Housing & Support Solutions - Bridlington Region

Housing & Support Solutions - Bridlington Region is a domiciliary care and supported living service providing personal care to people in their own homes. Three people were receiving support with personal care across three services. The service supports people living with learning disabilities or autistic spectrum disorder, mental health, older people, and people with physical disability or sensory impairment

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

Staff received training and supervision to ensure they had the skills and support for their role. However, staff were not receiving regular appraisals and the provider had no systems in place to record staff’s additional training and qualifications. Satisfaction surveys were carried out; however, these were for all the providers locations. Staff did not always received feedback from these and there was no service level results and action plan.

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. Staff gained consent prior to providing people with care. Mental capacity assessment and best interest decisions were carried out.

Staff had developed positive relationships with people which led to people feeling safe and happy.

The culture of the team was positive, and staff felt confident and supported in their role. The service had a clear set of values which staff understood and promoted.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were supported to maintain their independence and staff worked hard to improve and maintain people’s quality of life.

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

The rating at the last inspection and update

The last rating for the service was requires improvement (published 19 March 2020) and there were multiple breaches of regulation. 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 26 September, 29 September and 15 November 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve the governance systems.

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 Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. 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 Housing and Support Solutions – Bridlington Region on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Housing & Support Solutions - Bridlington Region is a domiciliary care and supported living service providing personal care to nine people at the time of the inspection. Three people received support with personal care in their own homes and six people lived in shared living accommodation across four homes. The service supports people living with learning disabilities or autistic spectrum disorder, mental health, older people, and people with physical disability or sensory impairment

Not everyone who used the service received personal care. The Care Quality Commission (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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Staff did not always feel supported or valued. Provider oversight of systems and processes had failed to ensure all staff had received supervisions and appraisals in line with the provider’s own policy and procedure.

The provider had failed to ensure all notifications required by the CQC had been submitted as required under regulatory requirements.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Records confirmed people's input. However, where they were unable to consent, and decisions were made on their behalf, they were at risk from receiving care and support that was not always in their best interest. Provider oversight to ensure checks on care plans had failed to ensure information associated with best interest decisions was robustly recorded.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People and their relatives were happy with recent improvements to the service provided. Staff understood the importance of providing person-centred care and had developed positive relationships with people.

People received support with personal care where this was required, and staff encouraged their independence to live fulfilled lives free from unnecessary restriction.

Staff had received training to keep people safe from avoidable abuse and followed clear guidance to report concerns. The provider was reviewing and improving recording systems further to ensure all concerns were reported and investigated without any unnecessary delay.

Where people had been assessed as at risk from any activity, for example accessing the community and other events, support plans provided guidance to ensure they remained safe. People talked excitedly about these activities and the benefits they provided.

Systems and processes were in place and followed by staff to ensure where people required support, their medicines were managed safely and administered as prescribed.

Staff received appropriate training and applied learning effectively in line with best practice. This led to good outcomes for people and supported a good quality of life.

The provider was passionate and creative about providing a service that was based around the needs of the individual person. The quality manager was responsive and proactive in implementing actions to any concerns CQC raised during the inspection. They sought feedback and engaged with people, staff and other stake holders to drive improvements.

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

Rating at last inspection.

The last rating for this service was Good (published 31 March 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to provider’s governance and oversight; failure to report certain incidents as required by law; to ensure staff received appropriate supervision and appraisal in their role and to ensure records were robustly completed 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 from the provider to understand what they will do to improve the standards of quality. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We undertook this comprehensive inspection on the 16 and 20 February 2017. This was the first inspection for this service.

The service had 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.

People told us they felt safe living at the service. They said that this was because there were staff in the premises over a 24 hour period, and that the premises were safe.

We found the registered manager and staff understood their responsibilities under the Mental Capacity Act 2005. They were aware of the need to gain consent when delivering care and support, and what to do if people lacked capacity to agree to it. People’s abilities to make decisions had been assessed and appropriate support had been provided to ensure that their views were taken into account when making decisions.

People received their medicines as prescribed, from staff who had been training about the management of medicines.

We found people who used the service were protected from the risk of harm and abuse because staff had received safeguarding training and they knew what to do should they have any concerns. Staff were recruited following the organisation’s policies and procedures.

Positive and caring relationships had been developed between staff and people who used the service. We saw people were treated with respect and their dignity was maintained. Staff were seen to speak with people in a kind, attentive and caring way.

Staff supported people to be involved in their care and to make choices about how they spent their time. Wherever possible staff encouraged people’s independence and supported them to access the local community. Care plans contained information on the care people needed and the risks they faced. Staff were aware of people’s health care needs and the support they provided helped to maintain them.

People told us they were happy with their meals. Some people worked alongside staff to prepare their meals and other people had their meals prepared for them by staff.

People who used the service had a wide range of support needs. People received support for between four and 12 hours per day. We found sufficient numbers of staff were employed to ensure people’s needs could be met.

Staff training and the on-going support staff received from the management team meant that the care provided was safe and effective.

There was a quality monitoring system that ensured people’s views were listened to, any complaints were addressed, audits were completed and checks carried out on staff practices and performance.