Aspire Supported Living improved from Requires Improvement to overall Good at this October 2019 inspection, with people receiving safe, effective, caring and responsive support. Well-led remained Requires Improvement due to governance systems still being embedded, incomplete medicine audits, inaccessible care records at head office, and inadequate analysis of feedback surveys.
Concerns (6)
moderate
Record keeping
: “People's care and support plans or personal information was not easily accessible to the management team at their head office.”
moderateGovernance: “Audits and checks were completed. Some improvements were required, including those in connection with monitoring medicines as they were not fully implemented.”
minorMedication management: “Medicines were generally managed safely, although we did find some recording issues.”
minorIncident learning: “The information was not always recorded on the providers IT systems for management to fully monitor as there had been a change in IT processes.”
minorPerson-centred care: “Outcomes were not always recorded fully or reflective of support or opportunities provided.”
minorCommunication with families: “Surveys were not fully analysed, or feedback recorded. We discussed this with the registered manager who said this was going to be addressed.”
Strengths
· People felt safe and staff were trained in safeguarding; safeguarding policies and procedures were in place and issues dealt with appropriately.
· Sufficient staffing levels maintained with safe recruitment processes; visits monitored to ensure people received care calls on time.
· Staff treated people with warmth, kindness and respect, upholding privacy, dignity and independence.
· Care and support plans reviewed monthly; people's needs assessed prior to using the service.
· People supported to access healthcare professionals, community activities and maintain family ties.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
Aspire Supported Living was rated Requires Improvement overall at its first inspection since re-registration in July 2017, with Safe, Effective, and Caring all rated Good but Responsive and Well-Led requiring improvement. Key concerns centred on outdated and inconsistent care records, gaps in risk assessments, sole reliance on e-learning for training, and a quality assurance programme that failed to identify the issues found at inspection.
Concerns (7)
criticalCare planning: “Risk assessments were not in place for all identified risk...such as for the management of epilepsy or self-harm.”
moderateRecord keeping: “records contained a range of historical and current information which did not all show they reflected people's current support needs”
moderateCare planning: “Some support plans showed they had been written in 2014 or 2015 and they did not all show they had been up-dated since then to accurately reflect people's current needs.”
moderateGovernance: “the audits had not identified areas of improvement identified at inspection”
moderateSafeguarding: “A safeguarding log was in place...it did not include that the safeguarding team had been notified, who was investigating the incident where required and the outcome of the safeguarding.”
moderateStaff training: “all training was provided by e-learning. This meant staff did not receive face-to-face training for courses with a practical element such as for fire training and moving and assisting.”
moderateStaffing levels: “if a member of staff called in sick it meant the member of staff was unable to go off duty after spending 72 continuous hours on the premises as no other members of regular staff may be available”
Strengths
· People consistently reported feeling safe and expressed satisfaction with the care and support provided by staff.
· Detailed behaviour management support plans were in place and regularly updated for people with distressed behaviours.
· Staff received regular supervision and appraisal and felt well supported by the management team.
· People were supported to live independently, make choices about their daily lives, and engage with community activities.
· Medicines management included staff training and periodic competency checks with management audits.
Quality-Statement breakdown (18)
safe: SafeguardingGood
safe: Risk managementGood
safe: Staffing levelsGood
safe: Medicines managementGood
safe: RecruitmentGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Mental Capacity Act / consentGood
effective: Nutrition and health care access
Good
caring: Person-centred care and dignityGood
caring: Involvement in care decisionsGood
caring: Communication with familiesGood
responsive: Record keeping and care planningRequires improvement
responsive: Activities and community engagementGood
responsive: Complaints handlingGood
well-led: Governance and quality assuranceRequires improvement