Foxglove Supported Living Limited was rated Good overall at its March 2020 inspection, with consistently Good ratings across all five key questions. Minor shortfalls were identified in medication record-keeping, consent documentation and governance audit systems, all of which the manager committed to addressing promptly.
Concerns (4)
moderate
Medication management
: “Medication monitoring systems had not identified or addressed all shortfalls. Systems had not identified some hand-written medication records had not been signed by two staff”
moderateRecord keeping: “Audits had not identified the shortfalls we found during the inspection, which included medicine and decision-making records.”
minorConsent / capacity: “Some decisions had been incorrectly recorded as best interest decisions. We discussed processes for appropriately recording these decisions with the manager.”
minorGovernance: “The provider had developed a new governance system to promote quality and consistency across their services. We were informed the system would be implemented following the inspection.”
Strengths
· People were kept safe from avoidable harm and abuse, with staff knowledgeable about risk management and positive behaviour support plans.
· People chose which staff supported them and when, with consistent small staff groups promoting continuity of care.
· Staff were kind, caring and had developed strong positive relationships with people, respecting their individuality and rights.
· People were supported to access a wide variety of meaningful activities and maintain relationships with family and friends.
· People's healthcare needs were met in a timely way, with effective collaboration with relevant professionals.
Quality-Statement breakdown (21)
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
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 care; Supporting people to live healthier livesGood
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: Supporting people to develop and maintain relationships to avoid social isolation; support to follow interests and activitiesGood
responsive: Meeting people's communication needsGood
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, understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staff; Continuous learning and improving careGood
Foxglove Supported Living Limited received a Good rating across all five key questions at its first inspection since registration in February 2016, demonstrating safe, person-centred care for nine people with learning disabilities, autism and/or physical disabilities. Minor shortfalls were noted in the recording of quality audits and management visit reports, which the operations manager committed to address.
Concerns (3)
minorRecord keeping: “some of these had not been recorded. The service would benefit from recording all results of audits and developing action plans in order to learn and develop.”
minorGovernance: “The visits took place on different days and at different times. They checked records, observed care support...These visits had not been reported upon.”
minorPerson-centred care: “The care records would benefit from including more pictorial information to better enable people's involvement.”
Strengths
· Robust recruitment procedures including DBS checks and reference verification ensured staff of appropriate character and skills.
· Medicines managed safely with correct MAR balances, secure storage, timely ordering and weekly checks by team leaders.
· Consistent staff teams allocated to each person, fostering familiarity, confidence and strong rapport.
· Staff received a comprehensive range of training tailored to individuals' health conditions, including autism and epilepsy.
· Person-centred support promoted independence, community access and involvement in care planning and daily choices.
Quality-Statement breakdown (15)
safe: Safeguarding adultsGood
safe: Medication managementGood
safe: Risk assessment and managementGood
safe: Staffing levels and recruitmentGood
effective: Staff training, supervision and appraisalGood
effective: Nutritional needsGood
effective: Access to healthcare professionalsGood
effective: Mental Capacity Act / consentGood
caring: Dignity, respect and person-centred interactions
Good
caring: Maintaining relationships and independenceGood
responsive: Care planning and reviewGood
responsive: Activities and community involvementGood