Paradise Independent Living

Paradise Independent Living is a supported living service providing personal care to people and which focuses on the rehabilitation of people with acquired brain injuries. At the time of the inspection, 16 people were using the service across four supporting living settings.

People in each setting had shared access to a kitchen, a communal lounge/dining area and a garden. Some people had their own en-suite facilities while others had access to communal bathrooms.

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

Improvements had been made around the management of medicines and people received their medicines as prescribed.

People and their relatives told us they received safe care and treatment. Risks associated with people’s care and health were identified and managed in a safe way. There were adequate numbers of suitably skilled staff deployed to meet people’s needs. The service adopted appropriate measures to prevent people from catching and spreading infections. Accident and incidents were recorded, and any lessons learnt were used as opportunities to improve the quality of service.

The service had made improvements around working within the principles of the MCA. 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.

The service assessed people’s needs and delivered care in line with current standards. Staff monitored people’s health routinely and supported them to access healthcare services when required. People were able to choose what they wanted to eat and drink. Staff told us they felt supported by management and received the training required to fulfil their roles.

Following our last inspection, the management team made several changes to their approach to show compliance with the regulations. There was a positive and inclusive culture within the service where people, their relatives and staff felt comfortable to speak up and contribute their views. Quality assurance systems were effective and enabled the management team to monitor their performance, learn continuously and deliver good care to people. The service provided person-centred care to people by working in collaboration with other agencies.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 09 December 2019) and there were breaches of regulations.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 20 and 24 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

Paradise Independent Living is a supported living service providing personal care and aims to support and rehabilitate people with acquired brain injuries. At the time of the inspection, 14 people were using the service in three supporting living settings.

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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, we found instances where people were subjected to restrictions and prompt action had not been taken by the provider to ensure any potential deprivation of liberty was lawful.

Medicines were not managed safely. There were no clear individual protocols for people receiving ‘as and when required’ (PRN) medicines.

Personal Emergency Evacuation Plans (PEEPS) for people using the service were not individualised in accordance to people’s needs.

There were systems in place to assess and monitor the quality of the service provided. However, these were not always effective and did not identify the shortfalls found during this inspection.

People and relatives spoke positively about the service. They told us they felt safe and their needs were being met. Risk assessments were in place to prevent or reduce the risk of people being harmed. Staff followed appropriate infection control practices. Appropriate numbers of suitably skilled staff were available to meet people's needs. Accident and incidents were recorded and acted upon. Any lessons learnt were used as opportunities to improve the quality of service

Staff had the knowledge and experience to support people's needs. They were supported through induction, training and supervision to ensure they performed their roles effectively. Assessments were carried out to ensure people's needs could be met. People were supported to maintain good health and access healthcare services when needed. People were supported with their nutritional and hydration needs.

People's privacy, dignity and independence was promoted. People told us support workers were kind and caring. There were procedures in place to respond to complaints. The provider had investigated and responded promptly to any concerns received.

The provider worked with healthcare services and professionals to plan and deliver an effective service.

Rating at last inspection

The last rating for this service was Good (published 21 March 2017).

Why we inspected

This was a planned inspection based on previous rating.

Enforcement

We have identified breaches in relation to safeguarding service users from abuse and improper treatment, safe care and treatment and good governance 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 for the provider to understand what they will do to improve the standards of quality and safety. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

The service was last inspected and rated on 19 January 2015 and was rated Good.

At this inspection we found that the service remained Good.

Paradise Independent Living currently provides personal care to 12 people living in three supporting living accommodation settings and to one person who lives in the community. The service aims to support and rehabilitate people with acquired brain injuries between the ages of 18 and over.

People told us they felt safe within their home and with the support that they received from the care staff. Care staff knew how to recognise and report abuse. The provider had systems and processes in place to ensure people were kept safe and free from harm. This included personalised risk assessments and safe recruitment procedures. People’s medicines were managed safely and staffing levels were seen to be appropriate according to the needs and requirements of the people being supported.

The provider ensured that all staff received the required training and support in order to deliver effective and high quality care. Staff received regular supervisions and appraisals. People were enabled to make their own choices and decisions in the least restrictive way possible and were offered support where required. People chose what they wanted eat and planned their own menus for the week. People decided the level of their own involvement with the preparation of their meal and where they required support. People had access to a variety of healthcare professionals and were supported by care staff where needed.

During the inspection we saw that the registered manager, compliance manager and all care staff had developed and established caring and respectful relationships with the people that they supported. Staff knew each person, their likes and dislikes, their needs and requirements and were observed to be respectful of these.

Care plans were person centred, detailed and clearly outlined the person’s background history and their care and support needs which were based on their choices and wishes. Each person had a planned activity schedule which they were supported to participate in. The service had received four complaints since the last inspection. Records confirmed that these had been dealt with according to the provider’s complaints policy. People and relatives knew who to complain to if they had any concerns or issues.

People and relatives knew the registered manager and told us that the management team was very approachable. Staff told us that they also felt supported and were able to speak with a member of the management team at any given time. The provider had a variety of systems in place that reviewed and monitored the quality of care delivered ensuring that this was never comprised.

Further information about our findings is detailed in the sections below.

Care plans were in place to help people maintain their health and safety. There were also procedures to ensure that people using the service were involved in decisions about their care and for obtaining their consent before they received care. In cases where people were not able to make a decision about their own care because of capacity the provider adhered to relevant guidance on how to work in that person's best interest.

The provider had an effective system of audits which monitored the quality of the service. There were action plans for when any problems or improvements were identified. There were also effective systems for selecting and recruiting suitably qualified members of staff. Staff qualifications were checked and staff engaged in regular training to keep their skills up to date.

People who used the service were protected from the risk of abuse, because the provider took reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff could describe what might constitute abuse and were aware of the provider's safeguarding and whistleblowing policies. Staff engaged people using the service in discussions about the risks of abuse so that they could communicate problems if they arose.

People told us that their individual care needs were discussed and agreed with them. They confirmed that the agency kept them informed about any issues and reviewed their care needs with them on a regular basis. Comments included, 'I meet up with my key worker to talk about my support plan' and 'the staff ask me if I'm OK.'

Staff had a good understanding of the needs of the people they supported and people told us that they felt safe with the staff who supported them. They told us they had no concerns about the service but felt able to talk to the manager or other staff if they needed to. One person commented, 'the staff are very willing to help. They sort things out'.

People told us that they had confidence in the staff team and that staff responded to their needs appropriately. Comments about staff included, 'they work well as a team,' and 'staff are well trained. They do a good job.'

Comments about the quality of service provision included, 'I am completely satisfied with the service given to me by Paradise Independent Living,' and 'since coming to this organisation I have learnt a lot. I have become more independent and confident.'