Liberty Support - Cheshire East

Updated 28 September 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

Two inspectors and an Expert by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in supported living settings and their own homes, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was not a registered manager in post. There was a manager who had made an application to register with CQC.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because the service was small, and people are often out and we wanted to be sure there would be people at home to speak with us.

Inspection activity started on 7 July and ended on 27 July 2022. We visited the location’s office on 7July 2022. As part of our inspection we conducted site visits to three supported living properties.

What we did before inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 26 May 2022, to help plan the inspection and inform our judgements. We also sought feedback from the local authority. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and six relatives about their experience of the care provided. Some people who used the service were unable to talk with us and used different ways of communicating including using Makaton, pictures and their body language.

We spoke with 14 members of staff including the manager, 10 members of the staff team, the director, the positive behaviour support coordinator and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with two social care professionals to gather feedback.

We reviewed a range of records. This included four people’s care records and three medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 28 September 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Liberty Support (Cheshire East) provides personal care to people living in their own houses and flats, and to people living in a 'supported living' settings, so they can live as independently as possible. People's care and housing are provided under separate contractual arrangements. The CQC does not regulate premises used for supported living; this inspection looked at people's care and support.

Not everyone using the service received a regulated activity; CQC only inspects the service being received by people who are provided with the regulated activity of 'personal care', for example which includes help with tasks such as personal hygiene and eating. Where they do, we also take into account any wider social care provided. At the time of our inspection eight people were in receipt of personal care.

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

The service was able to demonstrate how they were meeting most of the underpinning principles of right support, right care, right culture.

Right Support

Systems were not fully in place to ensure people had maximum choice and control of their lives. Records did not demonstrate people had consented to their care or where they lacked capacity to consent, the provider had complied with the Mental Capacity Act 2005 (MCA). However, care appeared to be provided in people’s best interests and in the least restrictive way possible.

The service aimed to support people with a small and consistent team of staff who knew people well. However, this was not always possible due to recruitment issues. The service was using agency staff to cover gaps in staffing and had taken steps to improve recruitment. Staff were recruited safely.

Staff were being supported to focus on people’s strengths and promote what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to make their own choices and understood their needs and preferences.

Staff had good awareness, skills and understanding of individual communication needs.

One of the settings required some refurbishment and redecoration, including the bathroom. The provider was not responsible for the accommodation and had escalated these issues to the landlord, but these were still awaiting repair. However, there were also issues with the cleanliness of one setting which was addressed during the inspection. We shared our concerns with the commissioners of the service.

Right Care

The management team had made some changes and were focused on supporting people to be at the centre of their care. They were making improvements to ensure people were supported by staff who had people's individual needs at their focus.

Feedback suggested some people were not consistently supported to engage with activities they were interested in, including appropriate sensory stimulation. Managers had already identified this and begun to review people’s support plans to consider more individualised and creative options. In some cases, we saw people were supported to take part in various activities within the community.

Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks. Staff liaise with other professionals to promote people’s well-being.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

Right Culture

Feedback from people and their relatives confirmed overall they were happy with the support and felt safe. The manager had taken steps to promote a positive culture. The training, supervision, monitoring and mentoring of staff was a focus.

Staff knew and understood people well and were responsive. People's support plans reflected their range of needs and this promoted their wellbeing, however some support plans needed to be updated and did not always fully reflect people's goals or aspirations.

The service employed a dedicated Positive Behaviour Support (PBS) coordinator and specialist nurse to support staff training and development, as well as approaches to peoples’ support needs. We saw examples where improved outcomes had been achieved for people receiving support.

Governance processes were being reviewed and new systems embedded. The manager was working on an action plan to help make improvements to the service. The provider sought feedback from people and those important to them and used the feedback to develop the service. However, further consideration was being given to gather this feedback more effectively.

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

Rating at last inspection

This service was registered with us on 9 September 2021 and this is the first inspection.

Why we inspected

This inspection was prompted by a review of the information we held about this service. We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

Enforcement

We have identified one breach of regulation in relation to consent at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.