Archived: The Old Exchange

Updated 1 February 2018

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 5 and 7 December and was announced. We gave 48 hours’ notice as we needed to be sure the provider was available to meet with us. We also wanted to request permission from the people using the service to visit them to gain their views of the support they received. The inspection was carried out by one inspector.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This 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 looked at notifications about important events that had taken place in the service which the provider is required to tell us by law. We used this information to help us plan our inspection.

We spoke with three people who lived at the service and three relatives, to gain their views and experience of the service provided. We also spoke to the provider and three staff.

We were invited into people’s home and were able to observe the interaction between people and staff in the lounge and communal areas. We visited the provider’s office base and looked at three people’s care files and medicine administration records, three staff recruitment records as well as staff training records, the staff rota and staff team meeting minutes. We spent time looking at the provider’s records such as; policies and procedures, auditing and monitoring systems, complaints and incident and accident recording systems. We also looked at tenants meeting minutes and satisfaction surveys undertaken by the provider.

We asked the provider to send us some documents by email following the inspection and this was sent in a timely manner.

The service had been registered with us since December 2016. This was the first inspection carried out on the service to check that it was safe, effective, caring, responsive and well led.

Updated 1 February 2018

The inspection took place on 5 and 7 December 2017. The inspection was an announced inspection.

The Old Exchange provides care and support to people with a learning disability or autistic spectrum disorder living in a supported living setting 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.

People using the service lived in a house in ‘multiple occupation’ shared by eight people near Tunbridge Wells in Kent. Houses in multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities.

People had a tenancy agreement and were supported by the same staff team providing their personal care and support to also successfully manage their housing and tenancy arrangements. People had their own bedroom which they could lock with a key and shared all communal areas such as lounges, kitchen and bathrooms. The service was in a residential street, close to shops and public transport so people could easily access community facilities. An office was situated on the premises to store confidential information and provide a private space where people could meet health and social care professionals and hold care plan reviews. The office had a sofa where people were welcome to sit whenever they wished. Due to the nature of the support needs of people, a member of staff slept on the premises each night and a bedroom was set aside for this purpose.

The service was previously registered with CQC as a residential home to provide accommodation with personal care. This was the first inspection since the provider cancelled that registration and registered to provide personal care and support within a supported living setting.

A registered manager was not employed at the service as the previous registered manager had left. A new manager, who was already employed by the provider within another setting was in the process of completing their application to register with CQC for this service. 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. The new manager would not be based on the premises, however a team leader was employed to carry out the day to day running of the service. The team leader would report directly to the new manager and in the meantime was reporting to the provider.

Staff were aware of their responsibilities in keeping people safe and reporting any suspicions of abuse. Staff knew what the reporting procedures were and were confident their concerns would be listened to.

Individual risks were identified and management plans to reduce and control risk were comprehensive, making sure people and staff had the guidance they needed to prevent harm while at the same time supporting independence. Accidents and incidents were recorded in detail by staff with actions taken. The provider monitored incidents to learn lessons from and support people to prevent accidents.

The processes for the administration of people’s prescribed medicines was managed and recorded well so people received their medicines as intended. Regular audits were undertaken to ensure safe procedures were followed and action was taken when errors were made.

Initial assessments were undertaken with people before they moved in to the service to make sure their assessed needs could be met and to inform the care plan. People and their relatives were involved in the development and reviewing of their care plans. People’s specific needs were taken account of and addressed in care planning and in practice to ensure equality of access to services.

People were supported to make their own choices and decisions. Staff had a good understanding of the basic principles of the Mental Capacity Act 20015 (MCA) and promoted people’s rights. Where people needed support with some decisions they were helped by a family member. As people were living within a supported living service, they had a tenancy agreement, protecting their housing rights. They were supported to understand their responsibilities by staff and were provided with an easy read guide to support their understanding further.

People were supported with cooking and mealtimes by staff. Most people chose to have communal meals where they ate together. When people decided they did not want to eat their meal with the rest of the group or at the same time this was respected and supported. People were supported to access health care when they needed it and assisted to maintain their health.

People had access to many different activities of their choice outside of the service and were supported to pursue and maintain these. Within the service, people were supported to take part in activities they said they wanted to do individually or together. Regular residents meetings took place where people were able to raise the issues that were important to them. People, their relatives and others involved in people’s care were asked their views of the service and action was taken to make improvements where necessary.

There was clear evidence of the caring approach of staff. People and their relatives were positive about the staff who supported them, describing them as caring and saying they were very happy living in their home. Staff knew people well and were able to respond to people’s needs on an individual basis. Promoting independence by developing people’s skills and confidence was a theme of staff support.

Suitable numbers of staff were available to provide the support people had been assessed as requiring. Staff support and the times it was given was tailored to the individual, changing when necessary to suit people’s changing needs and wishes. Safe recruitment practices were followed by the provider to make sure only suitable staff were employed to work with people in their own home.

Staff were supported well by the provider and the team leader. Staff told us they were approachable and listened to their views and suggestions. Training was generally up to date and staff were encouraged to pursue their personal development. Staff had the opportunity to take part in one to one supervision meetings to support their success in their role. Regular staff meetings were held to aid communication within the team and to provide updates and feedback.

Quality auditing processes were in place to check the safety and quality of the service provided. The provider had developed a more comprehensive care plan audit which had recently commenced.

The relatives we spoke with thought the service was well run and their loved ones were very happy with the service provided. People and their family members knew the provider well and were complimentary about the care and support they received.