Nottingham Supported Living (DCA) improved from Inadequate to Good across all five key questions, addressing previous breaches of Regulations 13, 17 and 18 through new management, enhanced training and stronger safeguarding oversight. Minor concerns remained around the detail of some risk assessments and care plans, which the provider amended during the inspection.
Concerns (2)
minor
Record keeping
: “a couple of care plans and risk assessments were reviewed, which lacked the details identified by the provider's audit”
minorCare planning: “Risk management procedures were not always effective. Some people's support plans and risk assessments were reviewed and amendments made.”
Strengths
· Significant improvements made since previous Inadequate rating, no longer in breach of Regulations 13, 17, or 18
· Safeguarding clinics held three times per week reduced safeguarding incidents significantly
· Staff received accredited training and additional clinical lead support for behaviour management
· New management structure (registered manager, operations manager, occupancy manager) improved oversight and staff morale
· Person-centred care with tailored Positive Behaviour Support Plans and respect for protected characteristics
Quality-Statement breakdown (20)
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies to provide consistent, effective, timely careNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Engaging and involving people using the service, the public and staff; Continuous learning and improving care; Working in partnership with othersNot rated
Nottingham Supported Living (DCA) deteriorated from Outstanding to Inadequate following a focused inspection, with three breaches of regulation covering staffing, safeguarding and good governance. People reported bullying and feeling unsafe, staff felt unsupported and under-skilled in managing challenging behaviour, and management oversight failed to identify fundamental care shortfalls, placing the service in special measures.
Concerns (13)
criticalSafeguarding: “There's bullying from other people, I've been hit, spat at, I feel frightened, I've threatened to self-harm, I sometimes call the police and have hit back too”
criticalSafeguarding: “The failure to ensure people were protected from abuse and having effective systems and processes to manage actual and allegations of abuse, put people at risk of harm.”
criticalStaffing levels: “Staff deployment in two supported living settings were identified as being unsafe, due to people's dependency and support needs. This had a negative impact on people's safety.”
criticalStaff competency: “staff feedback confirmed they did not feel sufficiently skilled or confident in some aspects of care. This included concerns in managing challenging behaviour and meeting associated mental health care”
criticalStaff training: “The failure to ensure staff deployment met people's individual care needs and safety, and staff were trained and supported effectively compromised people's safety.”
criticalIncident learning: “there was a lack learning to understand and manage incidents effectively and a lack of action post incident to support people's well-being.”
criticalGovernance: “the shortfalls in the fundamental care standards found during this inspection, had not been identified by the provider's internal checks.”
criticalLeadership: “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
moderateCare planning: “People's support plans and risk assessments were not always reviewed and amended in a timely manner following incidents.”
moderateMedication management: “people's medicine support plan, risk assessment and other additional care records were not fully detailed or consistent. This was confusing for staff”
moderateRecord keeping: “staff handover documents used to share information with staff about people's care and support needs were poorly completed. Information was limited impacting on staff ability”
moderateCommunication with families: “I have asked for a meeting with the manager, I have phoned and left messages, but they never got back to me.”
moderatePerson-centred care: “Improvements were required to ensure people were consistently supported to be involved in their care and support that maximised their choice, control and independence.”
Strengths
· Infection prevention and control best practice guidance was followed, with assurances around PPE, testing, shielding and outbreak management.
· Medicines were stored following best practice guidance and a sample stock check was correct; MAR records confirmed people received their prescribed medicines.
· People were supported to maintain their tenancy, with housing repairs reported and health and safety checks completed.
· The registered manager and provider met regulatory registration responsibilities of notifying CQC of reportable incidents.
· Information was made available in easy read to support people's communication and understanding.
Quality-Statement breakdown (9)
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Duty of candour and working in partnership with othersNot rated
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving care