10 May 2016
During a routine inspection
The inspection took place on 10 May 2016 and 17 May 2016. The provider was given twenty-four hours’ notice of the first inspection day.
The service did not have a registered manager in post. 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. The previous registered manager had left the organisation in January 2016. The provider has appointed another manager within the service to oversee the RNIB DCLSS and this person is in the process of applying for registration.
Due to some wider changes within the RNIB Charity, this service has recently experienced some significant changes. The RNIB previously operated a community living service to people living on a site owned by the provider in Redhill. Due to a large scale redevelopment project, this site ceased operating in October 2015. This meant that the existing community living service moved location and re-registered at the current address. As a result a number of people who previously had accommodation on this site, of which six received a personal care service, transferred to either two independent flats or one of the shared houses on the new site of the RNIB DCLSS, Swail House.
At the same time, two houses on the Redhill site which provided residential care to people also closed and these people also had to move. As such, six people were now in receipt of a personal care service at supported living properties, one in Leatherhead and the other in Ashstead.
The above process has been widely referred to across the RNIB Charity and all stakeholder as the “decant”. We have therefore retained this terminology for ease throughout this report. The impact of this decant has been varied according to whether people moved simply from one supported living location to another or from residential care to supported living. The former achieved a relatively smooth transition with people quickly settling into their new homes and adjusting to a different location. For those individuals who moved from residential care however, the decant process was poorly managed and resulted in a period of significant instability which failed to place people at the centre.
People and their representatives had been let down by a lack of communication about what was happening at provider level. As a result people some people moved into accommodation that did not initially meet their needs in a safe way.
The provider had also not taken sufficiently proactive steps to ensure people’s legal rights were protected. The management team had failed to work collaboratively with people, their relatives, funding authorities and the staff that knew them best. As a consequence decisions were made outside the Mental Capacity Act 2005 and best interests processes which exist to safeguard them.
The provider was not fully delivering the services set out in its Statement of Purpose. This was because some of its locations had not fully transitioned to the supported living model. These services were operating as care homes and were not offering people the same level of skill development and independence as those who were receiving a service from the Swail House site.
Insufficient planning had been undertaken in order to minimise the disruption of people’s daily lives and activities. The geographical move of location across towns meant that people had less contact with their friends and their activity plans were disrupted. For some people, the move also reduced their independence. This was because they could no longer access their local community on their own as they had done previously.
Staff had not been prepared or supported to adapt to their change in roles. Aside from the location change which for many staff was personally disruptive, some staff had never worked within a supporting living service before. The lack of training and transition for these staff left them vulnerable and exposed to mistakes.
The provider had however recently listened to the concerns raised by us, commissioners, relatives and staff and reflected on the lessons learnt. As such, the management team were now looking at the Swail House part of the service that was experienced at providing supported living to see how the service as a whole could grow and develop together.
Staff told us that there had recently been a greater management presence across the services and more opportunities for information sharing had been held. People told us that they were starting to feel more settled. Feedback from most relatives and care managers also indicated that improvements were now being made.
All people who had moved locations were at varying stages of formal re-assessment and their care plans and risk assessments were now up to date. The recent recruitment of a driver had increased people’s opportunities to access activities without the additional cost of taxis or public transport.
People had been supported to access new doctor’s surgeries and their healthcare needs were being met. Medicines were managed safely and there were good processes in place to ensure people received the right medicines at the right time.
Appropriate checks were undertaken to ensure only suitable staff were employed. The management team were reviewing staffing models to ensure that locations across the service could function as intended and meet people’s needs effectively.
People were protected from the risk of abuse, avoidable harm or discrimination because staff understood their roles and responsibilities in protecting them. All staff were trained in supporting people with visual impairment. Staff were passionate about protecting people and had recently acted as strong advocates for their needs.
People told us that staff were kind and caring towards them and promoted their privacy and dignity at all times. Relationships between people and staff across the service were positive and lots of fun and laughter were observed.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.