SCC Adult Social Care Supported Living and Mallow Crescent short breaks service

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We identified a breach of regulation in relation to the governance and oversight of the service. Best practice guidance was not always followed which meant people were not always fully involved in their own support and there was a risk people’s rights would not be upheld. There was no systematic approach to the assessment process which meant people’s needs were not always fully understood by staff. Inconsistencies in the way goals were set with people and outcomes measured meant the support meant people’s support was not always fully reviewed. Not all staff were aware of the principles of the Mental Capacity Act 2005 and processes were not always followed. For some people we found they had received support to gain independence, try new experiences and take advantages of opportunities. People’s health needs were monitored and guidance from professionals followed. We observed staff provided people with day to day choices and asked for consent prior to providing support.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People’s needs were not always thoroughly assessed which led to staff not always being aware of the support they required to meet their needs. We observed some people were not supported with their emotional wellbeing in an understanding way. These needs had not been assessed in detail and care plans and risk assessments had not been developed to address these needs.

Staff in one setting told us it had been difficult to understand people’s needs and employ a consistent approach to supporting them due to the lack of information available to them. However, they felt over time plans were developing as they got to know people more. The management team told us they were aware the assessment process needed to be more consistent. They stated this would form part of their action plan going forward.

We received mixed feedback from professionals involved in people’s care. One professional told us they felt the lack of assessment and review of changing needs had led to people in one setting not receiving the support they required. A second professional told us staff had responded well to difficulties in ensuring a person was supported through the assessment process and to settle well into their new home.

There was a lack of processes in place to assess people’s needs. All assessments viewed were very brief and did not contain detailed information regarding people’s support needs. No assessment form had been used consistently which meant the information gained varied greatly. The management team confirmed they had discussed reservations regarding the ability of the service to meet one person’s needs. However, there was no evidence of this area being assessed and no care plan or risk assessment had been implemented to guide staff in the area of concern. Although some guidance was implemented following our discussion, this needed further development and to be embedded into practice.

People did not benefit from best practice guidance being embedded into the way staff worked. Whilst people and their relatives did not directly comment on this we observed the lack of understanding in relation to supported living standards and Right Support Right Care, Right Culture meant people’s rights were not always known and considered. For example, people’s one to one hours were not always allocated flexibly, people were not always encouraged to take ownership of their homes and how they were run and there was no information or system in place for people to be able to choose who provided their support.

In other areas we found staff supported people in line with best practice such as promoting people’s independence and enabling people to take positive risks.

Staff feedback did not demonstrate a good understanding of the supported living model. One staff member told us, “Staff are frustrated that some people here are not suitable for supported living.” They went onto clarify staff did not believe people with personal care needs and those who showed distressed behaviour at times should live in a supported living environment. This demonstrated a lack of understanding regarding people’s right to hold their own tenancy and live an ordinary life.

The management team told us they had provided training to staff in relation to the supported living model when the settings changed from residential care. They acknowledged that whilst best practice guidance around supported living had been discussed with staff, this had not been fully explored. They assured us this would form part of their action plan going forward.

Systems to ensure people’s rights were protected in line with the real tenancy test were not in place. Staff and the management team were not fully aware that individuals should be afforded the right to choose their own support provider. They told us this had been discussed when transferring from residential care to supported living but no conclusion reached. They told us they did not see how this could work due to how the hours and staffing were arranged within the service. Processes to ensure people had the maximum choice and influence over their support such as people being involved in staff recruitment, rostering, appraisals and the monitoring of the quality of support they received were not in place.

People benefitted from consistent staff teams. In the majority of settings, we observed a genuine affection between people and staff. Many conversations we heard demonstrated staff understood people’s preferences and knew what was important to them. However, the lack of consistent systems in care planning across the settings meant some people were not always supported in this way. For example, there were no plans to encourage one person to make their home more personalised despite them living there for several months. Another person was approached inconsistently by staff when they acted in a way which may upset others.

Staff in individual settings told us they felt they worked well as a team and could rely on each other for support. One staff member told us, “We support each other, and we are flexible. We have a good team and that makes a happy place.” Some staff told us they felt the different settings could work more consistently as it could be difficult to support others when things were done differently. The management team were aware of these differences and had started to implement different systems such as electronic care notes and medicines records to streamline processes.

Comments from professionals involved in people’s care varied in relation to how well teams worked together to support people’s needs and aspirations. One professional told us they systems and people’s support varied across the different settings. A second professional told us they found the team supporting the person’s care they were involved with to be motivated and felt they worked well together to support them.

In line with feedback from staff and other professionals, we found that although individual teams worked well together, inconsistencies in the processes in place meant teams across the settings worked in isolation. This had led to there being differences in the quality of care people received. The management team assured us this concern had been identified. They were in the process of developing systems to ensure consistency in record keeping with central access. The aim of this development was to make monitoring people’s care more streamlined and personalised.

People had access to healthcare professionals in line with their needs. One relative told us, “They take her to her hospital appointments and the doctors. They keep an eye on all her appointments, so she attends.” Where people found it reassuring to have relatives accompany them to appointments this was supported by staff. We observed staff liaising with a person’s relative to make arrangements to attend an appointment together.

Staff told us they supported people with their health care appointments. One staff member told us, “Doctors and hospital appointments are always the priority.” The management team were knowledgeable about people’s health care needs and were able to describe how individuals were supported with any on-going health concerns.

Professionals involved in people’s care told us that referrals to health care professionals were made in a timely and appropriate way. They felt assured that people’s health was monitored. One healthcare professional told us they were confident that staff followed recommendations and treatment guidance when supporting people.

Records showed that people were supported to attend health appointments as required. We observed health appointments were planned for and monitored on an on-going basis. People were supported to attend annual health checks and medicines reviews with their GP and other professionals where appropriate.

Feedback from people and their relatives showed they were happy with the support provided at the service. However, we found inconsistencies in the support some people received to discuss and set goals. For some people there were no plans in place to support them in identifying their aspirations going forward. Following our inspection the provider sent examples of how they were addressing this concern through holding keyworker meetings. As with all new processes this will need to be embedded into practise. In other instances, we found people had been supported to increase their opportunities through travelling more independently and from exploring different work and leisure options.

Staff told us they wanted to support people to be happy in their homes and to do things they enjoyed. Whilst this was evident in the care staff showed towards people, consideration was not always given to how people’s opportunities could be developed to support them in increasing independence. Discussions with the management team demonstrated they were proud of the achievements of people and staff but understood systems to continually monitor people’s outcomes were required to ensure a consistent approach throughout the service.

There was a lack of consistency in how people’s outcomes were monitored and improved. Systems to record people’s wishes and how their aspirations were identified varied across different settings. For some people this meant their care plans and goals had not changed for long periods and their quality of life had not been holistically reviewed. The management team were looking at different systems to ensure greater consistency across the service. They told us training and development would be provided in conjunction with the new systems to support further understanding for people and staff.

People and relatives told us staff requested their consent and worked with them to make decisions. One person indicated to us that staff did not do anything they did not want them to and always asked before supporting them. One relative told us, “[relative] makes their own decisions and staff support her.” We observed staff supporting people to make day to day decisions and respecting people’s choices.

Not all staff we spoke with were aware of principles of the Mental Capacity Act 2005 (MCA). Staff informed us they had received training in relation to the MCA but were not able to describe how this impacted on the way they supported people. When asked about capacity assessments and best interest decisions a number of staff told us this was the role if the management team. This meant there was a risk people’s rights would not be protected. Other staff members were able to describe how they incorporated the MCA into their role and ensured they gained consent from people prior to supporting them.

The systematic implementation of the MCA was not fully embedded into practice. In some settings we found capacity assessments and best interest decisions were only completed by external professionals with staff believing this was not their role. One member of the management team had reviewed MCA and best interest decisions for people in a number of settings. They told us they had identified further work was required to fully embed systems. We saw evidence of this on the managers action plan. In other instances, we found systems in place to ensure these were completed in detail and reviewed regularly.