Creative Support - Stockport Extra Care Services

Creative Support – Stockport Extra Care Services provides care and support to people living in their own homes, based within 2 extra care housing schemes in the ‘Reddish’ area of Stockport. At the time of our inspection the service was providing support to 32 people. 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

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Staff were recruited using suitable method. Feedback was mixed about staffing levels, but it was generally people and families agreed that this had improved. People felt safe and action was taken to ensure lessons were learnt when things went wrong. People’s needs and risks were suitable assessed, and action taken to mitigate risk as much as possible. People were supported to take their medicines as needed but records were not always as robust as possible, and we have made a recommendation about this.

People’s needs were assessed, and people were supported in line with their needs. Staff worked closely with other services where needed, and ensured people had support with eating and drinking when required. Staff felt well supported in their role and accessed a variety of training. 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 told us staff were kind and caring and treated them well. People were encouraged to be involved in making decision about their care, decision were respected, and independence was promoted as much as possible.

People were supported with person-centred care. Information was provided to people in line with the accessible information standards. People were encouraged to engage in activities where these were available. People and relatives felt confident to raise concerns and these were investigated and addressed by the staff and managemnt team as needed. People were supported to receive end of life care when needed.

People told us the service was person-centred. Various systems for checks of the quality of the service were in place, although some of these were not always completed effectively. The registered manager and management team were committed to the service and people they supported, and responsive to any aspects of the service which could be improved. The service had good working relationships with other services.

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 24 October 2017).

Why we inspected

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

Recommendations

We have made a recommendation about the management of people’s medicines.

Follow up

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

This inspection took place on 12, 13 and 14 September 2017 and was announced.

At our comprehensive inspection of the service carried out in July 2016 we identified five breaches of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in relation to; safe management of medicines; taking actions to mitigate potential risks; ensuring the competence of staff; record keeping and effective systems to monitor the safety and quality of the service. We also made one recommendation, which was in relation to ensuring all members of staff receive regular supervision. The provider was informed of the actions required in order for the service to become compliant with the identified breaches of regulations.

We last inspected the service on 13 and 14 September 2016 when an unannounced focused inspection took place. At that inspection, the team inspected the service against three of the five questions we ask about services: is the service safe, effective and well-led. Although improvements had been made in some areas, and were underway in others, we found continued breaches of these regulations. Again, the provider was informed of the actions required in order for the service to become compliant with the relevant regulations. The provider sent the Care Quality Commission an action plan informing of how they intended to become compliant with the breaches of regulations identified.

During this inspection of the service we found that all previous breaches of Regulations had been satisfactorily addressed.

At the time of our inspection the registered manager of the service had recently resigned. The Care Quality Commission had received the appropriate documentation from the registered manager with details of their resignation. A new manager had been identified and, at the time of the inspection, was waiting the return of relevant documentation from the Disclosure and Barring Service (DBS) prior to sending their application for registration to the Care Quality Commission. 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.

Within the registered managers resignation documentation it was stated that they had concerns about their lack of support from line management and issues relating to their management of the staff team. During the inspection we spoke in depth with the service director about the concerns raised and evidence was supplied to demonstrate the support offered and provided to the registered manager during their employment with the service.

People told us that Stockport Extra Care provided them with safe and appropriate care to meet their identified needs.

We saw that all staff had been trained in keeping people safe and when we spoke with staff they told us they knew what to do should they witness or suspect poor practice or that abuse of any kind had occurred.

At the time of the inspection we found medicines to be safely managed with regular management overview of staff practice taking place.

People were supported to access health and social care professionals when required.

Staff were receiving training appropriate to the jobs they are employed to do.

People we spoke with were confident about raising complaints and confirmed that any complaint raised was dealt with in a timely manner.

Care plans were person-centred and provided the detail staff would require to provide support in accordance with the person’s identified needs and preferences. We saw care plans had been regularly reviewed and that reviews had involved the person and their relatives where appropriate.

This focussed inspection took place on 13 and 14 September 2016 and was unannounced. At our last comprehensive inspection of Creative Support – Stockport Extra Care we identified five breaches of three of the regulations. The breaches were in relation to; the safe management of medicines; taking actions to mitigate potential risks; ensuring the competence of staff; record keeping and effective systems to monitor the safety and quality of the service. At this inspection, although improvements had been made in some areas, and were underway in others, we found continued breaches of all these regulations. You can see what action we have told the provider to take at the end of this report. We are currently considering our options in relation to enforcement and will update this section once any action has been concluded.

Creative Support – Stockport Extra Care Services (Stockport Extra Care) provided care and support to people living in their own homes based within seven extra care housing schemes. The seven schemes were run as four projects/schemes dependent on their location. The four locations were Edgeley, Marple, Reddish and Heald Green areas of Stockport. The registered office for the service is located at Spey House in Reddish. At the time of our inspection the service was providing support to between 125 and 140 people across the schemes, although not all people received assistance with personal care.

At the time of our inspection there was a registered manager employed by the service. 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.

Following our last inspection we had identified that the provider was sending though a high volume of notifications relating to medicines errors, including errors that presented a risk of harm to people using the service. The provider had made some improvements following our last inspection to the processes relating to the auditing and administering medicines. For example, a new more frequent ‘spot-check’ was being carried out on people’s medicines, staff had received medicines supervisions and competency assessments, and the service had made efforts to ensure all people’s medicines were recorded on pharmacy printed administration records. Despite these steps, we identified on-going issues in relation to the recording and administration of medicines, including two serious medicines errors that had not been identified by the provider or registered manager. We requested the provider to refer these concerns to the local authority safeguarding team.

We found on-gong issues with the way the service identified and reduced risk to people using the service. Since our last inspection, actions had been taken to identify people at risk of pressure sores and we saw appropriate steps had been taken to reduce potential risks. However, one person who was supported using a hoist did not have a moving and handling risk assessment in their file for staff to review, and one person did not have a current risk assessment. This would increase the risk that staff would not know how to support these people safely.

The provider had recruited to a number of vacant posts staff since the last inspection, and we saw use of agency staff varied between the schemes and from week to week. A new induction process for temporary/agency staff had been devised to ensure agency staff received a sufficient induction to the scheme, and this was due to be implemented two weeks following the inspection. There was evidence agency staff who had recently worked at the service had not received an induction whilst awaiting the implementation of this new system.

We saw the new audit system for medicines had, in the majority of cases, identified potential concerns and shortfalls. However, one of the spot-checks carried out during the inspection failed to identify a serious medicines error. The service director took appropriate actions in relation to our concern.

We found some shortfalls in the way the service monitored and improved the safety of the service. Accident logs were not kept up to date at all the schemes, and shortfalls in the incident reporting procedures had been identified by the provider. The service director showed us a new system that had been put in place that should help to address this concern.

The provider was in the process of taking actions to improve the quality and safety of the service following feedback from our last inspection. We saw positive steps had been taken such as providing supervision to team leaders, producing action plans and providing training. It was acknowledged by the inspection team that some of the action plans were still in progress in relation to areas where we identified on-going concerns. The action plan submitted to CQC indicated completion dates of 26 September 2016 and December 2016.

Following concerns raised during the inspection, the service director informed us they had been released from their other responsibilities and would be based full-time at the service for a temporary period. They also informed us they had requested input from the provider’s quality assurance team. The service director has provided CQC with regular updates in relation to the safe management of medicines.

We last inspected the service on 21 July 2014 when we found the service to be meeting the requirements of the regulations inspected.

Creative Support – Stockport Extra Care Services (Stockport Extra Care) provides care and support to people living in their own homes based within seven extra care housing schemes. The seven schemes were based in the Edgeley, Marple, Reddish and Heald Green areas of Stockport. The registered office for the service is located at Spey House in Reddish. At the time of our inspection the service was providing support to 132 people across the seven schemes.

At the time of our inspection 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.

At this inspection, we identified five breaches of three of the regulations of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to; the safe management of medicines; taking actions to mitigate potential risks; ensuring the competence of staff; record keeping and effective systems to monitor the safety and quality of the service. You can see what action we told the provider to take at the back of this report. We made one recommendation, which was in relation to ensuring all members of staff receive regular supervision.

There was a reliance on the use of agency staff to ensure the service was able to meet all calls. We found there had been a high number of recent medicines errors by agency staff and there was a lack of evidence to demonstrate the provider’s process for inducting agency staff had been followed. Whilst people told us they were more recently being supported by the same staff on a consistent basis, they also told us they preferred to receive support from regular staff. We saw evidence the provider was actively trying to recruit permanent staff to the service.

People expressed satisfaction with the service they received from Stockport Extra Care and talked positively about the extra care model of care. People told us they felt staff respected their privacy and promoted their independence, for example, by allowing them time to complete tasks for themselves. People told us the permanent care staff knew them and their routines well.

People who had made a complaint told us the Registered Manager had dealt with their concerns to their satisfaction. We viewed records of complaints, which demonstrated complaints had been investigated, appropriate actions taken and a response provided to the person making the complaint. Everyone we spoke with told us they would feel confident to raise a complaint.

We found medicines were not managed in a safe way. Records were not always current or accurate, and there had been a large number of medicines errors occurring in the service. Medicines audits had not been effective at consistently identifying issues or ensuring actions were taken to improve the safe management of medicines. The provider had also identified concerns in relation to medicines and shortly before our visit had requested assistance from their quality assurance team.

We found there was not always evidence that appropriate actions had been taken to ensure potential risks were mitigated following incidents. For example, a risk assessment had not been reviewed following a person sustaining a fall, and another person’s risk assessment had not been reviewed following an incident involving a piece of equipment. The provider took action during our visit to rectify these issues and to improve procedures in place.

We saw staff received training in a variety of areas including safeguarding, moving and handling and dementia awareness. Staff told us the training was of good quality and that they could request to attend training they thought would help them in their role. We saw additional training had been identified by the Registered Manager, including training in pressure care and end of life care, which would help ensure an effective service was provided to people using the service. There were regular checks of staff competence, including checks in relation to specific areas such as maintaining people’s dignity.

Records were not maintained consistently to evidence that people had received the support they required with aspects of care such as repositioning. We were able to cross reference these records to daily notes, which did show people had received the care they required. People told us staff would support them to contact a GP if required and we received positive feedback from a district nurse in relation to the support the service had provided to an individual’s care they were involved in.

Care plans were person-centred and provided the detail staff would require to provide support in accordance with the person’s needs and preferences. We saw care plans had been regularly reviewed and that reviews had involved the person and their relatives where appropriate.

People who used the service and staff told us the Registered Manager and team leaders were approachable and listened to them. Staff told us they felt valued for the work they did and there were regular staff team meetings.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the office base of the service which is located at Spey House, Criterion Street, Reddish. There we met and spoke with the registered manager of the service. We also looked at some records. We also spoke with three people using the service at Spey House and six members of the staff team.

The full report contains the evidence to support this summary.

Is the service safe?

The people using the service who we asked said that they felt safe living at the scheme and with the care staff who supported them. Their comments included, 'I can honestly say I feel safe with any of the staff when they are with me in my flat'. Another person said, 'I like my flat and I've always felt safe living here. The staff are very kind and I don't worry about any of them when they are with me'.

Risks to the safety of people who used the service were identified and addressed. Staff had clear guidance to help maintain and support people's safety.

Is the service effective?

The manager told us that every person who received a service had their needs assessed before the service started. This enabled the service to identify anyone whose needs they could not effectively meet. The assessment process also enabled an effective person centred support plan to be developed.

All staff who we asked confirmed that there was always a written support plan available in the home of the person using the service. They told us that people using the service were involved in discussions about their support plan. They also told us people could influence the way in which their care and support was provided.

The service had effective quality monitoring systems in place. These would help to identify if the service needed to amend any of its practices or policies and procedures.

Is the service caring?

People who used the service were very positive about the attitude of the staff who visited them. Their comments included: 'The girls [care staff] are very good and very obliging when they come to me, I don't think they've ever missed coming although they do sometimes come a bit late, say by ten or twenty minutes'. Another person using the service told us 'All the one's [care staff] that come to me are absolutely lovely and have a really nice way with them'.

Is the service responsive?

A complaints log was available and a record was kept of all complaints, concerns, safeguarding referrals and investigations. All the complaints received had been responded to and action taken to prevent any further occurrences.

We saw evidence of completed copies of recent incident reports. From looking at these reports it became evident that two different Incident Report forms were in use which was causing some inconsistency in the information that was being collated. Information was not being fully completed with some questions being left blank. The provider should consider ways of making sure that the latest version of the Incident Report form is the only one available for use and is fully completed in all instances.

There was a range of quality monitoring systems in place. However at the time of this inspection the registered service had only been operating from this location since February 2014 and was therefore still developing the system. We did see evidence that quality monitoring checks had been conducted at the service by the Quality Monitoring team from Creative Support.

Is the service well led?

There were clear lines of accountability within the service.

The service had a manager that was registered with the Care Quality Commission.

There were a variety of systems in place to enable the manager to monitor quality and identify risk. This helped ensure that people continued to receive a safe and effective service.

The manager was described by staff as approachable and supportive.