Imagine Act and Succeed

Updated 10 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 19 and 20 September 2017. We gave the provider 24 hours’ notice of the inspection because they are a supported living and domiciliary care provider and we needed to make sure someone would be available to speak with us. The inspection team consisted of two inspectors on both days of the inspection.

The provider completed a Provider Information Return (PIR) prior to our inspection. The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed other information that we held about the service including notifications made to the Care Quality Commission. A notification is information about important events which the service is required to send us by law. We contacted the local authority commissioning and safeguarding teams. Their feedback on the service can be found within this report.

During the inspection we visited, with their permission, two people who had support in their own home, two supported living properties and the extra care service, Fiona Gardens. We spoke with 13 people, seven relatives, the registered manager, three deputy Heads of Operations, two service leaders, one support leader and seven care staff. We looked at records relating to the service. These included 12 care records, three staff recruitment files, daily record notes, medication administration records (MAR), maintenance records, quality assurance systems, incidents and other records relating to the management of the service.

Updated 10 November 2017

This inspection took place on the 19 and 20 September 2017. We gave the service 24 hours’ notice of the inspection to ensure that the managers were available to speak with us. This was the first inspection of Imagine Act and Succeed since it had been re-registered with the Care Quality Commission in June 2016. The re-registration had taken place due to a change in the office address for the service. The service, under its previous registration as IAS 65 Chorley Road, was inspected in May 2015 and was rated good overall.

Imagine Act and Succeed (IAS) is registered to provide personal care in people’s own homes. The service supports 55 people through their domiciliary care service, 22 people in an extra care scheme (Fiona Gardens) and 21 people lived in supported living properties, either on their own or sharing with others. The domiciliary care service provided support from one visit per week to multiple visits each day. The extra care scheme provided assessed support for 22 people and an emergency on call service for the remaining 50 flats in the scheme. Some of the supported living houses provided 24 hour support and others a planned schedule of support, depending on the assessed need.

The service had a registered manager in place. 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.

All the people who used the service and their relatives were complimentary about IAS and the support provided. The staff said they enjoyed working for the service and felt very well supported by their service leaders and senior managers.

There were sufficient staff on the rotas to meet people’s needs. In the domiciliary care service people said they were supported by regular staff, who were on time and did not miss visits. Relatives said the supported living staff teams were kept as stable and consistent as possible. This meant people were supported by staff who knew them and their support needs well. We were told there was good communication between the staff and people’s relatives.

Detailed person centred care plans and risk assessments were in place. These provided guidance and information about people’s support needs, their likes, dislikes and preferences and how to mitigate the identified risks. Comprehensive positive behaviour support plans were in place for those people with complex behaviours which may challenge the service.

Each person had a one page profile in place documenting key likes, dislikes and how they wanted to be supported.

A living well document was being introduced, part of which documented people’s wishes for their end of life care and support. Some people had completed this; however others did not want to discuss the end of their lives. People living at Fiona Gardens were supported to stay in their flat at the end of their lives if possible. Additional visits were made as their needs changed.

People and their families were involved in writing and reviewing the care plans and risk assessments. Relatives said they had regular feedback from the staff teams about their loved ones.

People received their medicines as prescribed. A medicines lead role and a new medicines system (called Bio-dose) had been introduced at Fiona Gardens in response to a series of medication errors. This had resulted in a large reduction in the medication errors made. We have made a recommendation that all medicines leads are made aware of the full prescribing instructions for the medicines they administer.

Guidelines for when ‘as required’ medicines were to be administered were in place in the supported living service. At the time of our inspection all the people supported at Fiona Gardens were able to tell staff if they needed an ‘as required’ medicine. We discussed with the registered manager that ‘as required’ guidelines would be required if people’s needs changed and they were not able to verbally request them.

The service was working within the principles of the Mental Capacity Act (2005). People had decision making tools in place so staff could support them to make decisions about their lives. Communication aids were in place where appropriate to support people to be able to communicate with staff and others.

The service was open and transparent. All incidents and safeguarding referrals were fully investigated and any potential improvements identified were implemented.

Staff received the training appropriate to their role. New staff completed a thorough induction and shadowed experienced staff so they were able to get to know people and their needs. Staff had regular job consultations (supervisions) with their manager to discuss their development and performance. Team meetings were held, which were open discussions. Staff said they felt well supported by their service leaders and senior managers. Staff representatives were involved in a development board with senior managers to discuss new initiatives and changes within the organisation.

Robust staff recruitment procedures were in place. People who used the service were involved in staff recruitment decisions. Staff were matched with the people who used the service so they shared similar interests.

People were supported to maintain their health, with care plans detailing the support they needed. Staff supported people to attend health appointments where required.

IAS sought the views of people who used the service and relatives through tenants meetings, friends and family meetings and surveys.

People were supported to participate in activities within their local community. A programme of regular activities such as a pub night had recently been arranged.

IAS had a complaints policy in place. All complaints received were investigated and outcomes agreed with the complainant.

A range of quality audit tools were in place, including monthly returns from each service leader recording the job consultations and care plan reviews completed. Managers monitoring training requirements through a database which highlighted the training that needed to be refreshed. A new quality team, including people who used the service and relatives, was being established.