Archived: Livability South East

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 is also registered to manage a care home and they told us that their time was split evenly between both services. They were registered two months before this inspection.

This comprehensive announced inspection was carried out on 2 and 6 December 2016.

There were a range of systems in place to assess the quality of the care and support provided to people. However, the last full analysis was carried out in March 2016 and although shortfalls identified at that time had been monitored to ensure they were completed, no further full assessment had been carried out. A range of shortfalls identified through our inspection would have been identified through effective and regular monitoring.

When people’s needs changed there was a delay in either introducing risk assessment documentation or in reviewing the risk assessment documentation already in place to ensure the risks of accident and/or incidents had been minimised and this left people at risk of harm.

DoLS applications had been made in respect of some people. (A DoLS is used when it is assessed as necessary to deprive a person of their liberty in their best interests and the methods used should be as least restrictive as possible). Some staff knew which people had restrictions in place but others were unsure. Documentation related to restrictions were not detailed in care plans.

Whilst staff felt supported by their line manager and attended regular supervision meetings, they did not feel supported by the management of the service. They felt the distance between the service and the office was too great to be effective. The registered manager had only met with people once since taking on their role as manager. However, six weekly staff meetings were held and detailed minutes were kept that demonstrated that staff were encouraged to share their views and that they were kept up to date with changes within the service.

Although there were staff vacancies, with the use of overtime, bank and agency staff there were enough staff to meet the needs of people. Staff understood what they needed to do to protect people from the risk of abuse and if there were concerns appropriate documentation was completed and sent to the local authority for investigation.

The service was committed to enabling people to gain and maintain daily living skills and improve their independence. Relatives spoke positively of this and recognised that independence often required risk and that this was done in a planned way to safeguard against accident and incidents.

People knew who to speak with if they had any concerns or worries. There was a detailed complaints procedure along with an easy read format. There were also additional measures in place to support anyone who might not be able to understand the easy read format so that anyone wanting to raise a concern could do so.

There were good systems to carry out environmental risk assessments and as part of this to ensure that all equipment in use was in working order. The business contingency plan had been used good effect following a recent electricity power cut and as a result learning from the experience had been added to the plan.

All staff completed basic training and more specialist training was provided for staff who supported people with specific needs. There was a thorough induction to the service and staff felt confident to meet people’s needs before they worked independently with them.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our visit we saw that people were being treated with respect and dignity and people's independence was encouraged. People were spoken with in a respectful way. People we spoke with told us that staff were polite, friendly and helpful. One person told us that staff 'are really patient all the time' and another person told us that they 'were happy with the support {they} receive'.

We saw that people experienced safe and effective care based on detailed care plans and risk assessments that met individual needs.

People using the service were protected from abuse as they were supported by a staff team who had appropriate knowledge and training in safeguarding adults. People told us if they had any concerns they would report them to a manager or senior person on duty.

Staff received ongoing training and supervision which provided them with the skills and knowledge to meet the needs of the people they were supporting.

The provider had effective systems in place to monitor and assess the quality of the service.

This told us people had received any care or treatment they had been asked for their consent and the service's staff had acted in accordance with their wishes. People or their representatives had been involved in making decisions about their care and treatment.

People's care needs had been assessed and reviewed, and care and treatment had been planned and delivered in line with their individual care plan.

People's care had been provided by care workers who understood their care needs and who had been provided with the appropriate training and support. Comments received included, 'They love the staff,' 'I can't fault them,' and 'I have no concerns about the care provided.'

When we reviewed employment documentation we could see that robust recruitment practices had been followed. Appropriate identity and security checks had been completed as part of the recruitment process.

The records needed for the management of the service had been maintained and were accurate and complete.