Archived: United Response - Central Lancashire Supported Living

Updated 3 January 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 site visit took place on 21, 22 and 23 November 2017 and was announced.

We gave the service 24 hours’ notice of the inspection visit because it is a domiciliary care service and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

The inspection team consisted of three adult social care inspectors and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service. The experts undertook telephone interviews with people and their relatives on 22 and 23 November 2017.

Before our inspection visit we reviewed the information we held on United Response - Central Lancashire Supported Living. We gained feedback from health and social care professionals who visited the service. We also reviewed the information we held about the service and the provider. This included safeguarding alerts, information from whistle blowers and statutory notifications sent to us by the registered provider about significant incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us.

Prior to the inspection we had received allegations of abuse against two care staff. We passed the concerns to the local safeguarding authority and the provider started their own investigations in line with their own safeguarding policy. We also explored how safeguarding concerns were managed in the service.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

We visited seven properties with people’s permission to observe how people were supported in their own homes. We were unable to speak to some people due to their communications needs. We observed their interactions with staff. We met nine people and seven care staff and one relative. In addition we emailed all staff who worked at the service. We spoke with the area manager, two service managers including the interim manager.

We looked at care records of nine people who used the service, five staff recruitment records, staff training records and records relating to the management of the service. We also contacted the safeguarding department at the local authority, the local mental health trust and Healthwatch.

Updated 3 January 2018

The inspection visit took place on 21, 22 and 23 November 2017 and was announced. We last inspected United Response - Central Lancashire Supported Living on 16 & 17June 2016. At that inspection, we found that people's safety was being compromised in a number of areas. This included how people's medicines were managed, managing risk to receiving care, a lack of person centred care and safe care and treatment. There was also a failure to provide good governance. These were breaches of Regulation 12 and Regulation 13 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection, the provider sent us an action plan, which set out what action they intended to take to improve the service.

During this inspection we reviewed actions the provider told us they had taken since our last inspection to gain compliance against the breaches of regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified. We saw that significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service. We found improvements had been made in order to meet the regulations in relation to medicines management and risk management. However; we found on going shortfalls in relation to governance and the oversight provided on staff.

United Response-Central Lancashire Supported Living is registered to provide personal care and support for people living with mental health needs and/or living with a learning disability or autistic spectrum disorder. This service provides care and support to people living in 19 ‘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. The Care Quality Commission does not regulate premises used for supported living; this inspection looked at people’s personal care and support. At the time of the visit there were 42 people who used the service.

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. The values aim to ensure people with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At the time of our inspection there was no registered manager in post. There was an area manager who was overseeing the running of the service and an interim manager who was in the process of completing an application to become the registered manager. A registered manager is a person who has registered with the CQC 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 provider had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required. Before the inspection we had received allegations of abuse. We informed the local safeguarding authority. They were undertaking safeguarding enquiries at the time of our inspection.

People and their relatives confirmed people were encouraged and supported to maintain and increase their independence. Some people who used the service had limited ability to provide us with feedback on the service due to their needs. We observed their interactions with care staff. Feedback from relatives about care staff was positive.

Recruitment checks were carried out to ensure suitable people were employed to work at the service.

During the inspection we noted there were adequate numbers of staff to meet people’s needs. Staff had received induction, supervision and training. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems at the service supported this practice.

Risk assessments had been developed to minimise the potential risk of harm to people who used the service. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care. People’s independence and choice was promoted.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. We noted improvements in medicines management practices.

People’s care needs were discussed with care commissioners before they started using the service to ensure the service was able to meet their assessed needs. Care plans showed how people and their relatives were involved in discussion around their care. People were encouraged to share their opinions on the quality of care and service being provided. People’s nutritional needs were met. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

There was a variety of meaningful activities to keep people occupied and to promote social inclusion. People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns.

There was a policy to support people at the end of their life to have a comfortable, dignified and pain-free death.

We received positive feedback from staff regarding the management and culture in the service. The manager understood their responsibilities, and was supported by the provider and other managers to deliver what was required. However, we found that there had been a lack of consistent oversight on staff following the departure of the registered manager. The area manager and the interim manager had identified the shortfalls and had started to rectify them. We have made a recommendation about management seeking training on governance.

There were a variety of methods used to assess and monitor the quality of service provided to people. These included regular internal audits of the service, surveys and staff and relatives meetings to seek the views of people about the quality of care being provided.