Liberty Support - Midlands

About the service

Liberty Support - Midlands is a supported living service providing personal care to 19 people at the time of the inspection. People lived in shared houses, flats and bungalows across different areas within the West Midlands. 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.

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

Right Support

People were not always supported by staff who had received training in line with their needs. However, staff knew people well and people told us they felt safe. People received their medicines safely, but the systems in place to manage medicines weren't always effective.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were assessed so any potential risks were identified, and steps taken to keep them safe. Systems in place safeguarded people from abuse and staff were knowledgeable about how to support people safely. People were protected from harm through infection control measures.

Right Care

Observations and records showed that people experienced choice and control over their support and care planning was person-centred. People's religion, culture and sexuality was considered as part of their care and staff knew people's likes and dislikes.

Right Culture

Systems and processes in place promoted a positive culture at the service. However, ongoing improvements were required to ensure the governance systems were effective. Action plans were in place to drive further changes to the service such as a new process for gaining feedback from people, relatives, staff and professionals.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 27 June 2022) and there were 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service which commenced on 23 March 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which were considered at the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Liberty Support - Midlands on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Liberty Support (West Midlands) provides personal care in supported living settings. At the time of the inspection they were supporting 42 people with a learning disability, autism or living with mental ill health. People lived in shared houses, flats and bungalows across different areas within the West Midlands.

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.

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

People using the service were not always safe. Staff knew when and how to report any concerns of abuse. However, there were occasions where people using the service were not always safe due to safe staffing levels.

People were not always supported by staff who understood their roles and did not always receive effective training.

People were not asked for their views of the service. There were not effective systems in place to monitor the service.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

Right support

People were supported to have choice, staff supported people in the least restrictive way possible.

The provider supported people to make choices, and have control over their own lives, such as what time they got up and went to bed.

Right care

We saw that staff were caring and promoted the people they were supporting dignity.

Right culture

Staff had training on how to recognise and report abuse and they knew how to apply it. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff told us how they would recognise pain, distress and discomfort in people who could not verbally communicate.

Why we inspected

We received concerns in relation to the safety of people and concerns about the numbers of staff available to support people.. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. Whilst undertaking this inspection we assessed whether the service was applying the principles of right support, right care and right culture.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

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

The provider has an action plan in place to address the concerns raised by the local authority as well as an action plan for across the region to improve the quality of care for people using the service. The action plan was in the early stages, so not enough time had passed to see the change.

Enforcement and Recommendations

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 will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to regulation 12 of safe care and treatment and regulation 17 of good governance at this inspection.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The provider has an action plan in place, and they understand what they need to do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was good (published on the 11 January 2020).

Liberty Support (West Midlands) provides personal care in supported living settings. At the time of the inspection they were supporting 16 people with a learning disability, autism or living with mental ill health. People lived in shared houses, flats and bungalows across different areas within the West Midlands.

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.

The service has been developed and designed in line with 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 autism to live meaningful lives that include control, choice, and independence. People using the service 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 protected from abuse and had risks to their safety assessed and plans in place to mitigate them. People received their medicines as prescribed. Staff followed infection control procedures and there were processes in place to learn when things went wrong. There were enough safely-recruited staff to support people.

People had their needs assessed and plans in place to meet them. Staff were trained and people received coordinated and consistent support. People were supported to maintain their health and wellbeing. People were supported to be as independent as possible in relation to their food and drink choices and preparation.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People received support from caring staff. Staff knew people well and people were supported to make their own decisions. People received responsive care which was personalised to meet their needs. People were supported to maintain their interests. People understood how to make a complaint. People were supported to communicate and access information in a way that suited them. No one was receiving end of life care, however work was ongoing by the provider to ensure people’s wishes were planned for.

People, relatives and staff were positive about the service and the approach of the registered manager. There were systems in place to check the quality of the service and the service worked in partnership and had a learning culture.

The service applied 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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 6 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide personal care and support to people in their own homes. At the time of the inspection the service was providing support and personal care to 25 people who were living in their own homes within a number of ‘supported living’ facilities within the community. Supported living enables people who need personal or social support to live in their own home supported by care staff instead of living in a care home or with family. The levels of support people received from the service varied, according to their assessed needs and levels of independence.

There was a registered manager. 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.

People were supported by staff who had been trained to recognise the signs of abuse and were aware of their responsibilities for reporting any concerns they may have.

Staff were aware of the risks to people and supported them to manage those risks in order to keep them safe. Accidents and incidents were reported appropriately and acted upon.

There were systems in place to ensure staff recruitment was robust. People were supported by a familiar group of staff who knew them well and any staff absences were covered by staff who were also familiar with the people they supported.

People were supported to safely take their medicines and regular audits were in place to ensure medicines were administered correctly and safely.

Staff received a comprehensive induction and training that provided them with the skills and knowledge to meet people’s needs effectively. Staff felt supported and listened to and their practice was regularly observed.

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 in the service supported this practice.

For those people who required it, support was offered at mealtimes and staff were aware of people’s dietary needs and preferences.

People were supported to access healthcare services and staff worked alongside other professionals in order to help people maintain good health.

People told us that the staff who supported them were kind and caring and they spoke warmly of the staff and management. People were treated with dignity and respect and supported to maintain and improve their independence.

People were involved in the planning of their care and were supported by staff who were knowledgeable about their likes, dislikes and preferences. People were encouraged to maintain friendships and were supported to be as independent as possible.

People were confident that if they raised any concerns, they would be listened to and acted upon.

People and staff all considered the service to be well led. There was a culture of openness and transparency and working together to support people to live their lives the way they wished.

Staff were motivated and supported in their role. There were a number of audits in place to assess the quality of the service provided and to drive improvement.