SCC Adult Social Care Supported Living and Mallow Crescent short breaks service

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

We identified a breach of regulation in relation to the governance and oversight of the service. Governance and audit systems were not fully embedded into the running of the service which meant concerns were not always identified and address in order to make improvements. No process was in place to support people in assessing the quality of the support they received. Whilst there was an ethos amongst staff of wanting people to be happy, on occasions staff referred to people in a derogatory or paternal manner. There had been a number of changes within the senior leadership team which had led to a lack of consistency and oversight. The current management team were in the process of reviewing systems and developing a strategic action plan to ensure learning and consistency were implemented within the service going forward. The leadership team and staff had developed positive relationships with external professionals and links within the community. Staff felt able to speak up about any concerns and believed the management team would take action to address any issues raised.

This service scored 57 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The culture within the service was not always positive as staff did not always see people as their equal. Staff showed an affection for the people they supported. However, there were numerous references made to describe people both verbally and in records which were derogatory. This included staff describing people by their health conditions rather than their names, describing people as being like children and referring to people not obeying instructions. Staff frequently described wanting to make people’s lives happy and all individual interactions we observed were meant with kindness. However, in some instances this was done in a paternal way rather than working in partnership with people.

In other areas we found a positive culture where staff were highly person centred and respectful in their approach to people. This included supporting people to gain independence, explore work options and have varied choices regarding how they spent their time.

The lack of shared direction across the settings had not been identified. The management team told us they were keen to address these issues and ensure staff had a greater understanding of the positive culture they wished to embed.

There was a lack of management oversight in relation to developing a shared culture across the settings. There had been no comprehensive reviews of documentation such as people’s daily support notes, tenants meeting minutes or handover information. Systems in place to complete observations in relation to the approach of staff when supporting people were not always effective in identifying concerns. This meant the concerns found during our inspection had not been identified and acted upon to ensure a consistent approach and understanding from the whole staff team. The inconsistent understanding of the supported living model also contributed to the difficulties in embedding a positive culture throughout the settings as staff did not have a shared ethos to work towards. The management team did identify positive practice in a number of instances and were looking to share these ideas across the settings. This included the development of life story/memory books for people and discussions regarding how menus were planned with people to ensure they were personalised.

Some staff told us they did not always feel supported in their roles. One staff member told us, “I can’t say I always feel supported. Everything is passed down to the houses [settings] but we don’t always get told how to do things. It can be like Chinese whispers with so many layers of management and we are stuck in the middle.” Other staff members told us they found individual managers to be supportive and felt they could ask for help if needed.

Leaders we spoke with were passionate about delivering person-centred, quality care. However, there had been a number of changes in the senior leadership team supporting the service. This had led to the oversight of the service become disjointed across the different settings. The current senior leadership team were in the process of reviewing the needs of the service going forward to ensure new systems being implemented were designed to give greater consistency and support to staff. They told us they would work alongside the training department to develop staff understanding and ability to embed systems and improve people quality of life.

Staff told us they felt able to discuss any concerns they had with their immediate managers and senior leaders. They were aware of who they could go to and how to contact them. The majority of staff we spoke with told us they felt they would be listened to if they raised issues and believed action would be taken. Leaders told us they operated an open-door policy and regularly met with staff to give the opportunity to raise concerns.

Processes were in place to support staff in reporting any concerns. We saw the management team were accessible and held regular staff meetings and supervisions with staff. In addition, the provider had policies in place to support staff such a whistleblowing and grievance procedures.

Staff told us they felt respected by their colleagues and treated fairly by the management team. One staff member told us, “I know I could speak to anyone if I felt I was being treated differently. We are very supportive of each other. It’s a good team we have here.” The management team told us they promoted through established systems which ensured consideration was given to the diverse needs of the staff.

The provider had systems in place to ensure staff were treated equitably. Training in equality and diversity was compulsory for all staff and robust policies had been developed. Reporting systems were in place and staff were able to tell us how they would report any concerns.

The leadership team told us the overall governance of the service was something they were aware needed to be more robust. Due to the number of changes to the senior leadership, the oversight of the quality of the service had not been consistent. This had led to managers developing their own governance systems and action plans rather than working towards a shared direction.

Audits in relation to the quality-of-care people received were not completed regularly. This included people’s care records, risk assessments, and daily support records. There was no system in place to review the quality of the support people received, how records were maintained or how systems such as assessments and capacity assessments were carried out. The lack of a systematic approach meant the inconsistencies found during our inspection such as the use of derogatory language and references, risk management plans not being in place and best practice guidance not being followed had not been identified and addressed. We found action had recently been taken to update audits in some areas although the actions identified continued to lack consistency and were not based on holistically reviewing people’s quality of life and the support they received.

People described how they accessed their local area with the support of staff. One person described how they enjoyed going shopping in the local area and had just returned from going to a café. Another person told us about the day centre they attended and the different things they enjoyed doing there. We reviewed records which reflected the support people received to maintain their employment. Relatives told us they, “They go out a lot and have made friends there which has made a big difference.”

Staff and leaders were able to describe the links they had with a wide range of professionals and organisations. These included healthcare professionals, day service partners, employment links in addition to support systems available from the wider organisation. The registered manager informed us of a range of workshops provided by Surrey County Council designed to provide information and support to people with a learning disability. The workshops were discussed within tenants’ meetings and arrangements made for those who wished to attend.

Professionals involved in people’s care told us they had good relationships with the service. One professional told us, “They always respond quickly when we ask for information, and we know we can rely on them doing what they say they will do.”

Processes were in place to foster positive links within the local area. Good communication links had been built over time and referrals to appropriate agencies were made in a timely manner.

Staff told us they felt changes made to the service such as each setting changing from residential care to supported living. However, they felt they would have benefitted from on-going training and support to implement the changes. One staff member told us, “It’s positive because people have more one to one time now but in general we need to understand this whole change more. Even after all this time that would be useful.” The management team told us they had ensured staff received training in relation to the changes to supported living at the time this was being considered. They acknowledged this had not been followed through over time and stated they would look at developing more training and support in relation to this for both existing staff and new recruits.

An action plan had been developed for the service by senior leaders. However, this did not fully address concerns identified during our inspection such as staff having a full understanding of the supported living and how the changes to the culture would be managed, how managers would be supported to take greater ownership of governance systems and how action plans for individual settings would be developed and monitored. Discussions with the provider and managers highlighted they were aware of the need to implement governance systems, introduce electronic records, enhance consistency and ensure people had greater involvement in the running of their homes. Management meeting minutes reviewed highlighted improvements required in some areas and passed on responsibilities for action to individual settings. However, it was not always made clear how staff in individual settings were supported to understand and implement developments. We did observe improvements in relation to daily support records. These were being implemented across the service at the time of our assessment and staff were positive regarding this change.