Creative Support - Sue Starkey House & Shipton House

At the time of this inspection there were 51 people using the service.

We found the following examples of good practice.

Staff received support to receive a vaccination against Covid-19. This included individualised supervisions and video calls from a director of the service. The provider also received support from local public health teams and religious organisations to explain the benefits and address misinformation.

There were clear procedures to follow should people test positive. Staff carried out regular checks of people’s vital signs and wellbeing when they were unwell and had guidance on when to seek additional medical advice.

The provider had detailed plans they could activate in the event of severe staff shortages to ensure that people’s essential care and support needs were still met.

Sue Starkey House and Shipton House provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented, and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.

People using the service lived in one of two blocks of flats in the London Borough of Tower Hamlets. Sue Starkey House consists of 32 self-contained single flats and eight double flats and Shipton House consists of 13 single flats. Both buildings have shared facilities such as a communal lounge and kitchen, laundry rooms and bathrooms and staff offices.

Not everyone using this service receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of our inspection the service was providing personal care to 30 people, including older people and people with physical and learning disabilities.

The service had a registered manager, who was the provider’s manager for the area. 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.

At our previous inspection we made a recommendation about how the service carried out checks of people’s finances and the equipment that was used to provide care. There were now systems in place to make sure that equipment was safe and that finances were checked to protect people from loss or financial abuse. Managers had systems in place to ensure that staff understood what was required of them and communicated well, and checked that care was delivered as planned. Managers investigated and made changes when things had gone wrong.

People were supported to express their views about the service and managers took action accordingly. We saw that complaints were investigated and appropriate measures taken when these were upheld.

The provider had systems in place to safeguard people from abuse and avoidable harm, and had worked with the police and local authority to address current issues which may affect people’s safety. We found that people received their medicines safely, although audits did not always detect some problems with recording.

There were suitable numbers of staff on duty who were recruited in line with best practice. We found that at Sue Starkey House there was a high reliance on agency staff, and the provider was attempting to recruit new care workers to address this. People told us that staff were kind and treated them with respect; some people expressed concerns about staff skills in relation to cooking which managers were addressing through making information available and providing additional training. There were measures in place to make sure that care workers received essential training and managers checked they had the right skills and knowledge.

People’s care was designed and delivered in a way which met their needs, but we found that care plans were not always clear about people’s needs around continence. People received the right support to eat and drink and to stay well. There were varied and interesting activities programmes in place and this was a high organisational priority. We found that keyworking was not yet sufficiently developed to support people to express their views about how they received care and spent their time, but people’s care was reviewed regularly. The provider notified us when allegations were made about people and when serious incidents had occurred.

Sue Starkey House provides extra care and supported living services to people with a range of needs, including older people, people with mental health needs, learning disabilities and physical disabilities. At the time of our inspection 29 people were receiving support with personal care at this location. Sue Starkey House consists of 32 self-contained single flats and eight double flats over a five storey building. There is a large communal living and dining room, a shared kitchen and a computer room on the ground floor and a second floor library and darts room.

The service’s registration includes Shipton House, which is a smaller extra care service for older people, particularly people living with dementia. The building had been recently renovated, and consisted of 13 self-contained single flats with a living room, accessible kitchen and wet room. There was a small shared lounge and kitchen on the ground floor. The building adjoined a day centre, which was attended by several people who lived in the building.

The service had a registered manager, who was also area manager for the provider. 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 provider had measures in place to safeguard people who use the service and mitigate risks. Risk assessments were reviewed regularly and contained detailed risk management plans, including moving and handling guidelines and guidelines for addressing when people became upset or displayed aggressive behaviours. There were checks in place to keep premises safe, although the provider had found that some equipment was overdue for servicing and was taking measures to address this. There were processes for checking people’s safety and the safety of the building. When the service supported people to manage their money, the provider obtained detailed information on people’s support needs in this area, however there were not sufficient checks of people’s finance records to ensure that people were safeguarded from financial abuse or loss. There were systems of audit to ensure that people’s medicines were safely administered by staff who had had training and observations of their competency in this area.

Care plans contained detailed information about how best to support people, and people had appropriately consented to their plans. The provider carried out assessments of whether people were able to consent to their care plans and whether they may be at risk of being deprived of their liberty. We found some care plans had not been updated when people required less support, although the provider was working with the local authority to update these. Reviews of care plans were taking place regularly and in response to particular events. The provider compiled plans to meet the need of people living with dementia and provided life story work and reminiscence activities to stimulate people’s memories. Keyworking systems were being implemented for people, although these were not yet fully embedded in the service and although the service recognised and celebrated people’s achievements, goals were not always set in a way that was specific and measureable.

People were supported to maintain good health and nutrition through planning and monitoring, and where there were concerns about people’s health or when people were refusing support, the provider worked well with other agencies in order to address these issues.

Staff received good levels of training and supervision, including in key areas such as dignity and safeguarding. Staff were recruited in line with safer recruitment processes, but staff were sometimes stretched at evenings and weekends, and some people did not receive their agreed support hours in line with their plans. Where complaints were received, the provider had investigated and addressed these, and worked to ensure that people knew how to complain.

There was a varied activity plan which was implemented with input from people who used the service and external agencies including charities and volunteers. Volunteers had worked with people who used the service to design and build a dementia friendly garden at Shipton House. People were supported to speak up through tenants meetings and events forums, and individual activities sessions were carried out to ensure that activities met people’s needs.

We have made a recommendation about how the service carries out checks of equipment, pull cords and finances.