Archived: A Star Support Services

A Star Support Services provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of this 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.

We last inspected A Star Support Services in July 2017. At that inspection we found breaches of legal requirement regarding safe care and treatment; need for consent; good governance; and fit and proper persons employed. The service was rated ‘Required Improvement’ and we required the registered manager to send us an action plan with timescales for improvement.

This follow-up comprehensive inspection was planned to check on progress. We found improvements had been made in the key question of ‘Safe’ which meant the service was no longer in breach of legal requirements for safe care and treatment and fit and proper persons employed; but insufficient progress had been made overall. At this inspection we found two continued breaches of legal requirement regarding the need for consent and good governance. You can see what action we have taken at the back of the full report.

Improvements had been made in respect of emergency procedures and the availability of Personal Emergency Evacuation Plans (PEEP). Recruitment and selection procedures had also been strengthen to ensure consistently safe recruitment practices.

We found continued issues related to record keeping and documentation around 'consent' and the decision-making process that led individuals to be placed with the service. We also found issues related to the signing of tenancy agreements for those people who lacked mental capacity and could not provide consent.

Systems for audit, quality assurance and questioning of practice were not operated effectively. In particular, quality assurance systems were not sufficiently robust to demonstrate remedial actions, outcomes and lessons learnt.

We found there was a variation in the layout, format, quality and content of support records across the service. However, we saw that work was already underway in developing a new style and format of support plans and we were shown a draft example of this.

Appropriate systems were in place for both safeguarding and whistleblowing which sought to protect people from abuse. Staff understood their role in helping to keep people safe and gave us examples of how they would do this. Safeguarding training was also provided to staff.

People were enabled to live active and fulfilled lives. Positive risk taking with people's individual risk assessments aligned with support plans. A variety of risk assessments were also in place related to accessing the wider community. For example, going to the swimming pool, gym, road safety and accessing public transport.

People's medicines were ordered, stored, administered and disposed of safely.

People who used the service were supported by staff who were skilled and competent to fulfil their roles. Training provided to staff was a combination of face-to-face and e-learning. Topic areas included medication, challenging behaviours, autism, moving and handling, safeguarding and positive interventions. Staff were also provided with opportunities for continuous development.

People who used the service were supported to maintain healthy balanced diets. Whilst we saw that menus were planned in advanced, this was done in consultation with people and individual preferences were catered for.

People's ongoing healthcare needs were met. Support planning documentation contained details of the healthcare professionals involved in a persons care and records demonstrated that people who used the service were supported to attend a variety of health related appointments and to maintain good health.

Relatives were consistent in their praise of staff. People who used the service and their relatives were positively engaged on a regular basis and were actively encouraged to contribute and participate as much as possible. Regular house meetings took place and people were encouraged and supported to share their views.

Staff had sufficient time to provide one-to-one support to people who used the service. We noted the positive impact of this with regards to emotional wellbeing and managing behaviours that might challenge the service.

The service had a complaints policy and procedure and information was readily available with regards to how to make a complaint. Relatives of people who used the service told us they knew how to raise a concern and they felt assured these would be taken seriously.

Relatives of people who used the service were complimentary about the registered manager and house managers. We were told managers were supportive, caring and helpful.

A Star Support Services Limited is a domiciliary care agency and provides care and support to people with their own tenancies in two houses. The administrative office is located in Davyhulme, Manchester. At the time of this inspection the agency supported three people with learning disabilities. This was the first inspection since the service was registered with the Care Quality Commission (CQC) in May 2015.

The service had a manager who had been registered with CQC since May 2015. 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.

Risks to people’s safety in the event of a fire had been identified, however, there were no personal emergency evacuation plans (PEEPs) in place for people using the service and no record of any fire drills or fire evacuations having taken place.

Staff and family members we spoke with did not raise any concern about staffing levels and told us people’s needs were met. However, there was no working rota in any of the houses to confirm staffing levels. The service had ‘borrowed’ a member of staff from a local day care provider but this was not acceptable. Care and support staff must be employed either by the provider or by a reputable recruitment agency, so that the manager is assured all required checks and training have been completed. Following the inspection we were provided with evidence that the member of staff was in receipt of a valid DBS check, had been recruited to the service and had completed a full company induction.

Risk assessments were in place for the physical environment, behaviours that challenge, nutrition, medicines, road safety and aspects of personal care. No accidents or incidents had been recorded at the service but there were appropriate systems in place for reporting and recording any that might take place in the future.

People told us they felt safe with the care and support they received from the agency. Staff we spoke with could tell us about the types of abuse and what action they would take if they suspected that abuse was taking place. Staff members had received mandatory safeguarding training. This meant people using the service were protected from risk as staff knew what to do if they identified concerns.

Support staff were introduced to the people they would be caring for prior to providing the service. This meant people were cared for by staff that were familiar with their care needs.

People and their relatives said care staff had the right skills and knowledge needed to undertake their caring role effectively. Care staff received an induction and mandatory training in key areas such as safeguarding, medicines and moving and handling. This should help to ensure that care staff supported people safely and effectively.

Staff understood the importance of protecting people’s best interests however, this was not always clearly documented on care plans. Care plans contained no consent to care documents.

Care staff we spoke with confirmed they had regular supervisions. Staff received guidance and support to help ensure they carried out their roles in a safe and effective way.

Staff assisted people with the preparation of meals. Meals were planned weekly with the full involvement of individuals receiving care and support, however people could choose alternative meals if they changed their minds.

People were supported to attend regular appointments. Relatives we spoke with were complimentary of the support their family members received for the benefit of their health and wellbeing.

Care staff were introduced to the people they were supporting before care and support started. Care staff we spoke with knew the people they supported. Close bonds and trusting relationships had been built up between staff and the people using the service.

Staff were able to give us examples of how they treated people with dignity and respect. Staff demonstrated they understood how to maintain people’s dignity in a caring and respectful way. Care records showed how people’s independence was promoted. Staff told us how people were encouraged to maintain life skills, particularly around aspects of personal care.

Care plans we looked at were person centred however care plans had not been signed by the people who used the service or family members to indicate they agreed with the content. There was limited evidence of reviews of care.

The activities people participated in had a positive impact on their lives and ultimately benefitted their health and wellbeing. People were assisted to establish and maintain community links, relationships and friendships that were important and beneficial to them.

The provider had a complaints policy and procedure in place. There was no easy read version of the complaints policy at the service to benefit people receiving care and support. We recommend that one be put in place.

Relatives and staff we spoke with were all very complimentary about the way the service was led by the registered manager. Care staff told us they enjoyed the support role and thought the service was a good one to work for.

It was not clear how the service ensured the quality of its care provision as there were no formal records. As there were no audits or weekly checks in place, errors would not be picked up and rectified. Quality assurance systems needed to be more robust to help the registered manager effectively monitor the quality of the service provided.

Staff told us they felt involved in the service and considered they were kept up to date with the information they required to do their role. Staff we spoke with were aware of the aims of the service which were to promote independence and help people integrate people into the community.

The service could demonstrate partnership working with local day services and other community ventures.

We found four breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. These were in relation to safe care and treatment, the need for consent and good governance. You can see what action we told the provider to take at the back of the full version of the report.