Background to this inspection
Updated
2 February 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection was carried out by five inspectors and an assistant inspector. An Expert by Experience made telephone calls. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in a number of ‘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 had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection because some of the people using the service could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.
Inspection activity started on 16 November 2021 and ended on 18 November 2021. We visited the office location on 16 November 2021.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We asked the local authority and Healthwatch whether they had any feedback to share about the service. They did not have any feedback to share. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We reviewed the information we held about the service, such as notifications the provider had submitted. We used all of this information to plan our inspection.
During the inspection
We visited people in their homes and spoke with other people and relatives over the phone. We spoke with 16 people who used the service and seven relatives about their experience of the care provided. We spoke with 15 members of staff including the registered manager, managers, senior care workers and care workers.
We reviewed a range of records. This included a mixture of 16 people’s care records and medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including audits, policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
2 February 2022
About the service
Living Ambitions Limited - Staffordshire is a supported living service. There were a range of types of accommodations such as independent apartments and bungalows. There were 12 properties. It varied per property how many people lived there. The service supported 42 people at the time of the inspection.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Risks were generally assessed and planned for and staff knew people well. We have made a recommendation about ensuring all aspects of people’s health and wellbeing are robustly assessed and planned for. Medicines were generally managed safely, however we found omissions at one property. We did have some mixed feedback regarding staffing levels. However, overall people were supported by enough safely recruited staff. People were protected from the risk of abuse. People told us they felt safe and relatives confirmed this. People were kept safe and infection control measures were in place and being followed by staff. Lessons were learned when things went wrong.
Quality assurance systems were in place which were largely effective, however they had failed to identify all the omissions we identified such as some missing documentation. Some further work was needed to ensure everyone was supported with their protected characteristics. There was a clear sense of duty of candour and learning from incidents. People and relatives felt positive about the management of the service and people were empowered to make their own choices. The service worked in partnership with other organisations and professionals.
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.
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 good (published 16 January 2020).
Why we inspected
The inspection was prompted in part due to an increased number of concerns we received about the service and about how staff supported people. A decision was made for us to inspect and examine those risks. Whilst we found areas for improvement relating to quality assurance and ensuring all risks were assessed and planned for, we did not find ongoing concerns about staff approach with people.
We received concerns in relation to staff approach with people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has remained good, however well-led has deteriorated to requires improvement. This is based on the findings at this inspection. We found some improvements were needed. The registered manager took action to respond to our feedback.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Living Ambitions Limited - Staffordshire on our website at www.cqc.org.uk.
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.