We carried out an assessment of Zeno Ltd. This is a specialist supported living service used by people with a learning disability and autistic people. The date of assessment was the 28 October to 25 November 2024. The assessment included visits to the provider’s office and 5 properties, telephone calls to relatives of people using the service, as well as seeking and receiving the views of additional staff members following our site visits by way of emailed questionnaires. The assessment was completed to follow up on our previous inspection in August 2023, when we identified issues relating to seeking of consent, risk management, incident and accident process and governance. The service had made improvements and is no longer in breach of regulations. People received safe care which met their needs and wishes. Risks to people and the environment were assessed appropriately, with clear management plans in place. Incident and accidents were logged and reviewed, with lessons learned considered. People’s ability to consent was assessed and documented in their care files. Staff sought people’s consent prior to the provision of care. Regular audit and governance processes were carried out. Actions plans were used to monitor and drive improvements. Staff were recruited safely and enough staff were on shift each day to support people in line with their care plans. Medicines were managed safely, by staff who were trained to do so. Any restrictions in place, were appropriate and proportionate, and had been discussed with people, relatives and relevant professionals. The provider sought feedback, in a number of ways and used this feedback to develop the service. We have assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
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Zeno Limited, a supported living provider in Stockport, was rated Requires Improvement overall following an August 2023 inspection, with breaches of regulations 11, 12 and 17 identified in relation to consent/MCA compliance, risk management, and governance. Key failures included unlawful blanket restrictions on residents without MCA assessment, ineffective quality assurance systems, and a safeguarding referral omission, though medicines management, staffing levels, personalised care planning, and external partnership working were noted as strengths.
Concerns (9)
criticalConsent / capacity: “The provider was not working in line with the principles of the MCA. There was no evidence of consent to restrictions placed on people in some of the supported living houses we visited.”
criticalGovernance: “The provider's quality assurance systems and processes did not enable them to effectively assess, monitor and improve the quality and safety of the service.”
criticalSafeguarding: “We found 1 occasion the registered manager didn't inform the local safeguarding team of an allegations raised against a staff members conduct.”
moderateIncident learning: “Within some incidents it was not always clear what level of interventions were used due to the way incidents were recorded.”
moderateRecord keeping: “Some incident records were much more detailed than others, quality checks from the registered managers did not always identify this.”
moderatePerson-centred care: “People who required a level of observation was spoken about as being 'man-marked' and some incident records were not person centred when describing the incidents.”
moderateCare planning: “High-level restrictions had not been appropriately assessed in line with the MCA and were not included in people's positive behavioural support plans.”
moderateStaff training: “Although care staff and managers had received MCA training, we were not assured they always understood the principles of the MCA or recognise restrictive practices.”
minorOther: “We identified 2 staff files where thorough employment histories had not been recorded.”
Strengths
· Medicines were managed safely, stored appropriately, audited regularly, and staff demonstrated knowledge of STOMP principles.
· Staff had the skills and training to support people effectively, including specialist accredited challenging behaviour and positive behaviour support training.
· People's care plans were personalised and reflective of their needs, with access to a community outreach college promoting independence.
· Staff had warm, respectful relationships with people and communicated in a dignified and peer-like manner.
· The provider responded promptly to inspection concerns, immediately remediating environmental hazards and removing peep holes.
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careGood
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: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive person-centred, open, inclusive and empowering cultureRequires improvement
well-led: Working in partnership with othersGood
well-led: How the provider understands and acts on the duty of candourGood