Archived: Congleton Supported Living Network

About the service

Congleton Supported Living Network is registered as a homecare agency to provide personal care to people who have a learning disability and/or autistic spectrum disorder in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of the inspection there were 14 people receiving personal care in six different ‘supported living’ settings with 24/7-hour support.

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

The service was able to demonstrate how they were meeting most of the underpinning principles of right support, right care, right culture.

Right Support

The service had enough staff to meet people's needs and keep them safe. The provider had experienced some recruitment challenges and were considering the use of agency staff to ensure staffing numbers were maintained. However overall staff turnover was low, which supported people to receive consistent care from staff who knew them well.

Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests. Since the last inspection changes had been made to provide a more a flexible service and to support people to consider alternatives to day care centres. Staff supported people to make decisions following best practice in decision-making.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.

The service gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their rooms.

Right Care

Governance processes were not fully effective, to help keep people safe, protect people’s rights and provide good quality care and support. They had not maintained full oversight or identified some of the issues found at this inspection, including oversight of training records and care records.

Staff had training on how to recognise and report abuse, however this had not always been fully applied. The provider had not ensured systems to review incidents were fully effective, as they had not identified themes requiring further action, to ensure people were fully protected.

Staff and people cooperated to assess the risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. However, care records did not always reflect the actions taken to mitigate these risks.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.

Right culture

Staff knew and understood people well and were responsive. People’s support plans reflected their range of needs and this promoted their wellbeing, however support plans did not always fully reflect people’s goals or aspirations.

Overall, people led inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

People and those important to them, including advocates, were involved in planning their care.

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 on 25 December 2019)) and there were two of breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made, however, the provider remained in breach of one regulation. The service remains rated requires improvement.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified one breach of regulation in relation to good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Congleton Supported Living Network is a supported living service providing personal care to people with a learning disability. Care is provided to people in their own homes and communities. At the time of the inspection 18 people were receiving shared care in eight houses. Each house was staffed between 4:00 pm and 10:00 am. A member of staff provided sleep-in cover overnight. Each house had basic facilities for administration purposes.

The service has not been developed and designed in line with all of the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

People were not consistently supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The service didn’t always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons; the staff rotas were based on regular attendance at a day centre and did not always offer the flexibility or responsiveness to allow people choice and control.

Staff did not receive training in accordance with the provider’s schedule. Some training considered essential by the provider was significantly overdue.

You can see what action we have asked the provider to take at the end of this full report.

Safety and quality were managed through the application of audit systems. However, these systems were not effective in identifying and correcting issues relating to staff training, risk assessment and care planning found during this inspection. The provider failed to adequately respond to the issues identified at the previous inspection.

You can see what action we have asked the provider to take at the end of this full report.

People using the service were involved in discussions about their care. Staff used alternative forms of communication to help people understand important information. However, the service did not routinely seek feedback from people and relatives through surveys or questionnaires.

People’s needs and choices were not always met in accordance with best-practice guidance for supported living services. We made a recommendation regarding this.

Risk assessments had been completed in sufficient detail. However, they had not been regularly reviewed which meant the service could not be certain they remained accurate or relevant. We made a recommendation regarding this.

Some care plans had not been reviewed regularly which meant the service could not be certain they remained valid and reflective of people’s needs and wishes.

There was regular contact with community health services and referrals were made in a timely manner. Contact was maintained with GPs, community nurses and dentists.

People were asked for consent and given choices in relation to their care and other important decisions. However, it was not clear if people were offered meaningful alternatives to attendance at the day service.

Relatives spoke positively about the caring nature of staff. Interactions between staff and people receiving care were kind, positive and respectful. Important information was made available in different formats to help people understand what was being discussed.

Safe recruitment practices were followed, and sufficient staff were deployed in accordance with people’s needs. Medicines were managed safely in accordance with best-practice guidance.

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 Good (published 31 May 2017). The service has deteriorated to Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staff training and governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Congleton Supported Living Network is one of a number of services provided by Care4CE the in-house provider of social care services for Cheshire East Council. The Network provides personal care services to adults with learning disabilities in their own homes. This arrangement is called ‘supported living’ because people are supported to live, often in groups, in properties which are provided by a social or other land lord. At the time of our inspection visit there were 19 people being supported. They were supported within eight separate properties in the local areas.

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.

We found that people and their relatives were positive and complimentary about the support they received from the service. People lived in clean and comfortable environments and the people spoken with indicated that they were happy and well treated.

Policies and procedures for safeguarding people from harm were in place. We saw from the records that staff had previously been trained in safeguarding procedures and understood their responsibilities to report any concerns of this nature. However, we noted that some members of staff had not undertaken any recent refresher training in this subject. The registered manager told us that safeguarding training was being arranged by the provider and a number of staff had undertaken this and assured us that the rest of the staff wold undertake this as soon as it was available. The registered manager kept a safeguarding file which held details about any safeguarding referrals that had been made to the local authority and demonstrated that these had been dealt with appropriately.

Risk assessments were undertaken with people to identify any risks around areas such as physical health, safeguarding, behaviours and medication. We reviewed risk assessments within people’s support plans which included detailed information about the action staff should take to support people as safely as possible. Staff were able to tell us about the risks people faced.

The were some staff vacancies and the provider aimed to recruit to these posts when possible. However there was a small pool of bank staff and an agency member of staff available to ensure that there were sufficient staff to meet people’s support needs. We found that people were provided with the level of support commissioned by the local authority to ensure people's needs were met. Appropriate recruitment checks had been made to ensure that staff were suitable to work with vulnerable adults.

Medicines were managed safely and people received their medication as prescribed.

During the inspection we saw from training records that there were some gaps in training undertaken. For example, certain staff had not completed refresher training in safeguarding, food hygiene or emergency aid for over three years. Staff spoken with told us that they had received training, whilst others thought they were overdue to complete training in some areas.

There had been a change to the way that the provider arranged and delivered training. Training had previously been managed by an internal training department within Cheshire East Council but new arrangements were being introduced and the procurement of new training was being undertaken. We found that this meant it had become more difficult for the registered manager and staff to access certain training courses and there had been some delays in training becoming available. We discussed the plans for training with the service manager who demonstrated that a new training programme was being developed. Some courses were now available such as safeguarding and staff would be nominated to attend further training as soon as it became available. Staff competence and knowledge was developed not only through formal training but through various other means, including mentoring, supervision and staff team meetings.

We checked whether the service was working within the principles of the MCA and found that staff had some understanding of the principles. Staff told us that they gained consent from people before undertaking any care tasks and supported people to make decisions where possible. However, records reviewed did not always evidence that people's capacity had been assessed and best interest decisions were not always recorded where necessary. We recommend that the service finds out more about training for registered managers, based on current best practice, in relation to MCA and adjust their practice accordingly.

People were supported to maintain their good health and were supported to access healthcare services and support.

Staff supported people in small teams which enabled them to build relationships and get to know them well. A number of staff had been employed by the service for several years and were very knowledgeable about people’s needs. During the inspection we observed positive and caring relationships had developed between staff and people using the service. We found that the atmosphere within both houses visited was happy, friendly and welcoming. Emphasis was placed on staff treating people with dignity and respect.

Support plans were in place. They provided sufficient detail to enable staff to support people and were regularly reviewed and updated. The support plans and risk assessments provided person centred information, which included people’s preferences and choices. We found that people were supported to maintain as much independence as possible and encouraged to take part in activities within the wider community.

People had access to the complaints procedure and told us that they knew how to raise any concerns should they need to. We found that the management team had regular contact with people and dealt with any issues and concerns as they arose.

The service was well-led. The registered manager was focused upon improving the quality of the service and was developing a ‘Service Improvement plan’. People knew who the registered manager was and felt able to raise any concerns with him. Staff told us that they felt well supported. We saw that regular tenants and staff meetings were held, as well as supervision meetings to support staff. There were quality assurance processes in place and people's feedback was sought about the quality of the care.

We spoke with six people who received support from the network to obtain their views on how well the staff members were providing safe and appropriate care. People told us that their support needs were being met and that they had confidence in the staff members who were visiting them. Comments included; 'I am very happy in my house' and 'I am fine, I like my house.'

We spoke to people using the services about whether they felt safe and what they might do if they didn't. They told us that they would speak to staff about any concerns they had. The people we spoke with also told us that they were happy with the staff members who were working with them.

We looked at the files for the two most recently appointed staff members to check that effective recruitment procedures had been completed. We found that the appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

Information about the safety and quality of service provided was gathered on a continuous and ongoing basis with feedback from the people who used the service.