Creative Support - Apsley Court

Creative Support – Apsley Court is an extra care housing scheme. People using the service live in their own flats in a single adapted building. Not everyone who used the service at the time of our inspection 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. Seven people were receiving personal care at the time of our inspection

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

People told us they felt safe and they were happy with the care and support they received. Staff were familiar with safeguarding procedures and where to raise any concerns.

People told us they received their support calls as planned and that there were always enough staff to support them. Appropriate recruitment checks were completed before staff started work.

Possible risks to people were identified and assessed and plans put in place to minimise risks occurring. Medicines were safely managed and administered.

Staff had received training on infection prevention. The provider had updated policies and processes in place to reflect current guidance on Covid-19 and developed initiatives to support staff during the pandemic.

People and their relatives said they were consulted about their needs and wishes and thought the service was well run. They told us any issues they raised were addressed. Their views about the service were sought through, spot checks and surveys.

There was an effective system to monitor the quality and safety of the service and identify learning to share with staff and understand where improvements might be needed.

The registered manager understood their role as registered manager. Staff were aware of their own individual responsibilities and told us they worked well as a team. Staff spoke positively about the registered manager and said she was approachable and supportive, and the way managed the service effectively.

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 ( report published 31 October 2019).

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 18 September 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 their management of medicines to ensure people received safe care.

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 Safe 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 Creative Support -Apsley Court 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.

Creative Support – Apsley Court is an extra care housing scheme. People using the service live in their own flats in a single adapted building. Not everyone who used the service at the time of our inspection 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. 15 people received personal care at the time of our inspection.

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

People’s medicines were not always safely managed. Improvement was required because the provider’s systems for monitoring the quality and safety of the service were not always effective in driving improvements.

People told us they felt safe with the support they received from staff. They were protected from the risk of abuse because staff were aware of the signs to look for and the procedures for reporting any abuse allegations. There were enough staff on each shift to safely meet people’s needs. Risks to people had been assessed and staff were aware of how to manage identified areas of risk safely. Staff followed safe infection control practices when supporting people. They reported any accidents or incidents which occurred at the service and the manager reviewed accident and incident records regularly to identify any learning and improve safety.

People’s needs were assessed when they started using the service, in line with nationally recognised guidance. Staff were supported in their roles through an induction, training and regular supervision. People were supported to maintain a balanced diet. They had access to a range of healthcare services when needed and staff worked with other services to ensure people’s needs were effectively met. 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 treated people with care and consideration. People were involved in making decisions about the support they received. Staff treated people with dignity and respected their privacy. People had care plans in place which identified their individual needs and preferences in the way they wished to be supported. The provider offered a range of activities for people to take part in to reduce the risk of social isolation. People had end of life care plans in place where they were happy to discuss this with staff. The provider had a complaint procedure in place. People told us they knew how to complain and expressed confidence that any issues they raised would be addressed.

People told us the service had an open and inclusive working culture. Staff spoke positively about the way in which they worked together and about the support they received from the manager. The provider worked with other agencies including the commissioning local authority and the housing provider to ensure people receive a good quality service. They sought people’s views through regular meetings and the use of surveys. The feedback from the most recent survey showed that people were experiencing positive outcomes from the support they received.

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 28 September 2018) and there was a breach of two regulations. 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 some improvement had been made. However, the provider remained in breach of one regulation.

The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach of regulations in relation to the failure to ensure people’s medicines were safely managed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

Not everyone using Creative Support – Apsley Court 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. There were 17 people receiving support with ‘personal care’ at the time of our inspection.

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.

This was the first inspection of the service. At this inspection we found breaches of regulations because people’s medicines were not safely managed, and because staff had not always completed training considered mandatory by the provider in order to keep up to date with current best practice.

We also found areas requiring improvement. Action had not consistently been taken to reduce the risk of incidents and accidents from recurring. Risks to people had been assessed, but staff had not always followed risk management guidelines to keep people safe. People told us there were sufficient staff on duty to meet their needs, but we found two examples of recent weekend shifts when staffing levels did not meet the service requirements based on the provider’s assessment of people’s needs. Staff received support through supervision, but night staff had not always been regularly supervised. The provider had systems in place to monitor the quality and safety of the service, but improvement was required to ensure medicines audits were effective in driving improvements.

People told us the service was well managed. Staff had mixed views about the management of the service and the changes that had been made since the provider took on the local authority contact to run the scheme. However, some of the changes they were concerned about had been implemented with a view to improving safety. Staff shared the provider’s vision in seeking to provider good quality care. The provider sought people’s views about the service and acted on their feedback.

People were protected from the risk of abuse because staff were aware of the types of abuse that could occur and the action to take if they suspected abuse. Staff followed safe practices in managing the risk of infection. The provider recruited staff safely.

People’s needs were assessed before they started receiving a service from the provider. People’s care was planned, in line with nationally recognised guidance. Staff sought consent from people when offering them support. 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. Staff supported people to eat and drink where this was part of their assessed needs.

People had access to a range of healthcare services to maintain good health. Staff worked with other agencies to ensure people received good quality, joined up care across different services. Staff treated people with care and consideration. People were involved in making decisions about their care and support. Staff treated people with dignity and respected their privacy.

People had care plans in place which reflected their individual needs and preferences. The provider had a complaints policy and procedure in place. People knew how to complain and expressed confidence that any issues they raised would be addressed. People’s end of life care preferences had been discussed and planned with them where they wished to do so.