21 August 2018
During a routine inspection
MOST provides care and support to people living in ‘supported living’ settings within the local communities, so that they can live in their own home as independently as possible. While MOST supports 51 people, and provides accommodation for some, only six of these received support with personal care, which is an activity requiring registration. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living therefore this inspection focused on the care and support provided to those six people. We also take into account any wider social care provided.
This is the first time the service has been inspected since the provider has changed to Aspens Charities. The service was previously provided by Larkfield With Hill Park Autistic Trust Limited and was rated as Requires Improvement. At the last inspection on 10 and 11 October 2016, we asked the provider to take action to make improvements within safe, effective, responsive and well-led.
At our last inspection we found risks to people’s safety were not managed as they had not followed up on actions needed from accidents and incidents; risks to people were not consistently managed and risk assessments were not up to date; safeguarding alerts were not consistently monitored and followed up; and staff did not receive medicines competency checks in line with the providers policy. At this inspection we found people were kept safe, they had comprehensive risk assessments and the provider had ensured environmental risks were managed and people were protected from the risk of infection. Staff understood their responsibilities in relation to safeguarding people from abuse, had identified concerns between people within shared homes and consequently worked with people to manage their relationships with the other people they lived with. People’s medicines were managed safely. There were enough staff to keep people safe, staff were recruited safely and had the training and skills required to meet people’s needs.
At our last inspection we found the provider had failed to ensure the principles of the Mental Capacity Act 2005 (MCA) were followed, and staff induction processes were not consistent. At this inspection we found the provider was working within the principles of MCA. 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 supported this practice. The provider had trained and supported staff to understand the requirements of the Mental Capacity Act. The managers ensured staff had the right induction, training and supervision to fulfil their roles. People’s needs were assessed, kept up to date and care was delivered to meet their needs. This included supporting people with their communication needs, complex health needs and with their behaviour which could be challenging. We made a recommendation that the provider seeks advice and guidance from a reputable source on implementing Accessible Information Standards.
The service had 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 could live as ordinary a life as any citizen. Staff were caring and respected people’s privacy and dignity. We observed that people were treated with kindness and respect. There was a strong person centred culture at the service, people were involved with their support and encouraged to remain as independent as possible.
At our last inspection we found that people’s preferences were not reflected in their care plans, and there was not an established and effective system for recording and responding to complaints. At this inspection we found people’s care plans were person centred and reflected their preferences. People received care and support which met their needs, and took part in activities which were meaningful to them. The provider responded to complaints and sought feedback from people. People’s wishes around the end of their life had been reflected in their care plans.
At our last inspection we found that the quality of the service had not been monitored effectively and staff did not have regular formal supervision and staff meetings. At this inspection there was a registered manager in post. A registered manager is a person who has registered with 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 management team consisted of the registered manager, four service managers and four senior support workers. We found that quality, performance and risks were managed. The provider had effective auditing systems in place and promoted continuous learning. Staff received regular supervision, appraisals and attended staff meetings. There was a positive culture which promoted good outcomes for people, and engaged people in their care. The managers worked in partnership with other health and social care professionals to ensure people’s needs were met.