Nottingham Regional Office

Updated 20 November 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 checked 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 comprehensive inspection took place on 19 and 21 September 2018 and was announced. We gave the service 24 hours’ notice of the inspection visit. We gave this notice because we planned to visit people in their homes and we needed to make sure they were notified of our potential arrival, causing them minimal disruption. On the 19 September 2018, two inspectors and two Experts by Experience carried out visits to people’s homes. An Expert by Experience is someone who has cared for someone who has used this type of service. Eight sites were visited as part of this inspection. On the 21 September 2018 two inspectors visited the provider’s office.

On this occasion, we had not asked the provider to send us a provider Information return (PIR). A PIR is a form that asks the provider to give some key information about the service. This includes what the service does well and improvements they plan to make. However, we offered the provider the opportunity to share information they felt was relevant.

Before the inspection, we reviewed other information we held about the service, which included notifications they had sent us. A notification is information about important events, which the provider is required to send us by law.

During the inspection, we spoke with the 11 people who used the service. Most of these could communicate their views verbally, whilst others used non-verbal methods to tell us their views. We also spoke with one relative, nine members of the support staff, four site managers and one of the two registered managers.

We looked at records relating to 14 people who used the service, as well as staff recruitment records. We looked at other information related to the running of and the quality of the service. This included quality assurance audits, training information for support staff, staff duty rotas, meeting minutes and arrangements for managing complaints. We asked the registered manager to provide us with additional information after the inspection which they provided within the required timeframe.

Updated 20 November 2018

We carried out an announced inspection of the service on 19 and 21 September 2018. This service provides care and support for 58 people living in ‘supported living’ settings, which will be referred to as ‘sites’ in this report. The sites referred to are people’s homes. People live at these sites with support from staff so that 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.

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.

The service has two registered managers, one of which was present during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. Each of the ‘sites’ was managed by a service manager who reported directly to one of the two registered managers.

This is the service’s second inspection under its current registration. In our previous inspection the service received a rating of ‘Good’ overall. After this inspection, the service has retained this rating.

Prior to the inspection we had received concerns that some people may have experienced neglect or avoidable harm at the service. During this inspection we reviewed these incidents with the registered manager and found they had taken the appropriate action in relation to these incidents. Most of these incidents were not substantiated, where inappropriate staff action had taken place, this was dealt with through disciplinary or dismissal. We concluded that the provider had the appropriate systems and staff in place to protect people from neglect and avoidable harm.

People had detailed risk assessments that were designed to support people to lead active lives, without unnecessary restrictions, whilst keeping them safe. Most of these were up to date and where they were not, action was taken to address this. People had the support of staff to keep them safe and lead their lives in the way they wanted to. People’s medicines were managed safely and staff followed procedures to protect people from the risk of the spread of infection. Processes were in place to ensure if accidents or incidents occurred, they were investigated and preventative measures put in place to minimise the risk of recurrence.

People’s received care and support in line with current legislation and best practice guidelines. Staff were well trained and received regular supervision of their role. People were supported to lead healthy lives and this included making healthy food choices. Effective relationships with external health and social care organisations were in place to ensure people’s health was regularly monitored. 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 support this practice.

People liked the staff and had formed positive relationships with them. Staff treated people with respect and dignity and people were supported to make decisions about their care and support.

Advocates were made available if people needed further support. People’s diverse needs were considered when care and support was planned for them. People’s records were handled appropriately and in line with the Data Protection Act.

People’s support records reflected their personal preferences and focused on supporting people’s independence. Where a small number of these support records needed updating, the registered manager had acted to ensure this was done. Transition arrangements for people joining the service were effective and well planned. Formal complaints had been responded to appropriately. Information was provided for people in a way they could understand. End of life care was not currently provided; however, efforts had been made to support people with making informed choices about their wishes for end of life care.

People liked where they lived and felt they received the support from staff that they needed. Each service manager that we met, spoke enthusiastically about improving people’s lives. The registered managers had a good oversight of each of their sites and took swift action to address any areas of concern. Staff felt valued and could give their views about the direction of service. People were offered the opportunity to comment on the development of their service. Robust quality assurance processes were in place which enabled regular monitoring of each sites performance.