Diverse Abilities Plus - Supported Living

Updated 1 July 2023

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

The inspection was undertaken by two inspectors, a medicines inspector and an Expert by Experience. 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 is a domiciliary care service. It provides personal care to people living in their own homes.

This service provides care and support to people living in 19 ‘supported living’ settings, so 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there were two registered managers in post.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for ‘best interests’ decisions about this. We also needed to be sure a registered manager would be in the office to support the inspection.

Inspection activity started on 22 February 2023 and ended on 17 March 2023. We visited the location’s office on 22 February, 1 March and 9 March 2023.

What we did before the inspection

We reviewed information we had received about the service since it was registered. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We also used information gathered as part of monitoring activity that took place on 7 February 2023 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and 10 relatives about their experience of the care provided. We spoke with or received email feedback from 13 members of staff including the registered managers, nominated individual, support workers and office-based staff. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 5 people's care and support assessments and plans, 5 people's medicines records, and 5 staff files in relation to recruitment, training and supervision. We used electronic file sharing to enable us to review records of the care 5 people had received. We also reviewed a variety of records relating to the management of the service, including staff rotas, training records, accident and incident analyses, policies and procedures and quality assurance records.

Updated 1 July 2023

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

Diverse Abilities Plus – Supported Living is a domiciliary care and supported living service. It provided personal care to 33 people at the time of the inspection.

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

Right Support:

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 have made a recommendation about the recording and review of mental capacity assessments and best interests decisions.

People and relatives said they felt consulted in decisions about care, and that their views were taken seriously.

There were enough staff with the use of agency staff to meet people’s needs. Regular staff supported people in a way that fostered their independence. However, people living in houses with staff vacancies had regularly experienced care from agency staff who did not know them as well. Relatives said because agency staff did not know people as well, they were not as attentive to their individual needs and preferences. We have made a recommendation about which staff support people.

Risks to people and to the staff supporting them were assessed. People’s support plans set out how staff should support people to manage these risks in the least restrictive way. Staff followed support plans with clear instructions about people’s preferences and support needs in relation to preparing food and eating and drinking.

People each had a health passport, which summarised succinctly what care staff and professionals in other settings needed to know about the person.

Staff understood people’s communication needs and provided the support required, as set out in their support plans. Where people had communication passports devised in consultation with a speech and language therapist, support plans referenced these.

Right Care:

People and relatives said they and their loved ones felt safe and comfortable with staff. There were pre-employment checks for new staff. Staff had training about their role in safeguarding people from abuse. The registered managers recognised there had been an issue with staff identifying the need to report incidents and had already started to address this. We have made recommendations about the incident monitoring process, and about the provider’s safeguarding adults policy.

The service had not always notified CQC of reportable incidents. The registered managers took steps to address this immediately we drew it to their attention.

People and relatives said they were happy with their or their family member’s care and support from regular staff, and they felt staff cared about them. People’s needs were assessed holistically, which formed the basis of their highly personalised support plans. Staff confirmed they had access to people’s clear, current support plans that enabled them to provide effective care and support.

People were supported with their medicines in the way prescribed for them. There had been some medicines errors and incidents recently and improvements had been put in place to reduce these.

Staff were supported through initial and update training, training specific to the needs of people they supported, regular individual supervision meetings and team meetings. They also had informal contact with the senior staff and managers connected with the house they worked in, and with on call staff.

Right Culture:

The registered managers were swift to address any issues we identified, or which they themselves had found. However, quality control processes and audits had not identified some issues reported by relatives nor the issues we found with missed notifications to CQC and with the recording of mental capacity assessments and best interests decisions.

The provider had a culture of inclusivity, person-centredness and openness. This was reflected in people, relatives and staff feeling comfortable to raise concerns with managers, and in efforts to ensure people and staff were not disadvantaged because of disability. We have made a recommendation regarding the service’s complaints policy.

The registered managers were open and honest with people and their families in the event of something going wrong or a near miss.

The registered managers recognised consistent staffing was important for people and, recognising the reliance on agency staff in some houses, were actively recruiting new staff. They also ensured that when a person was admitted to hospital, they continued to receive support from Diverse Abilities staff regardless of the hospital being able to fund this.

People were supported to keep in contact with their families and to pursue friendships. Staff also supported them to pursue hobbies and interests, at home and out.

People accessed health services as they needed, including annual health checks, age-related health screening, dental care, sight tests and check-ups with primary care or hospital specialists in relation to health conditions.

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 30 January 2022, and this is the first inspection.

The last rating for the service at the previous premises was good, published on 10 November 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified breaches in relation to notifying CQC of reportable incidents, and monitoring and improving the quality and safety of the service, at this inspection.

We have made recommendations in relation to accident and incident monitoring, the safeguarding adults policy, mental capacity assessments and best interests decisions, and the complaints policy.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.