One to One Plus South, a supported living homecare provider for people with learning disabilities and autism, was rated overall Good at its announced inspection on 30 January 2019, with Effective downgraded to Requires Improvement due to gaps in Mental Capacity Act compliance around liberty restrictions and inconsistent staff supervision recording. All other key questions remained Good, with particular strengths in person-centred care, specialist staff training, and responsive care planning.
Concerns (3)
criticalConsent / capacity: “staff and management were not fully aware of the need to ensure any restrictions on people's liberty were appropriately assessed and the correct authorisations in place via the best interests decision making process”
moderateSupervision / appraisal: “one staff member had no record of supervision but had completed an induction since they started work and two other staff had a record of only one supervision since July 2018”
minorRecord keeping: “staff did not follow the provider's procedure to record any medicines a person, or their relative, may take with them from a supported living service when people had an overnight stay”
Strengths
· Comprehensive risk assessments in place covering behaviour, personal care, moving and handling, eating and drinking, and community access
· Sufficient staffing levels maintained with 24-hour cover across all supported living services
· Strong person-centred care with individualised care plans reflecting needs, preferences and choices
· Excellent communication support including sign language training and accessible information formats
· Robust incident and accident review system with staff debriefs and action plans
Quality-Statement breakdown (18)
safe: Safeguarding procedures and risk managementGood
safe: Staffing levels and safer recruitmentGood
safe: Medicines managementGood
safe: Infection controlGood
safe: Incident learning and reviewGood
effective: Mental Capacity Act and Deprivation of Liberty Safeguards complianceRequires improvement
effective: Supervision and appraisal of staffRequires improvement
effective: Staff training and competencyGood
effective: Nutrition and hydration supportGood
effective: Health care needs and partnership workingGood
caring: Dignity, respect and person-centred approachGood
caring: Involvement in care decisions and promoting independenceGood
responsive: Care planning and needs assessmentGood
responsive: Accessible information and communication supportGood
responsive: Complaints handlingGood
well-led: Leadership, governance and quality assuranceGood
well-led: Engagement with people, families and staffGood
well-led: Partnership working with external agenciesGood
One to One Plus South was rated Good overall following a February 2016 inspection, with staff providing safe, personalised and caring support to 23 people with learning disabilities across three localities. The Well-Led domain was rated Requires Improvement due to unembedded improvement plans at the Brighton and Hove location, where prior concerns around medicines management, staffing and supervision were still being addressed.
Concerns (5)
moderateMedication management: “Areas that still needed to be embedded and sustained were around practice in medicines, staff supervisions and updating care plans and risk assessments.”
moderateGovernance: “In one of the localities there had been concerns that were being addressed via an action plan devised in partnership with the local authority. These actions needed to be embedded and sustained.”
moderateStaffing levels: “At one of the locations there had been significant concerns reported in relation to medicines management, staffing levels and staffing support.”
minorSupervision / appraisal: “At one location supervisions had not been as regular as at other locations. However a clear plan was in place to address this.”
minorCare planning: “Areas that still needed to be embedded and sustained were around practice in medicines, staff supervisions and updating care plans and risk assessments.”
Strengths
· People felt safe and spoke positively about staff relationships and the care provided.
· Robust medicines management systems implemented with annual staff competency assessments.
· Comprehensive, highly personalised support plans reviewed regularly and treated as live documents.
· Strong staff training programme including specialist PROACT-SCIPr-UK® and MCA/DoLS awareness.
· Staff knew people well, respected dignity and privacy, and supported meaningful community activities.
Quality-Statement breakdown (16)
safe: SafeguardingGood
safe: Medicines managementGood
safe: Risk assessment and incident managementGood
safe: Staffing levels and recruitmentGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Mental Capacity Act and DoLSGood
effective: Nutrition, hydration and healthcare accessGood
caring: Kindness, dignity and respect
Good
caring: Involvement in care decisions and choicesGood
responsive: Person-centred care planningGood
responsive: Activities and community engagementGood
responsive: Complaints handlingGood
well-led: Leadership and management oversightRequires improvement
well-led: Governance and quality auditingGood
well-led: Staff engagement and organisational cultureGood