Archived: Strada Care Ltd

Strada Care Ltd provide personal care for people in supported living settings, so that they can live in their own home 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.

Strada Care support older people and adults with learning disabilities and/or mental health issues. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our visit they were supporting 21 people at five locations across East Surrey and Sutton.

People’s experience of using this service and what we found

There were enough staff deployed across the service to ensure people received the support they needed, and that they were funded for. The provider carried out appropriate checks on prospective staff to ensure they were suitable and safe to support the people that used the Strada Care service. We have recommended that the provider review the possible impact of Brexit on their staffing provision.

People were supported to have their medicines when they needed them, and as prescribed. We have recommended that the provider considers the risks from flammable topical creams that some people have prescribed .

People were safe because staff understood their roles and responsibilities in minimising the risk of harm. Apart from the example above, hazards to people’s health and safety, whether that be from their support needs, or the environment, had been assessed and plans were in place to guide staff on keeping them safe . Staff followed safe working practices with regards to minimising the spread of infection. Accidents and incidents were reviewed across the service to understand what had happened and to prevent a reoccurrence.

Assessments of people’s needs ensured that the service could support them in the way they wanted. Staff received appropriate training and supervision to ensure they had the skills necessary to meet people’s needs. People were supported to access health care professionals should they become unwell, or for routine check-ups. Guidance given by health care professionals from these checks were well managed to ensure staff understood and catered for the changes in a person’s needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they were happy with the care and support they received from staff. People were involved in day to day decisions about their care and support as much as possible. People were treated with dignity and respect by the staff. Staff knew the people they cared for as individuals and were seen to take time to sit and talk with them, and involve them in activities and duties around the houses they lived in.

Care plans were under review and being updated onto a new electronic system. The new system enabled staff to update records quickly and spend more time providing care and support.

Quality assurance processes were in place and these ensured that a good level of care and support was given. The registered manager had built a staff team that had a shared passion for improving the care people received. As a result, they had made changes across the service that has improved the rating to good in all the areas that we inspect.

The registered manager understood their role and responsibilities with regards to the Health and Social Care Act Regulations and had ensured the requirements had been met.

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 requires improvement (published 25 October 2018).

Why we inspected

This was a planned inspection based on the date of registration.

Follow up:

We will continue to monitor intelligence 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.

This latest inspection took place on 08 and 10 August 2018 and was unannounced. During this inspection we found that the concerns identified at our previous inspection had been dealt with. The provider now needed time to embed the changes and demonstrate they could maintain the improvements.

Strada Care Ltd provide personal care for people in supported living settings, so that they can live in their own home 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.

Strada Care support older people and adults with learning disabilities and/or mental health issues. The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our visit they were supporting 21 people at four sites across East Surrey and Sutton.

There was a registered manager in post. 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 registered manager was at the service during the time of our inspection.

There was positive feedback about the service and caring nature of staff from people who use the service and their relatives.

People who used the Strada Care service received care and support in a safe way. Staff understood their duty should they suspect abuse was taking place. Risks around people’s health and safety had been identified and clear plans and guidelines were in place to minimise these risks. Staffing levels were based on the support hours that people were funded for. There were enough staff to meet people’s needs. The provider used safe recruitment processes to ensure new employees were suitable to support people who use this service. Staff managed the medicines in a safe way and were trained in the safe administration of medicines.

People received effective care and support. Assessments of people’s needs had been completed prior to them using the service. This ensured staff had the skills, knowledge and training to be able to support them. People were supported to have enough to eat and drink, with a good variety of choices available to them. Where specialist diets were needed, staff ensured people were supported with these. People had access to health care professionals if they felt unwell, or if their support needs changed. People’s health and confidence were seen to improve due to the effective care and support they received.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People were supported by staff that treated them with kindness and respect. People’s independence was promoted by the staff. People were involved in their day to day care and support decisions to enable them to live the life they wanted to lead. People had access to friends and relatives when they wanted, including going out to visit family at home.

Care plans had been undated and were based around people’s goals and aspirations. Staff gave support that was responsive to these needs. People had access to a range of activities. These helped stimulate people’s minds to prevent them from becoming bored or isolated. Where complaints and comments had been received the staff had responded to try to put things right. People would be supported at the end of their lives to have a dignified death.

The registered manager had a clear vision and set of values based on providing personalised care and support to people. Staff understood this and demonstrated these values during the inspection in their interactions with people. Quality assurance processes had improved and now had a positive impact to the home and the experience of people who used the Strada Care service.

People and staff were involved in improving the service. Feedback from meetings and annual surveys was reviewed and action taken to respond to ideas and suggestions. The management liaised with outside agencies to review and make improvements to the service.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

There was a registered manager in post. 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 inspection took place on 13 and 15 November 2017 and was unannounced. We carried out this inspection in response to concerns raised about the standard of care being given to people at one of the locations. At the time of the inspection a police investigation was ongoing with regards to how people’s monies were managed, and a local authority safeguarding process about allegations around staff conduct was also underway.

The lack of good leadership had an impact across all of the five key areas we looked at. It led to people experiencing inconsistent care and support, dependent on where they lived, and staff morale. It affected the safety of the service as medicines and risks where not always managed safely; it affected how effective the service was at meeting people’s needs; it affected how caring and responsive staff were; and how well the service was led. Three of the locations gave a better level of care and support, with the majority of our concerns being with the fourth location.

People were not always kept safe. Lack of safe management of people’s monies had put people at risk of financial abuse. Risks to people’s health and safety had been carried out, but the least restrictive option to keep people safe had not always been explored. Accidents and incidents had not been consistently reviewed to ensure the risk of them happening again was minimised. There were areas for improvement in how people’s medicines were managed.

The provider did not have effective systems in place to monitor the quality of care and support that people received. Quality assurance checks were completed on important aspects of the management of the home; however these had not been used to make improvements to the service that people received. Many of the issues identified by the provider’s consultant in April 2017 were still happening at the time of our inspection, seven months later. The provider had not ensured that notifications where sent to the CQC as required by their registration under the Health and Social Care Act. This meant we had not been told of some accidents and incidents, so could not assure ourselves that the provider had taken appropriate action.

People received the care and support they needed, however the care plans did not always reflect peoples current needs. Care plans were based around peoples support and medical needs and as such did not focus on people’s goals and aspirations, and how staff could support them to achieve them. People’s access to activities was inconsistent, with some receiving good support, and others not receiving activities that were scheduled.

Whilst staff were kind and caring and treated people with dignity and respect we heard one member of staff refer to people in a disrespectful manner. However the failures across the home demonstrated there was a lack of care and attention to following safe systems of work, and to meet the requirements of the Health and Social Care Act. There was positive feedback about the service and caring nature of staff from people who live here, and their relatives.

There were sufficient numbers of staff to meet the needs of the people. The manager regularly reviewed staffing levels to ensure they met the needs of people. The provider had carried out appropriate recruitment checks before staff commenced employment, to ensure they were safe to work with people who may be at risk. Staff understood their duty should they suspect abuse was taking place, including the agencies that needed to be notified, such as the local authority safeguarding team or the police.

In the event of an emergency people were protected because there were clear procedures in place to evacuate the houses they lived in. Each person had a plan which detailed the support they needed to get safely out of the house in an emergency.

Staff received an induction and ongoing training, to help them meet and understand the care needs of the people they supported. However training around one person’s specific medicines had either not been given or was out of date. Some staff supported people with specific conditions, without completing training to be able to meet those needs. This put them at risk, as staff may not be able to provide effective support if required. Not all staff received regular support in the form of annual appraisals and formal supervision to ensure they gave a good standard of safe care and support.

Where people did not have the capacity to understand or consent to a decision the provider had followed the requirements of the Mental Capacity Act (2005). An appropriate assessment of people’s ability to make decisions for themselves had been completed. Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected.

People had enough to eat and drink, and received support from staff where a need had been identified. People’s individual dietary requirements where met. People were supported to have access to healthcare professionals to maintain good health.

We have identified six breaches in the regulations. You can see what action we have asked the provider to take at the back of the full version of this report.

The overall rating for this provider is 'Inadequate'. This means that it has been placed into 'Special

measures' by CQC. The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

- Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

- Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal.

There was a registered manager in post. 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 and associated Regulations about how the service is run. The registered manager was present for the duration of the inspection.

People were safe. The service’s risk assessment process enabled people to take risks as safely as possible. The risk assessments identified risks and provided guidance for staff to manage these safely without compromising people’s independence.

Arrangements for the administration of medicines were in place which ensured that people received their medicines safely and in an appropriate way.

Staff recruitment processes were safe. Appropriate checks, such as a criminal record check, were carried out to help ensure only suitable staff worked in the service. Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the registered manager had good management oversight of the service.

Staff received training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

Staff were aware of their responsibilities regarding safeguarding people from abuse and were able to tell us what they would do if they suspected abuse had taken place. They had access to a whistleblowing policy should they need to use it.

People’s privacy and dignity were respected. Staff were professional and polite and addressed people in an appropriate manner. Gender specific staff were provided for people who made a specific choice and people’s information was handled confidentially.

Staff supported people to keep healthy by encouraging them in their choice of nutritious foods. People were either supported or supervised in their menu planning and shopping.

People had access to health care professional and staff supported people to have regular health checks and to attend appointments and clinics as appropriate. When people became anxious or distressed they had the support of clinical experts for advice and guidance.

People were supported to take part in a range of activities which were individualised and meaningful for them. People were encouraged to maintain their independence and participate in community activities.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

There were sufficient numbers of staff provided to meet people’s needs and support their activities. Staff knew people well and understood people’s needs and aspirations. Staff were very caring to people and responded well to their needs.

The registered manager and project managers undertook quality assurance audits to reflect on practices and aid continuous improvement. Any areas identified as needing improvement were actioned by staff.

If an emergency occurred people’s care would not be interrupted as there were procedures in place to manage this.

A complaints procedure was available for any concerns. This was available in a format that was easy for people to understand. People and their relatives were encouraged to feedback their views and ideas into the running of the service.

Records management was good and showed the service and staff practice was regularly checked to ensure it was of a good standard.

At this inspection we found the provider had taken appropriate steps to ensure that people who used the service were asked for their consent to care and treatment before this was undertaken. We also saw people who did not have capacity had an assessment in place in line with the Mental Capacity Act 2005.

We also noted at this inspection the provider had written a contingency plan that was service specific to replace a corporate procedure that was written for their care home settings. This is a plan to ensure that people would continue to be cared for in the event of an emergency.

We found that the provider was now compliant in the two outcomes we followed up

We spoke with the provider, registered manager, administration staff, care staff, three relatives of people who used the service and three people who received care from the service.

People who used the service that we spoke with said they liked the food and that the staff were nice and treated them well. People also told us about activities they were going to do that day, such as going out or shopping. One person told us about their recent birthday party supported by the agency.

The relatives of people who used the service told us they were involved in care planning and reviews, they were kept informed about any changes, contact was good, the staff were nice and they felt their relative was safe. People's relatives also said they had no complaints but felt the staff were approachable and they would feel comfortable to raise any concerns and felt that they would be listened to. One person's relative told us the manager and staff were brilliant, the building was always clean and that all the people at the supported living setting cared for by Care Unlimited looked well cared for.

We found that before people received any care or treatment they were not always asked for their consent and where people did not have capacity the provider did not always act in accordance within legal requirements.

We noted people experienced care, treatment and support that met their needs but there were no service specific written procedures in place to plan for all reasonable foreseeable emergencies, other than snow. This meant that if an emergency situation other than snow occurred, there would be no contingency procedures recorded to enable the agency to continue to provide safe appropriate care.

We found that the service had undertaken pre-employment checks with disclosure and barring services, had records of the staff's photographic proof of identity, qualifications, interview, and contracts, and there were two references. However, we saw that reference requirements for all the staff files sampled contained insufficient evidence about being physically and mentally able to do the job safely, or being suitability to work with the client group, vulnerable adults. None of the six staff files samples contained this information.

We found that although the health and safety of people was reviewed and audited, there was no quality assurance system implemented to record the findings of quality questionnaires, analyse the results, identify action to improve quality, record those proposed actions and feed back to the people who use the service.

We spoke with four staff members that all told us they felt well supported in their roles. When asked about the service one staff member told us 'We give people more independence, we don't just do things for people we guide them to do things for themselves'.

We found that people's likes, dislikes and preferences were recorded in their care plans and information about their usual routines. We found that people's needs were assessed and a care plans put in place to ensure that their needs were met.

We saw that the provider had a detailed safeguarding policy in place and a flow chart was available to demonstrate the reporting process. We saw that people had risk assessments with actions for staff to take to reduce the risks associated with abuse.

We found that staff had regular meetings and supervision with their line manager. We saw that some staff were being supported to achieve qualifications that were relevant to their roles. We saw regular audits were carried out to enable the provider to assess and monitor the service.