We carried out a review of the data available to us about Living Ambitions Limited - Essex on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Living Ambitions Limited - Essex, you can give feedback on this service.
About the service
Living Ambitions Limited - Essex is a supported living service providing personal care to approximately 64 people in 23 addresses. Support is primarily provided to people with learning disabilities and autistic people. People live in individual flats and shared houses.
People’s experience of using this service and what we found
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right Support
Although some people were supported by staff to pursue their interests, not everyone was enabled to achieve their individual aspirations and goals. The registered manager was working effectively to improve this and ensure people received consistently personalised support.
There was a new registered manager since our last inspection who had made changes in the service to ensure people received safer care.
Staff supported people to have the maximum possible choice, control and independence and have control over their own lives. People had the support they needed to make decisions following best practice in decision-making.
People accessed specialist health and social care support in the community. Staff supported people to play an active role in maintaining their own health and wellbeing.
Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome.
Right Care
Staff spoke respectfully about people and treated them with compassion. Staff respected people’s privacy and dignity. They understood and responded to people’s individual needs.
The service had improved how it worked with other agencies to protect people from the risk of abuse. There were improved systems to ensure effective investigations took place and actions were taken, where required. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it.
There had been a turnover of staff as the registered manager was focusing on building a stronger and more caring staff team. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.
People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
People’s care and support plans reflected their range of needs and this promoted their wellbeing. There was an ongoing programme to improve care plans to ensure they gave guidance to staff about how to continually enhance people’s lives. People and those important to them, were involved in planning their care.
Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.
Right culture
The registered manager had restructured the management team. As part of the changes, local managers were more visible. This helped reduce the risks of closed cultures. The management team were passionate about creating a culture where people’s wishes, needs and rights were at the heart of the service.
The leadership of the service had worked hard to create a learning culture where the whole organisation had a role in improving the support people received. People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.
Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. The registered manager had introduced improved checks on safety and the quality of care. There were new systems to ensure the registered manager and provider had better oversight 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 and update
The last rating for this service was requires improvement (published 30 April 2020).
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 undertook this inspection to assess that the service is applying the principles of Right support, right care, right culture and to follow up on action we told the provider to take at the last inspection.
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.
As there is a separation between the care and accommodation, the care they receive is regulated by the CQC but the accommodation is not. On the day of our inspection, 113 people were using the service across 28 locations, but not everyone was receiving a regulated activity. Some of the people using the service had complex needs and the frequency of the care and support depended on people's individual requirements.
Supported living
People receiving supported living services rented accommodation separately from the care that was provided by the service. These were small shared houses and bungalows. Where care staff were required to remain at the service overnight, they were provided with appropriate sleeping arrangements.
People’s experience of using this service and what we found
The registered manager had not always identified incidents and accidents that were safeguarding concerns and had not always followed safeguarding policies and procedures.
Incidents had not always been investigated thoroughly and we found little evidence that there had been lessons learnt from them.
The service had experienced a high use of agency staff at some of the supported living sites and staff told us this had made providing consistent care difficult. Whilst we did not review all 28 locations, for those staff we spoke to they told us that people had missed out on opportunities due to shortages of staff. However, the provider had implemented processes to reduce agency staff and recruit regular staff. At the time of inspection this area was improving.
Medicines were managed safely and staff were trained and observed to ensure that they remained competent.
People with high risk needs, such as risk of choking had robust risk assessments in place and staff followed these. However, not all risk assessments were up to date and some were no longer relevant to people’s current needs. The service was in the process of driving improvement in these areas.
Managers were working on improving people’s involvement in how the service was run in line with best practice guidance.
Staff supported people to access a range of health and social care appointments to ensure that they remained healthy. They sought advice from other health professionals if they had any concerns over people’s health and wellbeing.
People who needed support with fluid and nutritional needs were supported well.
Staff understood the importance of capacity and consent and people being able to make decisions about how they lived their lives.
Staff were caring and supported people to maintain their independence. Where staff had been found to be uncaring, managers had taken the appropriate action.
People were supported to maintain important relationships. However, it was not always clear how people had been involved in planning their care.
People did not always receive care that was person centred due to a period of high agency use. However, in areas where there had been regular sustained staff group people did receive care that supported them to live well every day. This was an area that was improving.
The provider had processes in place for people to raise complaints. This was in easy read format. The registered manager investigated complaints in line with the providers policy and procedures.
The service provided end of life care. At the time of inspection one person was receiving end of life care.
Staff told us they did not always feel supported or listened to by senior managers.
Governance systems did identify some areas of improvement needed, but improvements were slow and there was a lack of identifying lessons learnt. Governance systems did not identify all the concerns we found at this inspection.
The registered manager had not always notified the Commission of notifiable incidents.
However, the service had open and transparent relationships with commissioners, the local authority quality improvement and safe guarding teams.
People were supported in the least restrictive way possible and inline their best interests. The policies. and systems in the service supported this practice.
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 good (published 6 May 2016)
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified breaches in relation to the provider notifying the Commission of notifiable incidents, safeguarding people from harm and ensuring that risks to people’s health and wellbeing were identified and mitigated. Governance process in place failed to identify these shortfalls over a twelve-month period.
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 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.
The service had a registered manager in post. 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 and associate Regulations about how the service is run.
The service is registered for the provision of personal care in people's own homes. This includes assistance or prompting with washing, toileting, dressing eating and drinking. We call this type of service a 'supported living' service. The service also provided other forms of support such as shopping and assistance to access the community.
Some of the people's accommodation was provided by separate landlord, usually on a rental or lease arrangement. The service was solely responsible for the provision of the support service and not for the provision of the premises. This meant people could choose an alternative service provider if they wished. People who used the service had a wide range of support needs, ranging from mild to severe learning disabilities. Some of the people had very complex support needs and required support from the service 24 hours a day. Other people were more independent and received support for just a few hours a day to help with their daily routines.
People were safe and staff knew what actions to take to protect them from abuse. The provider had processes in place to identify and manage risk.
People received care from a consistent staff team who were well supported and trained.
Care staff understood the need to obtain consent when providing care.
The provider had systems in place to support people to take their prescribed medicines safely.
People were supported with meals and to make choices about the food and drink they received. Staff supported people to maintain good health and access health care
professionals when needed.
Assessments had been carried out and personalised care plans were in place which reflected individual needs and preferences.
The provider had an effective complaints procedure and people had confidence that concerns would be investigated and addressed.
The service benefitted from a clear management structure and visible leadership. A range of systems were in place to monitor the quality of the service being delivered and drive improvement.