Archived: United Response - Central Lancashire Supported Living

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.

We last inspected this service in July 2014. At that inspection we found the service was meeting the regulatory requirements in place at the time.

Chorley DCA is a branch of United Response, a national charity providing social care support services. Chorley DCA provides support for people with learning disabilities, physical disabilities and/or mental health needs within individual or shared accommodation to enable them to lead independent lives.

At the time of our inspection visit Chorley DCA provided services to 53 people in 23 houses.

The registered manager of the service was present throughout our inspection. 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 looked at recruitment processes and found the service had policies and procedures in place to help ensure safety in the recruitment of staff. However the policies had not been effectively followed to ensure staff were recruited safely. We found an instance where safe recruitment had not taken place.

We looked at assessments undertaken for eight people. Risk assessments were undertaken. We found care plans identified risk management in a person centred manner however these had not always been updated to show what had been learnt from accidents and incidents and how future incidents would be reduced.

People were not consistently protected from bullying, harassment, avoidable harm and abuse because staff had not responded to requests for support with medication. We found that the service followed safeguarding reporting systems, as outlined in its policies and procedures.

The service promoted staff development; staff received training appropriate to their roles and responsibilities. Staff told us they felt well supported by management and we saw evidence that regular supervisions were being held.

The service had gained people’s consent to care and treatment in line with the Mental Capacity Act [MCA]. We looked at people's care records and found mental capacity assessments, with supporting best interests decisions where required. Authorisation was sought from the local authority for people whose care involved restrictive practice.

Care records held details of joint working with health and social care professionals who were involved with people who accessed the service.

We received consistent positive feedback about the staff and about the care that people received. Staff received training to help ensure they understood how to respect people’s privacy, dignity and rights. People and their relatives told us they had develop positive relationships with care staff.

We found people's needs were being met in a person centred manner and reflected their personal preferences. There were clear assessment processes in place, which helped to ensure staff had a good understanding of people's needs before they started to support them. People’s care was delivered in a way that took account of their needs and the support they required to live independently in the community. People’s independence was promoted.

Staff and people who used the service told us that the management team were approachable. We found the registered manager was familiar with people who used the service and their needs. When we discussed people's needs the manager showed good knowledge about the people in their care.

The registered manager had monthly meetings with people who used the service to gather their views. Advocacy services were available for people who needed someone to speak up for them.

We looked at staff meeting minutes, they showed staff were involved in discussions about improving the service and management input was motivating to encourage the staff team to provide good standards of care and support.

The service had a complaints procedure which was made available to people they supported. People we spoke with told us they knew how to make a complaint if they had any concerns and the service had sent information on how to make a complaint. The registered manager used a variety of methods to assess and monitor the quality of the service. These included meetings with people, satisfaction surveys, audits, and care reviews. We however found findings from the audits had not been turned into effective action plans that were monitored and followed up.

We found people were satisfied with the service they received. We found the registered manager receptive to feedback and keen to improve the service. They worked with us in a positive manner providing all the information we requested.

We found a breach of, regulation 12- safe care, regulation 13-Safeguarding service users from abuse and improper treatment and treatment and regulation 17- Good Governance.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

Is the service safe?

We observed staff had a good understanding of the service's safeguarding procedures. One staff member explained, 'I would have no hesitation in contacting my manager, senior manager or CQC if I had anything that concerned me that needed reporting'.

Our discussions with staff confirmed they understood the needs of the people in their care. This matched the information we found in people's care records. This meant the provider had protected people from unsafe care by ensuring care planning and risk assessment was appropriate.

Is the service effective?

We observed that staff had a good understanding of consent and related principals. One staff member told us, 'We actively support people to manage themselves and not doing things for people'. This meant people were safeguarded against inappropriate care because the service gained people's consent prior to giving support.

Documents we reviewed showed support plans and risk assessments were individualised and regularly updated. Support planning matched people's assessed needs. This meant people were protected against ineffective care provision because people's needs were adequately assessed.

Is the service caring?

We spoke with people and their relatives to gain an understanding of their experiences of the support they received. Their response was positive. One person told us, 'I feel very safe and happy with the support I get'.

Staff explained they worked in a caring and friendly manner. They described being respectful to and working with people to understand their needs. One staff member told us, 'I love my job, it's so important to have the time to get to know people and their individual needs. This is important in finding the best way to support people'. This showed people were safeguarded against inappropriate care provision because staff understood people's individual needs.

Is the service responsive?

Care records we reviewed evidenced that where people's needs changed, care planning was amended to incorporate these changes. This demonstrated the service had minimised the risks of unsafe care because the service had responded to people's changing needs.

We saw that the service responded appropriately to complaints received. This followed the service's policy. Responses to issues raised and actions undertaken were recorded. This meant the provider had minimised the risks of unsafe care because complaints had been acted upon.

Is the service well-led?

Chorley DCA had a range of quality audits in place. Other regular processes underpinned this, such as staff supervision and team meetings. This meant people were protected against inappropriate care because the manager had systems to check the quality of care.

The manager and staff had a good understanding of the appropriate handling of complaints. We were shown evidence of complaints that had been handled correctly and in a timely-manner. This meant the service was well-led because people were enabled to make complaints, which managers acted upon.