Helping Hands is a supported living service in Eccles, Salford and provides 24 hour support to people with learning difficulties. There are three supported living tenancies known as Bath House, Milton Crescent and ‘Number 19’.
We carried out our unannounced inspection of Helping Hands on 27 October 2015. At the previous inspection in 2013 we found the service was meeting all standards assessed.
During this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safe Care and Treatment and Good Governance. You can see what action we told the provider to take at the back of the full version of this report.
There was a registered manager in day to day charge of 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.
Staff recruitment procedures were safe. We saw appropriate checks were undertaken before staff began work. However, we did identify one member of staff who started their induction before an appropriate DBS had been obtained.
We found that people’s risk assessments were not always reviewed at regular intervals. Some risk assessments showed no evidence of review since 2013. This meant that people’s individual needs and any associated risks were not being monitored regularly enough by staff which could place them at risk. One person had no risk assessment in their support plan, whilst another person, who we had observed to be ‘unsteady’ on their feet, did not have an appropriate mobility risk assessment in place. These concerns meant there had been a breach of Regulation 12 (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to Safe Care and Treatment.
The premises were not always safe on the day of the inspection. This was because there was nothing stopping people walking off the street and gaining unauthorised access to the supported living accommodation. This was mainly in relation to Milton Crescent and Bath House, as the doors leading into these tenancies were not secure.
The people we spoke with said they felt safe as a result of the care and support they received and trusted the staff who looked after them.
People’s medicines were looked after properly by staff that had been given training to help them with this.
We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe. We looked at the staff rotas. We found the service had sufficient skilled staff to meet people's needs. Staff spoken with told us any shortfalls, due to sickness or leave, were covered by existing staff which ensured people were looked after by staff who knew them. They also said staffing numbers were kept under review and adjusted to respond to people’s choices, routines and needs.
We looked at the training matrix to establish the kinds of training staff had undertaken. We found there were gaps on the matrix, which the manager told us was up to date. Some of these courses included safeguarding, moving and handling, infection control and health and safety. The manager said the expectation was to update these courses each year. Additionally, the training matrix stated only three members of staff had completed any training in learning disabilities, which was the main specialism of the service.
Several of the people who used the service could not communicate verbally and we saw staff had been appropriately training in British Sign Language (BSL).
The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. At the time of the inspection, there was nobody using the service who was subject to a DoLS.
People living at the service were involved in the planning of the menus and went shopping with staff to local shops and supermarkets each week. People, who were able to, were given support by staff to prepare their own meals. There was no set meal for lunch time and people living in the service were able to choose either to dine in or out at a time convenient to them. The manager told us an evening meal was always prepared by staff and that people who lived at the service were able to contribute where possible. We saw the service promoted healthy eating where possible and were actively encouraging people to lose weight if that was what they wanted.
From looking at records, and from discussions with people who used the service, it was clear there were opportunities for involvement in many interesting activities both inside and outside the service. People were involved in discussions and decisions about the activities they would prefer which would help make sure activities were tailored to each individual. Activities were arranged for groups of people or on a one to one basis. Some people had devised their own ‘weekly planner’, which set out the different types of things they liked to do during the weeks and at weekends.
The service had an appropriate complaints procedure in place. The procedure was available in an easy read format that could be understood by everyone who lived at the service. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.
There was a system in place to monitor accidents and incidents. However we found no analysis of these was done which would identify any trends and prevent future re-occurrences. The manager said this was down to current time constraints.
There were policies and procedures in place, however many of these required updating.
There were systems in place to regularly assess and monitor the quality of the service. These included audits of care plans and medication. The manager also spent time speaking with people who used the service at several points during the year to ask them about the service and if it was to their satisfaction. These were clearly recorded within people’s support plans.
We did find however, that there were no systems in place to ensure that appropriate risk assessments were in place and reviewed at regular intervals, that the premises were safe and that all staff training was up to date. These were areas where we found concerns during the inspection. These concerns meant there had been a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation Good Governance.