Creative Support - Brownley Road

Updated 21 March 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 06 and 07 February 2018 and was unannounced. Inspection site visit activity started on 06 February and ended on 07 February. It included visiting the service’s main office, which was located in one of the two houses where people were living. We also visited people living in two shared flats. We carried out phone calls to relatives of people using the service on 15 February 2018.

The inspection team consisted of one adult social care inspector. An inspection manager also accompanied the inspector on the first day of the inspection as part of an annual practice observation.

Prior to the inspection we reviewed information we held about the service. This included statutory notifications the provider had sent us about serious injuries and safeguarding. Statutory notifications are information the provider must send to the CQC about certain significant events that occur whilst providing a service. We reviewed the registration report for the service, which was completed by a registration inspector from the CQC at the time the service registered with us in July 2015.

We sought feedback about the service from the local authority commissioners and quality monitoring team, Healthwatch Manchester and professionals with recent involvement in the service. We did not receive any feedback in response. The focus of the inspection was in part informed by the response to questionnaires we had received from staff and professionals involved with the service. Questionnaire responses were generally positive, but suggested that improvements could be made in relation to the provision of meaningful activities and stimulation for people using the service.

Due to technical problems we were not able to view the most recent provider information return (PIR) submitted by the provider. However, we viewed the PIR they submitted in December 2015. A PIR is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took into account that we weren’t able to view the most recent PIR when we inspected the service and made judgements in this report.

Some people using the service were not able to make an informed decision about whether they would be happy for us to visit them at home. We therefore asked the registered manager to complete best-interest decisions for certain people who were not able to provide their consent to our visit. As a result, we visited people living in both of the two shared flats at Brownley Road. We observed the support that staff provided to people whilst they were at home, and spoke with two people who were using the service. We were only able to get limited feedback on the service from our conversations with people using it, and therefore sought further feedback from people’s relatives. We spoke with three people’s relatives by phone shortly after in inspection site visit.

We also spoke with the registered manager, four support workers, the service director and the locality manager. We reviewed records relating to the care people were receiving. This included daily records of care, medication administration records (MARs) and the care files of three people. We looked at records related to the running of a supported living service, including, three staff personnel files and recruitment records, records of training and supervision, accident records, staff rotas and quality audits.

Updated 21 March 2018

This inspection took place on 06 and 07 February and was unannounced.

This is the first inspection we have carried out of Creative Support – Brownley Road (Brownley Road) since it was registered with us in July 2015. Prior to its’ registration in July 2015, Brownley Road formed part of Creative Support’s ‘South Manchester Services’.

This service 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. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The service provided support to people who had a learning disability or who had an autism spectrum disorder (ASD). People using the service lived in one of two houses that were located on the same site. Each house had a staff office and was split into one ground floor four bed flat, and two first floor single bedroom flats. People living in the shared flats had access to communal kitchen, bathroom and lounge areas. The premises are modern and purpose built. In total, the service could accommodate up to 12 people across both houses.

At the time of our inspection the service was providing support to ten people. Not everyone using the service received support with a ‘regulated activity’; CQC only inspects the service being received by people provided with the regulated activity of ‘personal care’. Personal care includes help with tasks related to personal hygiene and eating. Where people are supported with personal care, we also take into account any wider social care provided.

Brownley Road had not been developed and designed entirely in line with the values that underpin the Registering the Right Support and other best practice guidance. The service was providing support in-line with the values outlined in this guidance, including those of choice, promotion of independence and inclusion. However, the physical environment where people were living was not consistent with recommendations for newly developed learning disability services. This was as the setting provided support to a larger number of people living in a small campus style setting. However, the service worked to minimise the impact of the physical setting, and to provide people with person-centred care.

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.

The service had a number of vacancies for permanent staff, which meant they relied on using agency and ‘bank’ staff to cover gaps in the staff rotas. However, the registered manager had sought to minimise the impact of this. For example, they ensured there were always permanent staff members working alongside temporary staff, and they had processes in place to try and ensure the same temporary staff were used on a rolling basis. Relatives we spoke with told us both they and their family members knew the staff well and had developed positive relationships with them.

Staff assessed risks to people’s health, safety and wellbeing. We saw that where staff had identified potential risks, that they had put in place measures to help reduce the likelihood of that person coming to any harm. However, we found one person’s moving and handling risk assessment and support plans had not been completed in a timely way. Whilst staff were aware of the support this person needed, this would increase the risk that staff may not be aware of how to support this person safely.

We saw staff completed a variety of checks to help ensure people were protected from harm. For example, they checked the fire alarms, escape routes, people’s medicines and finances regularly. However, we saw a fire risk assessment completed for the housing association that owned and managed the premises indicated that people would not be safe to stay in the building in the event of a fire. It recommended that the suitability of the premises should be assessed for anyone who could refuse to evacuate. The provider was not aware of these recommendations. The provider was in contact with various parties, including the housing association and fire risk assessor at the time of writing this report. We asked them to let us know about any required actions to ensure people were safe.

Medicines were stored and managed safely. We saw staff kept accurate records of the medicines they administered. The registered manager had introduced a number of measures to help reduce the likelihood of any medicines errors occurring, which included having a second member of staff to verify the correct medicines had been dispensed. We saw that whenever any errors had occurred, that these had been appropriately investigated and acted upon.

Staff were happy and motivated in their roles. They told us they were well supported by the registered manager who both staff and relatives told us was approachable. The registered manager had encouraged an open and honest culture within the service. This helped ensure staff and the service as a whole were able to learn from any mistakes. Staff felt comfortable raising any concerns they might have. However, we saw there were also systems in place to allow them to raise concerns anonymously if they didn’t feel confident to do this openly.

Staff received a range of training that helped them provide effective support that met people’s needs. Staff told us they were encouraged to identify any training opportunities that they felt would upskill the staff team and enable them to better meet people’s needs. The registered manager was in the process of arranging training to support the staff team in meeting the needs of people whose behaviour could challenge the service.

Staff understood the principles of the Mental Capacity Act (2005) and supported people to make their own decisions whenever possible. However, consent forms had not always been signed where the person had capacity, and one person’s care plan directed staff to seek consent via a relative. Whilst this person’s relative should have been consulted about significant decisions, they would not normally have been the person to make the final decision about matters such as medical treatment. The registered manager told us they would review these documents.

Staff supported people to access a range of activities that meet their needs and interests. This included making use of facilities in the local community. Staff showed a good understanding of the need to support people to be as independent as possible. They were able to give us examples of how they supported people to build skills and become more involved in the running of their home.

People support plans contained relevant details about the support staff should provide to meet a range of the physical health, mental health and social support needs. People were involved in planning and reviewing their care through formal reviews and monthly keyworker sessions. However, we found that the knowledge staff had about people’s support needs was not always recorded in the support plans. One person’s support plan had also not been updated following a significant change in their care. However, the registered manager had identified this issue and had produced an action plan for staff to update the relevant documents shortly after our inspection.

The service had not received any formal complaints within the past year. Relatives we spoke with told us they would feel confident approaching staff or the registered manager if they did want to raise a concern. We saw the complaints policy was also available in pictorial format, which would allow staff to better support people using the service to understand how they could raise a complaint if they felt the need to do this.