Archived: Aylesbury Supported Living Scheme

Aylesbury Supported Living Scheme provides support for 27 adults with learning and physical disabilities across four sites in the Aylesbury and surrounding areas. Each property blends in with other housing in the area and is indistinguishable as a care setting. At one of the sites, night time support is provided by another service which is separate to The Fremantle Trust. This is a contractual arrangement with Buckinghamshire Council. People are supported in individual flats and shared houses which are owned by a housing association. People’s care and housing are provided under separate contractual agreements.

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

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.

Based on our review of the Safe and Well-led key questions, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were not always supported to manage their weight and food choices. There was the potential for people to develop health conditions related to obesity. People’s views may not always have been sought about the quality of their care, as there were no checks to make sure processes to do this were followed. We have made a recommendation regarding engagement with people and providing them with feedback about actions taken.

People did not receive safe care. Safeguarding concerns had not always been referred to the local authority. Improvements had not been made in relation to on-going concerns about poor medicines practice and people could not be confident their medicines would be given according to their prescriptions.

There were poor infection prevention and control measures in place. Standards of cleanliness were not sufficient, placing people at risk of infection.

People could not be confident appropriate actions would always be taken when things went wrong. Records of distressed behaviour were not always recorded and trends in accidents were not always analysed, to prevent recurrence.

We had not always been informed of incidents which are notifiable. This meant we could not be assured appropriate action was taken in response to these occurrences, to keep people safe.

Monitoring of the service had not been effective in identifying areas of poor practice, to make sure people received safe care. There was a deterioration in standards of care since the previous inspection.

People were cared for by staff who had been recruited appropriately. There was mixed feedback from staff about the support they received from managers.

A community professional spoke positively about the service. Their feedback included “The staff have been working hard to support someone whose needs have changed significantly over the last couple of years and have adapted their support as his needs have increased.” Another person told us “All the tenants are cared for on an individual basis, not all treated the same and this is always taken into consideration when they are providing activities. Independence is promoted and encouraged and the tenants are empowered to do as much as possible for themselves.”

Relatives spoke positively about standards of care and the support their family members received. Comments included “So fortunate to have such a caring team, they are like family,” “The care (the person) gets is first class” and “They look after (name) very well.”

Rating at last inspection

The last rating for this service was good (report published 12 January 2018).

At our last inspection, we recommended the service followed best practice by ensuring all staff had been trained and rehearsed in what to do in the event of a fire. At this inspection, we found the provider had made improvements. We also recommended the service followed best practice when handwriting medicines records, to ensure accurate instructions were provided. We did not see any handwritten entries on the sample of records we checked.

Why we inspected

We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of Sate and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of the report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Aylesbury Supported Living Scheme on our website at www.cqc.org.uk.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safeguarding people from abuse, ensuring people receive safe care and treatment, notification of incidents and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

We previously inspected the service in December 2015. The service was meeting the requirements of the regulations at that time. The service was rated ‘good’ overall.

Aylesbury Supported Living Scheme provides support for 27 adults with learning and physical disabilities across four sites in the Aylesbury and surrounding area. At one of these sites, night time support is provided by another service which is separate to The Fremantle Trust. This is a contractual arrangement with Buckinghamshire County Council.

People are supported in individual flats and shared houses which are owned by a housing association. 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 had 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.

We received positive feedback about the service. Comments from people included “My (family member) is treated with kindness by the staff,” “The whole place is amazing. I wouldn’t want him anywhere else,” “Staff are very approachable” and “The staff are very compassionate.” A community professional told us “Staff have a very good knowledge of people’s histories and backgrounds.”

People were supported by staff who had been thoroughly recruited. There were enough staff around to help people access the community and be as independent as possible. Risks were assessed and measures were put in place to help prevent accidental injury or harm.

People received support with their medicines where necessary. We have made a recommendation for the service to follow best practice when staff handwrite medicines charts. This is to ensure the strength of the medicine and maximum amount per day is recorded.

People were protected from the risk of infection. Various health and safety checks were carried out in people’s homes to make sure they were clean and safe.

People’s accommodation was fitted with fire detecting equipment. Tests were carried out to make sure this worked effectively and kept people safe. We found fire drills were carried out but not all of the staff had been involved in drills. They may therefore not know how to respond safely in the event of a fire. We have made a recommendation for the service to follow best practice by ensuring all staff have received sufficient training and rehearsal in what to do in the event of a fire.

People received care which was person-centred and responsive to their needs. Care plans had been written to document people’s needs and their preferences for how they wished to be supported.

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.

The service was managed well. The registered manager kept us informed of notifiable occurrences; they worked in partnership with external agencies and ensured staff received appropriate support and training.

We previously inspected the service on 31 October 2013. The service was meeting the requirements of the regulations at that time.

Aylesbury Supported Living Scheme provides support for up to 30 people with learning disabilities in their own homes. Twenty nine people were using the service at the time of our inspection.

The service had 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.

We received positive feedback from people using the service. Comments included “I feel safe here,” “It’s good having my own flat,” and “Staff are brilliant.” Two relatives we spoke with were complimentary of the service and the support provided to their family member.

People were kept safe at the service. There were safeguarding procedures and training on abuse to provide staff with the skills and knowledge to recognise and respond to safeguarding concerns. There were enough staff to support people and to help them access the community. The service used robust recruitment procedures to make sure people were supported by staff with the right skills and attributes.

Staff received the support they needed to help them develop in their roles and support people appropriately. This included regular supervision, staff meetings and an on-going training programme.

The provider monitored the service to make sure it met people’s needs safely and effectively.

People’s needs and their preferences for how they wished to be supported were recorded in their care plans. Risk assessments had been reviewed regularly to make sure they still reflected people’s circumstances.

People were supported to keep well and attend healthcare appointments. Medicines were managed well.