This announced inspection took place on 06 and 07 February 2018 and 12 and 13 February 2018.

This service provides personal care and support to adults living in ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection only looked at people’s personal care. This supported living service meets the needs of people with learning disabilities, autism or people with more complex health needs such as epilepsy. At the time of this inspection there were 24 people receiving personal care. The service is run from an office in New Romney.

A registered manager was not employed at the service. However, the provider’s regional manager had applied to register as the manager and was available to support the inspection process. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Craegmoor Supporting You in the South East Services was placed in special measures in December 2016. [Services that are in special measures are kept under review and inspected again within six months.] We expect services to make significant improvements within this timeframe. The last inspection report for Craegmoor Supporting You in the South East was published on 05 September 2017, with an 'Inadequate' rating following a comprehensive inspection, which took place on 28, 29 and 30 June 2017 and 03 July 2017. At that inspection, although we found improvements, we found six breaches of the legal requirements set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to Regulation 9, Person centred care; Regulation 12, Safe care and treatment; Regulation 13, Safeguarding service users; Regulation 16, Receiving and acting on complaints; Regulation 17, Good governance; Regulation 18, Staffing. Due to these breaches we used our regulatory powers by imposing conditions on the provider’s registration and this service remained in special measures.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The provider had restructured the management of this supported living service from a centralised model to a localised model. This had facilitated improved operational and quality management oversight by the deployment of an experienced regional manager to take day-to-day charge of this service. The regional manager had been supported to make significant improvements in the last six months by an experienced senior quality improvement manager. These changes had assisted the provider to meet the Regulations set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The regional manager and the provider had demonstrated a desire to improve the quality of the service for people with a learning disability by listening to feedback, asking people their views and improving how the service was delivered. People, their relatives and staff felt that the service was now well led. They told us that the management understood people’s needs, were approachable and listened to their views. The service commissioners told us that the service had improved. The provider and regional manager continued to develop business plans to further improve the quality of the service.

The regional manager had involved people in planning their care by re-assessing their needs based on a person centred approach. Care management reviews had taken place and in some cases, people were now receiving higher le

The inspection took place on the 28, 29, 30 June and 3 July 2017, and was announced. We gave '48 hours' notice of the inspection, as this is our methodology for inspecting domiciliary care agencies.

Craegmoor Supporting You in The South East provides personal care and support to adults in their own homes. It provides care in five separate locations where people share a home together; and an outreach services to people that live alone. The service provides care and support for people living with a learning disability; it is registered to provide personal care. At the time of this inspection 23 people were receiving the regulated activity of personal care from the service.

The service did not have a registered manager; A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. There had been several changes of management over the past year, a new manager had been appointed in May 2017 and was present throughout the inspection, they were in the process of applying for their registration with The Commission. They were being supported by a senior manager who had provided support to the service since May 2017.

The service was last inspected in November 2016 where five breaches of our regulations were identified. The safe and well led domains were rated as inadequate and an overall rating of inadequate was given at that inspection. The breaches of regulation related to person centred care, risk assessments, reporting of accidents and incidents, safeguarding, staffing and training. We took enforcement action and required the provider to make improvements. This service was placed in special measures. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us regular information and records about actions taken to make improvements following our inspection. At this inspection we found that although improvements had been made in some areas, other significant problems had emerged and some new breaches were identified.

People had not been protected from harm, concerns about their safety had not always been listened to and incidents had gone unreported. One person told us they were frequently bullied by another person. The provider's processes for recording and responding to safeguarding incidents were not robust. Some incidents had not been reported to the correct professional bodies for further investigation and the provider had been unaware about some of the incidents we found during our visit.

There were not enough staff to protect people from harm or support them in a way which met their needs. During the inspection a person was asked to keep an eye on another person who was distressed so the staff member could seek guidance from another member of staff. People did not always receive all of their one to one hours of support; this meant they had been restricted in going out to pursue their outside interests.

People’s health had been placed at risk. Staff did not have a good understanding of how risk should be minimised and the provider had been unaware about the assistive technology a person should use to monitor their seizures. Peoples health needs had not always been well monitored of responded to.

Concerns and complaints had not always been responded to or recorded well. A relative said they had raised concerns but had not received a response from the provider.

Staff had not received all of the necessary training to support people with their individual needs. Since the new manager had been appointed staff fedback supervisions and the support they received had improved.

People had choice around their meals. Staff

The inspection took place on the 7 and 9 November 2016, and was announced. We gave '48 hours' notice of the inspection, as this is our methodology for inspecting domiciliary care agencies.

Craegmoor Supporting You in The South East provides personal care and support to adults in their own homes. It provides care in six separate locations where people share a home together; and an outreach services to people that live alone. The service provides care and support for people living with a learning disability; it is registered to provide personal care. At the time of this inspection 31 people were using the service. 25 people lived in shared accommodation and six people lived alone in their own home. The number of people using the service had increased since the last inspection. Two of the shared homes were formally residential services within the providers group; they had de-registered in July 2016. People from these homes now received support with their personal care from Craegmoor Supporting You in the South East.

The service had a registered manager; however they no longer worked at the service and were in the process of de-registering. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The regional manager was managing the service until a new manager was employed.

The service was last inspected in February 2016 where eight breaches of our regulations were identified. The safe domain was rated as inadequate and an overall rating of requires improvement was given at that inspection. The breaches of regulation related to notifications of incidents, person centred care, obtaining peoples consent, medicines, risk assessments, safeguarding, recruitment, leadership and staffing. The provider had made minor improvements, but more were needed in a number of areas, and not enough improvement had been made regarding keeping people safe and the management and leadership of the service. We found some new breaches of our regulations at this inspection.

The provider could not demonstrate that when risks had been identified measures had been put in place to reduce the likelihood of repeating incidents. Risk assessments had not been updated or implemented when people had been put at risk or suffered harm.

The provider’s processes for recording and responding to safeguarding incidents were not robust. Some incidents had not been reported to the correct professional bodies for further investigation.

People did not always receive all of their one to one hours of support; this meant they had been restricted in going out to pursue their outside interests.

The provider had not always appropriately checked new staff were competent to complete their roles effectively before allowing them to work alone. Agency staff worked alone with people and had not been given enough information to understand their individual needs which impacted on the care that was provided. Staff did not have clear guidance to support people with their individual behaviour needs, this left people and staff at risk of harm.

Some staff training had lapsed or had not been completed. This meant people were not supported by staff who had the most up to date knowledge and skills to meet their needs. Staff had not received regular supervision to support their roles. The provider could not be assured that people were being supported well by staff as competency checks had not been conducted to assess this.

Peoples care plans did not always contain up to date information regarding their health needs, people had not been supported well with their weight management. People had been supported with the management of their other health needs such as attending outside health care appointments.

Staff

The inspection took place on the 12, 15 and 16 February 2016, and was announced. We gave ‘48 hours’ notice of the inspection, as this is our methodology for inspecting domiciliary care agencies.

Craegmoor Supporting You in The South East provides personal care and support to adults in their own homes. It provides care in four separate locations where people share a home together; and an outreach services to people that live alone. The service provides care and support for people living with a learning disability; it is registered to provide personal care. The service was last inspected in November 2013 and had met our standards of compliance. At the time of the inspection 22 people were using the service. 15 people lived in shared accommodation and seven people lived alone in their own home.

The service had a registered manager; however they no longer worked at the service and were in the process of de-registering. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A new manager was in the process of registering with the Commission and was present on all three days of the inspection.

The service had not safeguarded people from abuse. Several incidents had not been reported to the local authority for investigation or notified to the Commission. The provider had been unaware about the incidents until raised by the inspectors. Since the new acting manager had been in post safeguarding incidents had been reported following the correct processes to protect people from further harm.

Risk assessments had not been updated or introduced when people or others had been put at risk or suffered harm. The provider could not demonstrate that when risks had been identified additional measures had been put in place to reduce the likelihood of repeating incidents.

The provider’s systems for reporting, recording and responding to accidents and incidents were ineffective. The provider had been unaware about numerous incidents where people had been placed at risk. When staff had reported incidents they had not been acted on appropriately by the management team.

People were not benefiting from staffing, which was flexible to their preferences and support needs, but were dependent on the availability of staff. At a location where people shared an environment insufficient staff numbers were deployed from Monday to Friday after 2:00pm. This impacted on the freedom people had to leave the service and when they could receive support with their personal care.

Staff had not completed their essential training before working alone. The provider had not checked staff’s competency in their ability to work alone safely. Not all staff had received specialised training to support people with their individual needs. Staff lacked understanding and knowledge around fundamental areas, which were necessary to keep people safe, for example, safeguarding, diabetes and epilepsy.

Staff recruitment files lacked some information, which is a requirement of the regulations and needs to be obtained to ensure people are kept safe. This included photographs, exploration into employment gaps, reasons for the termination of previous employment and suitable references.

The provider was not fully complying with The Mental Capacity Act 2005. Restrictions had been placed on people, which had not been assessed as the least restrictive option available and best interest meetings had not taken place in line with the Act. Understanding around this important area was lacking.

The service was inconstant in meeting people’s health needs. Some people had been supported well when they required specialist help with their health needs; other people had not been supported when deterioration in their hea

At the time of the inspection six people were receiving personal care from the service. We visited a flat that was shared by four people who used the service and telephoned one person who used it. We also telephoned a social care professional who supported some people who used the service and spoke with two members of staff.

We saw that people made decisions about how their care and support was provided and had been consulted about their views and preferences. People had been involved in developing their own care plans and involved in regular reviews of their support.

People received the support they needed at the right time and it was given by staff they knew. People were involved in choosing the staff who worked with them. One person told us “I’m absolutely happy with them” and that “all my carers are pretty good”.

There were enough staff working with people to make sure that each person received the support they needed in line with their assessed needs. Staff received the training they needed to help them to understand how to care for people safely, and to understand their specific needs. We observed that interactions between staff and people were respectful and positive.

The provider had effective systems in place to monitor the quality of the service provided. These included internal audits and systems for consulting people who used the service.

We visited one of the flats accommodated by people that used the service; we spoke with four people that used the service, two staff members and the manager.

People we spoke with told us they were satisfied with their care and support. One person said, “It’s fantastic”. They talked about the community activities they were involved in and how they could make their own decisions about what to do and when. People said they liked the meals, were able to choose what they had and were involved in the shopping and cooking.

People said they were happy living in supported living. One person said, “This is the best place”. Another said, “It’s not far from the shops or the pub”. People were aware of their care plan although could not always recall the detail. They confirmed that they had been involved in discussions about their care and said they had attended a review meeting. This was a meeting for them with their social worker and staff to discuss their care and support. People told us they felt safe living in supported living and if they had any concerns then they would speak with the staff or manager. People spoke positively about the staff. One said, “The staff are excellent, really nice”.