around.

People had choice around their food and drink and were encouraged to make their own decisions around this. People were supported to prepare their own meals and have lunches out or takeaways if they wished.

Staff demonstrated they cared for the people using the service and wanted things to improve. Staff had caring interactions with people, which indicated they knew them well. If people were unhappy, there was a complaints procedure they could follow and people told us they knew how to complain.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

We saw that people made decisions about how their care and support was provided and had been consulted about their views and preferences. People had been involved in developing their own care plans and involved in regular reviews of their support.

People received the support they needed at the right time and it was given by staff they knew. People were involved in choosing the staff who worked with them. One person told us 'I'm absolutely happy with them' and that 'all my carers are pretty good'.

There were enough staff working with people to make sure that each person received the support they needed in line with their assessed needs. Staff received the training they needed to help them to understand how to care for people safely, and to understand their specific needs. We observed that interactions between staff and people were respectful and positive.

The provider had effective systems in place to monitor the quality of the service provided. These included internal audits and systems for consulting people who used the service.

People we spoke with told us they were satisfied with their care and support. One person said, 'It's fantastic'. They talked about the community activities they were involved in and how they could make their own decisions about what to do and when. People said they liked the meals, were able to choose what they had and were involved in the shopping and cooking.

People said they were happy living in supported living. One person said, 'This is the best place'. Another said, 'It's not far from the shops or the pub'. People were aware of their care plan although could not always recall the detail. They confirmed that they had been involved in discussions about their care and said they had attended a review meeting. This was a meeting for them with their social worker and staff to discuss their care and support. People told us they felt safe living in supported living and if they had any concerns then they would speak with the staff or manager. People spoke positively about the staff. One said, 'The staff are excellent, really nice'.