Kings Lynn Supported Living

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We observed that people received safe care from staff who knew them and understood their needs. We saw staff following guidance from professionals. A large proportion of the staff had worked within the service for many years and knew how to support people and their individual risks , and how to protect people from abuse. The provider ensured that staff had the necessary training to support people. People were supported to take risks which enabled them to have a greater level of independence. One person told us that they walked independently to their placement and felt safe because staff had supported them to achieve that goal. The property was well maintained we reviewed records of required checks health and safety.The manager recorded safeguarding concerns and reported them as appropriate to CQC and the local authority and would assist in the investigation when asked to. We did not identify any safeguarding concerns as part of this inspection. There was information around the service advising people how to raise concerns. Where people had recently moved in, the provider had insisted on a gradual process to give the person the best chance of success. Risk assessments were not always in place or had not been reviewed within the Stated timeframe on the risk assessment.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

A person told us that they had been supported by the service to stay safe. People had attended a keeping safe workshop with Opening Doors, a user led organisation for people with learning disabilities which specialises in recognising people as individuals. The focus had been on keeping safe within the community and explored who to contact and what would make the community safer for people. A person showed us their certificates from horse riding, and was very proud to have completed all the stages of their development.

Incidents were generally recorded in a timely manner. However, we found that some incidents were recorded in people's daily notes as usual behaviour, rather than on the providers incident log meaning a true reflection of behaviour incidents could not always be provided. We found evidence that incidents were discussed at staff meetings and lessons learned shared. Incidents were generally reported to the local authority safeguarding team and the Care Quality Commission in a timely manner.

A partner organisation told us that "Communication is good and when compromise and flexibility is needed regarding service users, we are almost always able to come up with a plan that works for everyone". We found that where there was learning, this was shared with the various stakeholders. A family member told us that staff frequently called where there were changes in the lives of their relatives.

The registered manager ensured that any learning was passed down to the staff team through training, team meetings, and supervisions. Complaints were investigated and outcomes shared. The service had recently had an internal quality audit, and we saw that the resulting action plan was being implemented.

A person had recently moved into the service at the age of 63, having lived at home all her life. There had been a detailed transition plan, which involved overnight stays, and the person got to know the staff and other people within the service prior to moving in. A relative told us that the person was a lot happier now they had settled into their new environment. Another person was still settling in after moving into the service, and still spent weekends at home while she adjusted to her new home.

Staff told us that they got to know people well prior to them moving in. Staff got the opportunity to work with people away from the home prior to their moving in date. We saw evidence that staff supported people to plan medical appointments as well as social interactions.

An external partner told us: "They are interested in their client’s progress, ask for any help they can give with developing riders and are kind and thoughtful to their clients at all times. One of the riders is often nervous when she gets to the riding school but she gently manages these nerves with the help of carers and our volunteers so she invariably finishes her lessons wreathed in smiles".

We found that service user guides were in place and detailed the service and the customers who currently live there. People had picture support plans that was a quick reference to staff on the preferences of people as well as their important information. We found that care plans were often incomplete and some risk assessments were generic and not person specific.

People told us that they felt safe within their home. One person told us they knew to call the manager if they had any issues. People were seen to speak to staff about things they were worried about. Another person told us that they had been supported by the manager to end a bad relationship. People had picture plans that captured their needs. Support plans were mostly not up to date, but the provider was in the process of transferring all support plans onto a new template.

Staff had received safeguarding training, and knew the provider's procedures for reporting safeguarding concerns. Staff received both e-learning and face-to-face training in safeguarding. Staff understood the principles of the mental capacity act and the deprivation of liberty safeguards. Staff were able to tell us how these principles were applied to their day to day interactions with people.

We observed staff giving people choice and respecting their wishes. People's needs were assessed appropriately and staff were aware of those needs. people were enabled to maintain relationships with their friends and families. There was good communication between the home and external partners. People's health needs were met in a timely manner.

Safeguarding information was available at the registered office including a contact number and posters, and there was a whistleblowing poster in place. There were also contact details for the Local authority safeguarding team and CQC within the locations. There was management presence within each of the locations, with a team manager based at each site, and the service manager between the two. People and staff said they could always speak to the managers. Incidents were recorded and reported on time, and where there had been lessons learnt, these were shared with the staff at team meetings. There were gaps in risk assessments and capacity assessments but the provider was in the process of transferring to new paperwork.

Staff supported individuals to manage risks within their home. We observed people doing their laundry and cooking dinner with guidance from staff. People had been supported to learn how to check the identities of visitors, and how to stay safe within the community. People told us that staff always involved them in any decision regarding their care.

Staff had received positive behaviour support training and told us how they supported people in crisis. There were ABC charts in place, although we did not see that they were completed consistently. Staff were aware of risks associated with peoples care and support. When we arrived, we were greeted on each occasion by a person living within the home, supported by their staff member.

There were no obvious environmental risks, and the buildings were well laid out with no clutter. At one of the properties, annual fire equipment check were taking place, and staff told us confidently what they would do in the event of a fire. Health and safety checks were completed on time. We found that recording of people’s daily notes was inconsistent during our first visit, but there had been a marked improvement during our next visit.

People had been supported to learn how to check the identities of visitors, and how to stay safe within the community. We found that while people were able to independently access the community, there were no risk assessments indicating how they would get in touch with the home if they got into trouble. In one person’s support plan we found the risk assessments to be out of date and carried the names of the previous manager.

A person who had just moved in was happy to show us their bedroom. They were being supported by staff to personalise their bedroom and had ordered some butterfly wall art online to go on their walls. All bedrooms were spacious, clean and personalised.

The housing association and landlord were responsible for the maintenance, and the provider was able to provide evidence that the home, the equipment, and furniture was all subject to regular checks to ensure its safety. We found that fire exits were clearly marked, and free of clutter. Staff told us that where issues were raised, these were resolved in a timely manner.

We observed that one of the properties was having new front doors and windows replaced, while internal fire maintenance work was also ongoing. The homes were clean and in a good state of repair. Staffing levels were appropriate and not intrusive. The properties were secure, and people were supported to maintain their privacy within the home.

The home had input from the organisation's quality team, meaning issues were quickly escalated and resolved. Servicing records were viewed included fire safety, legionnaires, water safety, environmental health reports, asbestos, and these were in order, where remedial actions were identified these were addressed. Staff had received the right training to meet people's needs.

People had agreed hours of support and there were always enough staff to meet people’s commissioned hours. However, a person told us “I don’t get to go out sometimes at the weekend as I share a staff with my housemate, and I cannot go out on my own”. The service manager told us that this had been raised with the commissioning authorities. People were supported by male and female staff and their preferences were taken into consideration. Staff worked a variety of shift patterns to meet the needs of the people.

Staff told us that they were supported by the manager and had the relevant training to complete their work effectively. Some staff had been in the organisation for over 10 years and knew the people well. Where there was a need for agency staffing, the home used staff from organisations on the local authority approved list. Staff told us that it sometimes took long to replace staff where there was a vacancy, but they were always kept informed of recruitment efforts.

Our observations were that staff all brought something different to the role. Staff worked well as a team and the service was well organised around the needs and interests of people using the service. Staff were keen to speak to us and were proud of their job, and the support they were able to offer people.

Assessments determined people’s level of need, and rotas were designed to show who was working and allocations were completed in advance to support day services and activities. Two people within a property had to share one staff with another person that lived in a flat independently, and we observed that due to the frequency of incidents between both persons this did not provide safe staffing levels. This had already been raised by the provider.

People looked smart and wore clothes of their choice. The home was clean, organised and well decorated. One person's bedroom we looked at was personalised and they were supported by staff to keep their home clean. An external professional we spoke to told us “ We see them out in town all the time and they always look smart and tidy”.

People were supported by staff to keep their environment clean. We observed a person folding their laundry, which they had washed themselves with guidance from staff. There were cleaning tasks assigned to staff and these were completed. Temperature checks were completed regularly with few gaps. Staff confirmed they had completed infection control training.

The services were clean throughout. The kitchen was well organised, and in one property, people had separate fridges for their own personal shopping. There were no odours or clutter. Food hygiene procedures were followed during meal preparations, and all food within the property was in date. Legionella checks were carried out regularly.

The service has supported people to have medication reviews annually. We saw evidence that Stopping over medication of people with a learning disability and autistic people (STOMP), was active in the approach of the service in collaboration with other medical professionals. There were however gaps within the medication plans of people. The person centred approach of staff we observed was not recorded in their medication plans leading to inconsistency of approach. Although the service was in the process of changing over their care plan documentation, there was a lack of information within the current plans. One person had a bowel chart within their medication folder, which was filled in daily, however there was no care plan to inform staff what to do with this data. One person's folder had no patient information leaflets to inform staff in the case of any side effects.

People's medication were kept securely within their bedrooms and we saw staff asking for consent from people to dispense their medication. People received their medication on time and were supported to attend their medical appointments on time. A relative told us that 'a few weeks ago, 3 resident's had missed their medication as agency staff are not allowed to administer medication and there was only one staff member trained' He got a call from the manager to say that the person hadn’t had his meds. He said that staff at the home acted quickly and sought advice from 111 and a GP. The relative told us that the incident was a one off and had been satisfactorily resolved. The relative told us that there have been no further medication errors since this incident. A relative told us that his sister who had been on a lot of medication prior to moving into the service had been supported by the team and GP to reduce her medication safely, as she had no real need for them.

Staff told us that they took into account the mental capacity act when supporting people with their medication. Staff also told us that because agency staff were not allowed to dispense medication, it could become overwhelming if there was just one person to dispense medication. They however felt that they were competent and knew people well enough to cope. The team managers and registered manager provided crucial support and coaching to the staff.

Staff were observed to be competent when dispensing medication. We observed a staff member who empowered a person to take part in counting their medication before and after dispensing their medication. Staff took their time to explain to people what they were doing. One person told us what medication they were on, and also knew what medication they were allergic to.

The service has supported people to have medication reviews annually. We saw evidence that Stopping over medication of people with a learning disability and autistic people (STOMP), was active in the approach of the service in collaboration with other medical professionals. There were however gaps within the medication plans for people. The person centred approach of staff we observed was not recorded in their medication plans leading to inconsistency of approach. Although the service was in the process of changing over their care plan documentation, there was a lack of information within the current plans. One person had a bowel chart within their medication folder, which was filled in daily, however there was no care plan to inform staff what to do with this data. One person's folder had no patient information leaflets to inform staff in the case of any side effects.