The Old Print Works is a supported living service registered to provide personal care services to people living in their own flats. Services were provided to people with learning disabilities, physical disabilities, and mental health needs. Each person had their own facilities which included a kitchen, bathroom, living room and bedroom.

This inspection took place on the 17 and 19 October 2018. The inspection was announced to ensure someone would be in to help facilitate the inspection. At The Old Print Works last inspection on 3, 7 and 9 December 2015, the service was rated good overall with a rating of “requires improvement” in the key question Safe. The service had made improvements to bring this key question to “Good”. There were no breaches of the regulations found during their last inspection.

At the time of our inspection 37 people were receiving personal care.

This service provides care and support to people living in ‘supported living’ settings, so that they can live in their own home 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 looked at people’s personal care and support.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

This registration had three sites and each site had its own registered manager at the time of the inspection.

People were kept safe at the service as there were staff on site 24 hours a day. People told us they felt safe. Staff understood their safeguarding responsibilities and could explain how they would escalate their concerns further or whistleblow if no action was taken.

Risk assessments were robust and staff knew how to mitigate against risk. People were supported to live in a less restrictive way and to take positive risks. Staff followed people’s positive behaviour support plan where risks presented themselves.

Staff were recruited safely and the provider performed a number of checks to ensure suitability and safety to work with people at the service. Medicines were managed safely and staff received thorough training before being able to administer medicine. People had detailed medicine profiles which outlined side effects and reasons for prescribed medicines.

The risk of infection was minimised as staff followed safe hygiene practices and wore personal protective equipment.

People received an assessment of need to ensure the needs could be met by the service. Staff received an induction, and mandatory and specialist training to support them in their role. Supervisions took place regularly and time was protected for this and staff received an annual appraisal where applicable.

People were encouraged to make their own decisions and be as independent as they could with staff there for support. Staff understood the principles of the Mental Capacity Act 2005. Appropriate referrals had been submitted to the local authority for Court of Protection applications where people’s liberty was being deprived.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to eat and drink well and staff were vigilant to people’s dietary requirements where it may impact their health.

Staff w

We inspected this service as a result of information provided to us following our last inspection of the service on 24 April 2014. We focussed on specific outcomes and did not review progress the service was making with addressing the findings of our previous inspection.

We spent the majority of the inspection visit at two adjacent supported living schemes at which the service supports 24 people. We met with seven people using the service although many were not able to speak with us due to communication needs. We spoke with the staff supporting them, and looked at records available at the office of these schemes and in some people’s homes in these schemes. We also spoke with two community healthcare professionals following our visit.

People using the service that we spoke with indicated that they were happy with the service. “I like it here,” one person said. Most staff we spoke with indicated that they were supported in their work and to meet people’s needs. We saw records of ongoing training and supervision of permanent staff. We found that there was an overall focus on supporting people to access the community and be involved in activities and occupations that they enjoyed, and for many people this support was being provided.

However, we found that the service was not effective at identifying, assessing and managing risks relating to the health, safety and welfare of people using the service. Where incidents affecting the safety and welfare of people using the service had taken place since our last inspection, many had no record of action in response to the incident. Therefore we could not be assured of effective risk management. These included incidents of someone repeatedly activating the fire alarm, and a person using the service attending hospital as a result of the actions of another person using the service. We also found cases where action had been taken but had not been effective at minimising risk. For example, an allegation of financial abuse that had not been acted on promptly which allowed a repeated incident to occur the following week. The provider’s risk management processes, particularly around incidents, was failing to protect people against the risk of inappropriate or unsafe care, and so we were not assured of a well-led service.

We found three occasions when the service had not promptly notified us of important events that affected people's health, safety and welfare. As a result, we could not be confident that people using the service were being protected from risks and safeguarded when needed.

We tracked the support being provided to five people with higher care needs and found that for one person, the planning and delivery of support with drinking was not protecting them from the risks of dehydration. Their support plan had not been kept up-to-date in this respect despite community healthcare input, and records of fluid intake were not consistently recorded or used. The support provided to them was not consistently enabling them to drink enough to protect them from the risks of dehydration, and so we were not assured of the effectiveness of the service in this respect.

We found that some care and support records about people using the service were not kept securely in the office of the two adjacent supported living schemes. We also found pages torn out of the communication book in that office. These matters failed to protect people using the service against the risks of inappropriate or unsafe care.

This inspection took place on 3, 7 and 9 December 2015. We told the service about this two days before the inspection to ensure that management were available.

The Old Print Works is registered to provide personal care services to people living at supported living services and in their own homes. Services are provided to people with learning disabilities, physical disabilities, and mental health needs. At the time of our inspection 45 people were using the service. At our last inspections in April and July 2014 the service failed to meet regulations relating to care planning, records, supporting workers, nutrition, quality assurance, and notifications. However we found significant improvements in all these areas during the current visit.

The service did not have a registered manager, however an operations manager was in place covering this role since September 2014. They advised of the service’s intention to split into three separate services with a registered manager for each. 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 and associated Regulations about how the service is run.

We found that people lived in a safe and clean environment. They felt well supported by the staff at the service, and had developed positive relationships with them. However improvements were needed in procedures to further protect people using the service from financial abuse..

Staff received appropriate training, supervision and support for their roles, including training in the Mental Capacity Act 2005, and there were systems in place to ensure that this was followed.

Staff knew the people they were supporting and provided a personalised service. Care plans were in place detailing how people wished to be supported. People spoke highly of the support staff provided including support to meet their cultural needs.

Staff supported people with eating and drinking and to attend health care appointments. Safe systems were in place for staff to support people to take their prescribed medicines.

People told us that the management were accessible and approachable, and that they felt able to speak up about any areas for improvement. There were regular checks in place to review the quality of the service provided to people and to seek their views.

There were financial procedures in place to keep peoples’ money safe. However we made a recommendation about reviewing the way staff supported two people

when using their cash cards

to ensure that all parties were protected as far as possible.