Archived: SENSE - Community Services (North)

This inspection took place on 14 September 2016 and was announced.

A registered manager was 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.

There were safeguarding policies and procedures in place and staff had received training related to the safeguarding of vulnerable adults. Safe recruitment practices were following which helped to protect people from abuse. There were suitable numbers of staff working in the service. Regular staff visited people to maintain consistency and to avoid causing distress to people.

A policy was in place for the safe administration of medicines, and we spoke with staff who confirmed that medicines were appropriately stored, administered and recorded. A lone working policy was in place which recognised the potential risks to staff who were working in isolation away from other colleagues. On call managerial support was available to staff out of hours.

Risks in people's homes had been assessed, as had individual risk to people including those related to health needs or behavioural disturbance and distress. Person centred support plans were in place which detailed the support needs of people, and how staff should interpret the individual communication by people which could indicate their happiness or discontent in a situation. People were supported with eating and drinking, and training and competency assessments had been carried out to ensure staff could do so safely where people required specialist support such as enteral feeding [through a tube in the abdomen].

Staff received regular training, supervision and appraisals. Staff meetings were also held. Staff were line managed on a day to day basis by the day centred managers where they also worked, and did not have regular contact with the registered manager.

Staff were caring and respectful in their discussions about people who used the service. Care records were also sensitively written and courteous. The privacy and dignity of people was maintained and people were afforded maximum independence and privacy within clear boundaries for safety.

The registered manager was not taking day to day charge of the service when we carried out the inspection. They explained to us that they had taken on a regional operational role which prevented them from doing so and that they planned to de register with the Care Quality Commission [CQC]. Responsibility for the day to day running of the service had been delegated to two day services managers who were not registered with CQC. They took responsibility for monitoring staff training, carrying our supervision, appraisals and competency assessments, holding staff meetings, monitoring care and support plans and responding to enquiries from family members. Although the registered manager could be contacted for advice and support when necessary, we judged that they were unable to provide sufficient managerial oversight of the service due to their other commitments and responsibilities. Quality assurance systems were insufficiently structured to ensure the quality and safety of the service, and the responsibility for carrying out certain checks and audits was unclear. We have made a recommendation about this.

The relatives we spoke with were complimentary about the level of care and support provided by all the staff working in the service. One relative told us, 'The service is fantastic, a life saver, it has transformed our lives'.

Staff told us how they worked closely with people's families and described how they worked together with other agencies and specialists, where relevant, to make decisions about the persons care and support in their best interest.

We reviewed the care records of people who used the service. We found they were person centred and provided a lot of detail about each person's likes and dislikes, and what was important to them. However, the provider may find it useful to note that the care and support plans relating to identified risks were not always sufficiently specific.

During our visit we saw the service had an effective system in place to regularly assess and monitor the quality of service that people received. We reviewed four staff records and found appropriate checks had been undertaken before staff began work.