Allerton C&S N Limited

Wave Supported Lives Ltd offers personal care only as a domiciliary care service. They support younger people living in their own home with a learning disability, physical disability or sensory impairment. The main office is based in a business park near Blackpool Airport. At the time of our inspection, the service supported five people who received a regulated activity in their own homes.

People’s experience of using this service:

We found the management team had completed extensive processes since our last inspection to enahnce safety. People and their relatives confirmed they experienced a responsive service and felt safe when staff delivered their care packages. A relative told us, “Now, I really do feel I can take a step back because I know [my relative] is safe and I can finally relax after all these years.”

The registered manager had introduced multiple documents focused on maintaining people’s safety and protecting them from inappropriate care and abuse. One staff member said, “Any concerns at all, and there have been, we are strongly advised to report.”

The management team had developed detailed, person-centred risk assessments to better support people with behaviours that challenged the service. A relative commented, “[My relative] is improving and that’s down to the staff and the care plans in place.”

The registered manager had implemented new systems to ensure they recruited staff safely and followed robust employment practices. People were supported by small staff teams to ensure they received care from regular staff who understood their needs.

Staff told us they followed procedures to ensure the safe management of medicines administration. The registered manager had worked with other healthcare professionals to develop robust protocols for people who received ‘when required’ medication.

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. A staff member said, “It is absolutley [the person’s] decision about what he wants to do. We don't use restraint, we use distraction and avoidance of triggers.”

The management team completed an initial assessment of each person’s nutritional requirements to protect them from associated risks.

Wave had a wide-ranging training programme to develop staff skills and understanding of their roles. A relative told us, “They do seem to be well-trained and they try different things to see what works and what doesn't.”

Staff demonstrated genuine affection and kindness for people they supported. One person stated, “I love the staff and they love me.” People and relatives told us the management team was highly inclusive of them in the development of their care plans.

Wave had strong leadership evidenced in the actions taken since our last inspection. The provider worked openly with people, staff and other organisations to deliver good standards of care. Staff stated they were fully involved in the ongoing development of the service and felt valued by the providers. One staff member commented, “All the managers and [the providers] are fantastic.”

The principles and values of Registering the Right Support and other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes that include control, choice and independence. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support. We observed care practices were centred on maximising each person’s safety, independence and support. Care records included each person’s preferences and details guided staff to better understand them and how to meet their needs.

Rating at last inspection and update:

At the last inspection the service was rated requires improvement (published 25 December 2018).

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This inspection was carried out to follow up action the provider told us they had taken to improve the service in all five domains.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

A registered manager was in place. 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.

Waves registered as a new service on 29 November 2017. Consequently, this was their first inspection.

This service is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to people of all ages. Waves also provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing were not always provided under separate contractual agreements. However, we saw the provider was acting to ensure housing was provided under a different agreement so that people’s independence could be optimised. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The care service was not always 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 did not consistently live as ordinary a life as any citizen.

During this inspection, people and relatives we spoke with confirmed they felt safe whilst using the service. However, we found the management team failed to continuously ensure people were not exposed to the risk of harm. There were multiple incidents where they used physical intervention without legal authorisation. Records we looked at identified disproportionate management of behaviours that challenged the service. This placed individuals at risk of unsafe and inappropriate care because staff could not be assured they employed permitted, correct and safe measures.

People were not always supported to have maximum choice and control of their lives and staff did not consistently support them in the least restrictive way possible. The policies and systems in the service did not reflect important up-to-date guidance to inform staff practices. There was no accurate oversight and monitoring of behaviours that challenged the service. Consequently, the registered manager could not effectively identify clear triggers, successful support actions and improved outcomes. Care records did not include effective, evidence-based best practice to diffuse escalating behaviours.

You can see what action we told the provider to take at the back of the full version of the report.

The registered manager completed detailed risk assessments to guide staff about protecting people from unsafe care in their own homes. However, we found staff and the management team did not always follow risk assessments fully through in the management of behaviours that challenged the service. Unauthorised restraint was used on multiple occasions with no management strategies or monitoring systems to achieve safe outcomes. The management team failed to do all that is reasonably practicable to mitigate risks to maintain people’s safety.

You can see what action we told the provider to take at the back of the full version of the report.

When we reviewed the provider’s recruitment procedures, we found DBS checks and references had been acquired after staff started in post. We saw there were gaps in records and reasons for leaving had not been fully explained. Where staff pre-employment checks identified risks, the registered manager had not implemented measures to mitigate them. These practices exposed people to the risk of unsafe care because the management team failed to ensure the safe recruitment of suitable staff.

You can see what action we told the provider to take at the back of the full version of the report.

We found there was no clear process from pre-assessment to care plan development, monitoring and review. Behaviour management plans were particularly poor because staff guidance only covered when people were at crisis point. Consequently, treatment responsiveness and outcomes could not be properly measured to assess their impact on people. The management team failed to consistently maintain quality records to guide staff responsiveness to people’s needs.

The continued safety and wellbeing of everyone at the service could not always be assured because the management team did not have clear oversight. Audits were not completed regularly and they failed to consistently follow their policies and procedures. Protocols were missing, such as recruitment risk assessments, and did not always follow current national guidelines.

You can see what action we told the provider to take at the back of the full version of the report.

We reviewed the administration of people’s medicines in their own homes and noted these were stored safely. People said they received their medication on time and as prescribed. However, the management team had not always followed good practice in safe medicines administration. This was because protocols to guide staff about the use of ‘when required’ medicines were not in place.

We have made a recommendation the provider seeks guidance about safe medicines administration.

Staffing levels to meet each person’s requirements had been assessed and were sufficient to ensure a safe and timely approach. The management team strengthened staff skills and support through training and supervision. A staff member said, “I feel well-trained and able to carry out my duties. The managers are very good at making sure we get the training we need.”

The registered manager developed care planning with people and their relatives to reduce the risk of malnutrition. Information, including details about diet and healthy eating, assisted staff to understand each person’s nutritional requirements.

Staff demonstrated a good understanding of supporting people with diverse needs. Support planning was personalised and focused on retaining people’s independence. Care records held good levels of guidance to help staff understand and manage people’s privacy. The management team endeavoured to include people and their relatives in the development of their care plans. A staff member stated, “This is my second home and I am really pleased to see how much [the person] has progressed along the way.”

Throughout our inspection process, we found the provider was keen to work closely with CQC and other health and social care services to improve. People and their relatives responded positively in satisfaction surveys about their experiences of using Waves. Staff said they felt there was good communication and the management team encouraged them to share ideas and good practice.