Elderberry Mews and Mulberry Court

Elderberry Mews and Mulberry Court is a supported living service providing personal care to three people at the time of the inspection. The service is split into two units known as Elderberry Mews and Mulberry Court.

People receive personal care in their own self- contained flats which are all in one building where the offices are situated. Many people received 24 hour care and support.

Not everyone who used the service 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. The service was supporting three younger adults living with a learning disability, autistic people and mental health needs.

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

Whilst people’s care plans were in the most part detailed we found improvements were needed to ensure they contained all the relevant details to support people safely.

We found that there had been improvements made around the quality and safety of the service following our last inspection. However, we identified additional areas that needed further improvement and that the new systems introduced needed to become embedded into practice.

People were supported by staff who had received training around safeguarding and knew the appropriate action to take should they have concerns. Staff were recruited safely.

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 felt well supported in their roles and told us they received appropriate training and supervision.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. Staff we spoke with knew people and their needs well and told us of recent achievements people at the service had made. We received mixed feedback from relatives about the culture of the service.

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

Rating at last inspection

The last rating for this service was requires improvement (Published 26 February 2020). We found a continued breach of regulation 17 which relates to how the service is monitored for quality. We placed conditions on the providers registration for monthly reports. At this inspection we found that improvements had been made. However further areas of improvement were identified, and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This inspection was prompted in part by concerns we received. We received concerns in relation to meeting people’s needs, concerns with staff competency, concerns around the effectiveness of the management of the service and Infection prevention and control concerns. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

We have found the service needs to make improvement. Please see the safe and well led sections of the report. You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Elderberry Mews and Mulberry Court on our website at www.cqc.org.uk.

Follow up

We will request an action plan for 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.

Precious Homes Limited provides personal care to people in their own homes within a supported living setting in18 self-contained flats. The flats are split into two units known as Elderberry Mews and Mulberry Court. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. The service provides personal care to younger adults who have learning disabilities, autistic spectrum disorders or mental health needs. At the time of the inspection there were four people receiving personal care at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People did not consistently receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

At this inspection in December 2019 we found some improvements had been made and people were now supported by s regular staff team with the use of agency staff reduced to a minimum. A new management team was also in place and a new management structure had been introduced by the provider to provide greater support to the individual units across the provider organisation.

However, we found that further improvements were required. At our last inspection we found the provider's systems and processes were not always effective to asses, monitor and improve the quality and safety of the service. This was a breach of regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found although some improvements had been made, further improvements were required to ensure all provider systems are fully embedded to support the continued development of the service. The provider remains in breach of regulation 17.

We found we found that the systems to monitor and maintain a managerial overview of the service were ineffective. There was no evidence of care plan audits; therefore, the provider processes had failed to identify that when a specific incident had occurred, care records had not been reviewed to ensure that appropriate guidance for staff was in place to mitigate the risk of the incident occurring again.

Provider processes had failed to identify that staff had not received the training required to meet the needs of the service users they supported, and the providers staff supervision matrix showed supervisions and probation reviews had not been carried out in line the providers stated timescales.

The provider had made a number of changes to strengthen the management team of the service. Staff said the service and the care provided had improved since the last inspection and they felt listened to and that management team were approachable and supportive.

Staff had training in safeguarding people from abuse and understood the different types of abuse people may be subject to. Since the last inspection the provider had completed a monthly report for all incidents which was reviewed by the provider’s operational manager.

Staffing had improved, and people were now supported by a core staff team. However, specialist training was required to support people who were living with very complex care needs. For example, specialist training to support people who may be at risk of self-harming or training to support people with anxiety disorders or depression.

People had developed good relationships with the staff that supported them. People were privacy was respected and staff promoted people’s independence.

People were supported to have choice and control over their care and to receive care in their preferred way. Information was available to people in different formats. Staff supported people with their individual communication systems to share information.

Relatives told us they felt involved in people’s care and were able to raise any concerns they may have and overall, they felt the management team were responsive to concerns.

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

Rating at last inspection.

The last rating for this service was Inadequate (inspection date 8 and 9 August 2019). There were breaches of regulation and a warning notice was issued to the provider stating governance arrangements needed to improve. 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 improvements had been made. The provider was no longer in breach of two regulations, but further improvements were required in the management of the service and provider processes need to continue to be embedded into the services' routine practices. The service remains in breach of regulation 17 Good Governance.

Why we inspected.

This was a comprehensive inspection based on the enforcement actions taken following the last inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Elderberry Mews and Mulberry Court on our website at www.cqc.org.uk.

Enforcement

We have identified a continued breach of regulation in relation to good governance arrangements for monitoring the care provided at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Precious Homes Limited provides personal care to people in their own homes within a supported living setting in18 self-contained flats. The flats are split into two units known as Elderberry Mews and Mulberry Court. Each flat consists of a bedroom, lounge, kitchen and bathroom. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. The service provides personal care to younger adults who have learning disabilities, autistic spectrum disorders or mental health needs. At the time of the inspection there were five people receiving personal care at the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. The outcomes for people did not fully reflect the principles and values of Registering the Right Support. People did not consistently receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

At this inspection in August 2019 we found serious concerns about the management of people’s medicines. Medicine errors were not identified, or action taken to mitigate risks. This exposed people to actual harm. People had been subjected to unsafe staffing levels and inadequate care and support. Incidents were not consistently recorded, monitored or reviewed to improve people’s safety. Actions to support people with their behaviour had not been identified to reduce risks to their safety. Allegations of harm or abuse were not always recognised, investigated or referred to external agencies, to promote people’s safety at the time they occurred.

Staff had not received training and support and their competencies were not checked to ensure they worked to the required standards and were able to meet people’s needs. People had access to a variety of healthcare support. However, this was not coordinated in a timely way to ensure people new to the service had access to a GP. People were supported to have maximum choice and control of their lives. Staff knew how to support people in the least restrictive way possible and in their best interests.

People were relatively new to the service and their support plans were still at the development stage as staff began to understand people’s needs and preferences . People and their relatives were being involved in this process. People had not always received care from staff they were familiar with, this had affected the consistency of care they received. Relatives said people had not always been well supported, with a lack of consideration for peoples’ diverse needs.

The provider had made some recent changes to how the service was managed and led this meant that people’s needs had started to be responded to with more consistency. Relatives stated they were happy with the improvements that were being made to staffing levels, and skills mix. Relatives described individual staff as caring and could see that positive relations with people were developed with the regular staff.

Relatives had felt their concerns and complaints were not always listened to or acted upon. However, they were confident with the new management team in place and the level of consultation they were currently having.

The provider's quality assurance system failed to identify that care and treatment was not provided in a safe way or that this newly registered service was adequately resourced to meet people’s needs. Audits did not identify serious concerns with medicine management, staffing levels and skills and the management of incidents and risks.

The provider had undertaken an analysis of incidents and a lessons learnt report. A review of incidents to identify safeguarding concerns had taken place, with retrospective safeguarding referrals made. The provider had acted on their duty of candour and shared information about the current issues within the service with people who used the service.

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

This service was registered with us on 28/03/2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about unsafe medicines management, staffing levels, and concerns shared with us about people’s care. A decision was made for us to inspect and examine those risks.

Due to unforeseen circumstances there was a delay in the report being completed and published following inspection and a further inspection visit has taken place. For more details, please see the most recent report which is on the CQC website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to medicine management, staffing levels, training and staff supervision, and good governance arrangements for monitoring the care provided at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement

procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.