Health Personnel

Health personnel is a supported living service providing personal care and support to people living in 4 separate supported living houses and a flat with sleep in arrangements. At the time of the inspection, 14 people were using the service. CQC does not regulate premises for supported living; this inspection looked at people’s care and support.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

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. The registered manager and staff understood the requirements of the Mental Capacity Act 2005 (MCA). Staff told us they asked for people's consent before offering support. Staff involved people in making decisions about their daily care and support requirements and promoted their independence. People were supported to have enough to eat and drink and had access to healthcare professionals when required to maintain good health. Risks to people were assessed, identified, and safely managed. Medicines were managed safely. There were enough staff deployed to meet people's needs. The provider followed safe recruitment practices. People were protected from risk of infection.

Right Care:

People's care plans were reflective of their individual care needs and preferences, and they were reviewed on a regular basis. A variety of activities were on offer and available for people to take part in. People's cultural needs and religious beliefs were recorded, and they were supported to meet their individual needs. Staff offered choices tailored to individual people using a communication method appropriate to that person. Staff were caring, considerate and respected people’s privacy and dignity.

Right Culture:

The provider had effective quality assurance systems in place to monitor the quality and safety of the service. Regular feedback was sought from people about the service. The registered manager responded to complaints appropriately. The service had a system in place to record accidents and incidents and acted on them in a timely manner. Staff were complimentary about the management team. The provider worked in partnership with health and social care professionals to ensure people's needs were planned and met.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 April 2020). At that inspection we found breaches of regulations in relation to need for consent, safe care, and treatment, receiving and acting on complaints, staffing, and good governance. 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 11, 12, 16, 17, and 18.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service didn’t always consistently apply 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.

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

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. This was because the registered manager was not aware of the legal requirement to work within the principles of the Mental Capacity Act and people were restricted without authorisation by a relevant body in a supported living environment. Medicines and people’s risks were not managed safely. Improvement was required to ensure safe staffing levels. Complaints were not managed in line with the providers policy. The registered manager had no oversight of the service and did not know their responsibility to work within the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to notify the CQC of four significant incidents. The quality assurance process was not robust to identify these concerns and or to make improvements.

We made one recommendation about learning lessons from incidents and accidents.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

There were safeguarding procedures in place. Appropriate recruitment checks took place before staff started work. There were procedures in place to reduce the risk of the spread of infections.

People’s care and support needs were assessed before they started using the service. Staff had received training and support relevant to people’s needs. People were supported to cook and maintain a balanced diet. People had access to health care professionals when they needed them.

Staff treated people in a caring and respectful manner. People had been consulted about the care and support they received, and they participated in activities that met their needs. The registered manager and staff worked in partnership with health and social care providers to plan and deliver an effective service. Staff said they felt supported by the registered manage and team manager.

The last rating for this service was Good date last report published (31 July 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified five breaches, the provider had not always worked within the principles of Mental Capacity Act (MCA), medicines were not managed safely, Improvement was required to ensure safe staffing levels, complaints were not managed in line with the provider’s policy, the provider failed to notify CQC of four significant incidents. The quality assurance process was not robust to identify these concerns and to make improvements.

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 and safety. 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.

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

The service had a registered manager in place. 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.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place. Risk assessments provided information about how to support people in a safe manner. Medicines were managed in a safe way. Systems were in place to protect people from the risk of financial abuse.

Staff received on-going training to support them in their role. People were able to make choices for themselves and the service operated within the spirit of the Mental Capacity Act 2005. People told us they enjoyed the food. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the senior staff at the service. Quality assurance and monitoring systems were in place which included seeking the views of people who used the service.