Supported Lives provides a domiciliary care service, providing support to people in their own homes. In addition it provides service to people living in three supported living settings. In these instances people’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support. These services are provided to people with learning disabilities in the Bradford and Calderdale area. The provider of the service is called Potens. Not everyone using Supported Lives receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do provide regulated activity we also take into account any wider social care provided.
We undertook the inspection between 20 October 2017 and 3 November 2017. The inspection was announced which meant we gave a small amount of notice of our visit to the providers office to ensure a manager would be present. At the last inspection in September 2016 we rated the service ’Good’ overall. At this inspection we found the quality of the service had deteriorated. Feedback from relatives and staff was poor. They said that the service was no longer reliable, calls had been cancelled and management did not get back to them about their concerns and complaints. People said the staff delivering care and support were kind and caring.
Medicines were not managed safely as there was no proper oversight of the medicines management system to ensure staff were working safely and adhering to best practice.
Whilst people and relatives said people were safe in the company of regular staff, we received complaints that people’s care was provided by staff that were unfamiliar with people’s needs. We received complaints this caused upset and worry to people and their relatives.
Safeguarding procedures were in place. We saw evidence they had been followed. However, concerns about staff conduct had not been properly logged and investigated. Risks to people’s health and safety had been assessed but many assessments were out of date. Staff and management told us they thought they did not reflect people’s current needs. Incidents were not consistently recorded and properly investigated.
There were insufficient staff deployed in the right places to ensure a consistent and reliable service. People, relatives and staff reported missed and cancelled calls and some staff arriving without the necessary skills to deliver appropriate care. There was a lack of staff available to undertake duties such as supervision, spot checks and care reviews.
People said regular staff had the right skills and knowledge to care for them. However we saw there was no effective system in place to monitor staff training and ensure it did not expire. We saw a number of staff were not up-to-date with their required training. Staff said they did not feel supported by management. There had been no recent support mechanism such as meetings, supervisions or appraisals.
People and relatives reported appropriate support at mealtimes, although we saw issues with the reliability of the service had impacted on the consistency of this support.
We concluded the service was compliant with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) although where people lacked capacity more information needed to be recorded to robustly demonstrate this.
People said the staff delivering care and support treated them well. We saw some good relationships had developed between people and regular staff. Staff demonstrated they cared about the people they were supporting. However we found the service as a whole did not treat people well as people had been let down with cancelled visits and not being informed who would be offering care and support. People were not always listened to as the office did not always get back to people and meetings and reviews no longer took place.
People’s care needs were assessed prior to using the service. However these had not been regularly reviewed and staff and management said they were no longer an accurate reflection of people’s needs. Reviews and meetings had stopped early in 2017 which meant that mechanisms to respond to people’s changing needs were no longer in place.
The number of complaints logged by the service did not reflect the widespread concerns reported by relatives and staff. The manager told us they recognised complaints had not been properly logged. Relatives said their complaints had not been appropriately responded to.
We identified widespread failings in the service which should have been prevented from happening through the operation of robust systems of governance. There was a lack of oversight of the service with office staff unable to tell us about people’s needs and whether there was anybody who was particularly at risk due to the service’s current failings. Audits and checks did not consistently take place to check the service was operating appropriately.
Mechanisms to obtain and act on people’s feedback were not in place and relatives said they didn’t feel listened to.
A new manager had been appointed and senior managers were regularly working at the service to help ensure improvements were made. Management were open and honest with us about the current failings and following the inspection they sent us an action plan and supporting documentation stating how they would ensure the service was improved.
We found seven breaches of the Health and Social Care Act (2008) Regulated Activities 2014 Regulations. You can see what action we asked the provider to take at the back of the report.
The overall rating for this service is 'Inadequate' and the service is therefore placed into '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.