Nottingham Supported Living (DCA)

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 carried out the inspection and an Expert by Experience made telephone calls to relatives to seek their feedback on care provided to people using the service. 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 11 ‘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 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 a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is an office based service and we needed to be sure the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

Before our inspection, we reviewed our information we held about the service. This included information received from the local authority and professionals who work with the service. We looked at statutory notifications. A statutory notification is information about important events, which the provider is required to send us by law, such as allegations of abuse and serious injuries. We reviewed the last inspection report.

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.

During the inspection

During the inspection we spoke with four people who used the service and nine relatives of people who used the service. We spoke with the registered manager, operations manager and we received feedback from eight support staff. We also received feedback from external health and social care professionals.

We reviewed a range of records, this included in part, seven people's care records. We looked at two staff files in relation to recruitment, and a variety of records relating to the management of the service, including incident records and analysis, meeting records, staff rota's, complaints and the provider's quality assurance feedback.

After the inspection

We continued to seek clarification from the provider to validate evidence found. This included but was not limited to the provider's current action plan, training data, policies and procedures.

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 guidance CQC follows 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 fully meeting some of the underpinning principles of the Right support, right care, right culture. Improvements were required to ensure people were consistently supported to be involved in their care and support that maximised their choice, control and independence.

Some people using the service raised concerns about safety and experiencing bullying, intimidation and abuse by others they lived with. Some relatives and external professionals also raised concerns about safeguarding incidents, and staff’s competency in managing people’s needs and management oversight.

Staff deployment did not meet people’s individual care and support needs and safety. ‘Whilst during the inspection evidence of commissioned hours were not provided for two supported living settings, this information was forwarded post inspection. Information received confirmed hours had been provided and, in some instances, hours provided exceeded what was commissioned by the local authority. However, we remained concerned that evidence provided was not sufficiently detailed to show people had received their individual care and support hours.

Incident and risk management, including analysis and learning were not fully effective. People had not been sufficiently protected from the risk of abuse.

Staff training, skills and competency needed reviewing, to ensure people’s care and support needs were effectively met.

People’s support plans and risk assessments had not consistently been reviewed and updated at the frequency the provider expected. People received their prescribed medicines when required but related support plans required further guidance to be made available for staff.

Infection, prevention and control best practice guidance was followed. People were supported to maintain their tenancy. Housing repairs were reported when required and health and safety checks on the environment were completed.

The staff team did not feel fully supported, valued or listened to and raised concerns about a staff bulling culture.

The provider had systems and processes to monitor quality and safety and an improvement plan was in place. However, this did not reflect the shortfalls identified in the expected fundamental care standards found during this inspection.

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 Outstanding (published 28 February 2018). The service has deteriorated to Inadequate.

Why we inspected

We received concerns about the safe care and treatment of people. Including concerns about staff deployment, skills and competency, people not being protected from abuse and staff bullying. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Nottingham Supported Living on our website at www.cqc.org.uk

Enforcement

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified three breaches in relation to staff deployment, staff training, skill and competency, protecting people from abuse and harm and governance.

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

At our last inspection in December 2015, the service was rated 'Good'. At this inspection we found that the service remained 'Good' in Safe, Effective and Well-led and had improved to 'Outstanding' in the Responsive and Caring key questions.

The service had a registered manager in place at the time of our inspection. 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 remained safe because staff had received appropriate training and the provider had systems and processes in place to support people from avoidable harm. 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. People were supported with their tenancy to live in a safe environment. People received support from a team of staff that provided consistency and continuity. Safe staff recruitment checks were carried out before staff commenced employment. People who used the service were involved or represented in the recruitment of staff. People received appropriate support with the administration, storage and management of their prescribed medicines. Staff were aware of the importance of infection control measures and had received appropriate training.

People continued to receive an effective service. People were supported by staff that had received an appropriate induction and ongoing support and training. The registered manager used best practice guidance to develop and support staff to provide effective care and support. People were fully involved in meal preparation and choice. Staff were aware of people's nutritional needs and promoted healthy eating. Systems were in place to share information with external services and professionals when required. People received appropriate support to maintain their health and achieve good health outcomes.

People received outstanding care. Staff provided excellent person centred care; they were a dedicated staff team who went above and beyond what was expected of them. People who used the service and relatives described staff as very caring, kind and compassionate who wanted the very best for the people they supported. People were involved in their care and support and staff respected their privacy and dignity. Independence was promoted by staff, who clearly understood the principles of supported living. People were enabled to self-direct the support they received; this was empowering and gave people maximum choice and control of how they lived their life. Staff had a good understanding of people's diverse needs, preferences, routines and personal histories. People had access to advocacy support should this support be required.

People received an outstanding responsive service. People were fully involved in their care and support and lead active and fulfilling lives. The service was very responsive and supported people to achieve their hopes, dreams and aspirations. People participated in person centred reviews, where best practice was used enabling the person to be at the focus throughout. People were supported to be active citizens of their community. With the right approach and support, some people had developed their confidence and skills that enabled them to be in paid employment. People had been supported to experience holidays and staff had been creative and used innovative approaches in supporting people to pursue their interests, hobbies and personal goals. This had led to people’s friendship and social circle increasing. People's support plans focussed on their individual needs, creating a person centred approach in the delivery of care and support. Staff used effective communication methods to support people's sensory and communication needs. People had access to the registered provider's complaints procedure that was presented in an appropriate format for their communication needs.

The service continued to be well-led. The registered manager was experienced, dedicated and passionate about providing people with the right support that enabled them to grow and develop. The registered manager had developed an open and inclusive service, they had a clear vision and set of values based on social inclusion that the staff fully understood and adhered to. Staff felt listened to, supported and involved in the development of the service. People who used the service and relatives received opportunities to share their views, experience of the service and were involved in developing the service further. Audits were carried out and action plans put in place to address any issues which were identified.

The service had 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 felt safe and were supported by staff who knew how to keep them safe. Risks to people’s health and safety were assessed and appropriately managed and people were supported by a sufficient number of staff. People received the support they needed to safely manage their medicines and were encouraged to be as independent as possible in the management of their own medicines.

Staff had the knowledge and skills to care for people effectively and felt well supported. People received the level of support they required to have enough to eat and drink and were supported to access a range of healthcare services.

The Care Quality Commission (CQC) monitors the use of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We found this legislation was being used correctly to protect people who were not able to make their own decisions about the care they received. Where people had the capacity they were asked to provide their consent to the care being provided.

People were treated with kindness and respect by staff. Caring relationships had been developed and people were supported by staff who understood their personalities and sense of humour. People and their relatives were able to be involved in the planning and reviewing of their care. Staff supported people to make day to day decisions.

People were provided with support that was responsive to their changing needs and staff helped people to maintain any hobbies and interests they had. People felt able to make a complaint and the provider had taken action to raise awareness of the complaints procedure. There was an appropriate response to any complaints received.

The culture of the service was open and honest. People and staff gave their opinions on how the service was run and their suggestions were implemented where possible. There were effective systems in place to monitor the quality of the service and a service improvement plan ensured that improvements to the service were made.

We saw records to confirm that the provider had taken the necessary action to become compliant by providing staff with appropriate support through regular supervision and appraisal meetings.

People who used the service told us the care and support provided was good and they got on well with staff. One person said. "The support staff are the best I have had ' I have come on a long way thanks to them'. People's needs and risks were assessed and care and support was planned and delivered in line with their individual care plans. Arrangements were in place to deal with foreseeable emergencies.

People were not always cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Some staff did not receive regular supervision and not all staff had had an appraisal during the previous year.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately.

We spoke with five people who used the service and asked them if they received support that met their needs. People were positive in their responses and comments included: 'this year's been the best yet, I feel really well supported', 'I get on well with everybody' and 'they let me decide what I do'.

We found that people's needs had been assessed and then a support plan had been produced. People had been involved in reviewing their support plan and records contained appropriate details about people's health and social support network.

We found that staff had been screened as to their suitability to work with vulnerable adults and were aware of the appropriate reporting processes should an allegation of abuse be raised.

The service had an effective quality assurance system.