Background to this inspection
Updated
12 June 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team included five inspectors, an inspection manager, an assistant inspector and three Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
CCS Homecare Services Limited provides a range of services which include domiciliary care. It provides personal care to people living in their own houses and flats.
The service also provides care and support to people living in 16 supported living settings, so 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 looked at people’s personal care and support.
In addition, CCS Homecare Services Limited provides care and support to people living in specialist ‘extra care’ housing. Extra care housing is purpose-built or adapted single household accommodation in a shared site or building. The accommodation is rented and is the occupant’s own home. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for extra care housing; this inspection looked at people’s personal care and support service.
The service had three managers registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short notice period of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.
Inspection activity started on 19 April 2021 and ended on 7 May 2021. We visited the office location on 20 April 2021 and 21 April 2021. We also undertook visits to two extra care sites and three supported living homes between 21 April 2021 and 23 April 2021. From 26 April 2021 to 7 May 2021 we continued to review evidence remotely and spoke with staff and managers.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with 38 people who used the service and 23 relatives about their experience of the care provided. We spoke with 48 members of staff including the nominated individual, two registered managers, five service managers, one medication officer, field liaison supervisors, team leaders and care workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also received feedback from 21 members of staff electronically, either by email or using CQC’s ‘Give Feedback on Care’ online feedback form.
We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us
Updated
12 June 2021
About the service
CCS Homecare Services Limited provides a range of care and support services. At the time of our inspection, the service supported approximately 334 people. People had diverse needs, including younger adults with learning disabilities, people with mental health needs, older people and people living with dementia.
Some people received personal care in supported living accommodation. At the time of our inspection, support was provided at 16 supported living sites. Accommodation ranged in size, from single person flats to a development of 16 one-bedroom flats, with shared facilities such as a communal lounge and garden. Most sites supported around five to seven people living with learning disabilities, and some people also required mental health support.
The service supported individuals at four extra care housing sites within the London Borough of Hillingdon. People using the service lived in flats, with access to care support. The size of these buildings ranged from 47 to 88 flats. One of the buildings contained a six-flat unit, used to provide short term care support for people discharged from hospital.
The service also supported people living in their own homes. Some people received support as part of discharge to assess arrangements, meaning they received short-term care following hospital discharge. Other people received care support on an ongoing basis.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
We spoke with people and families about their experiences of the discharge to assess pathway. People received a welcome letter but did not receive a copy of their care plan. Care was arranged quickly to help people return home at short notice. This meant the service could not provide set visit times. Some people were unhappy with not knowing what time staff were turning up which impacted on their meals and medication. A relative told us, “There was inconsistency with times carers came. My relative felt trapped and stressed because of erratic times.” Another person commented, “They are kind but don’t always stay the right amount of time and turned up at different times.”
Most people felt safe whilst receiving discharge to assess support. Some people provided positive feedback. One relative told us, “It was an excellent transition from hospital to home. She feels safe with the carers who come as they help her confidence and trusts them to do a good job.” Another person advised, “I felt safe with the carers as whatever I asked them to do, they did it. They reminded me of the risks with walking and how to use the zimmer frame.”
We also spoke with people and families in relation to long-term care and support at home. Most people told us they felt safe with the care and support they received. One person told us, “The carers inspect me for sores as it is part of my plan, I self-medicate and I’m treated with dignity and respect”. Another person added, “I feel safe and comfortable when carers are here”.
We heard varying feedback about the consistency of people’s support, particularly regarding punctuality of staff. One person told us, “Lunchtime can be anywhere between 11.00am and 2.00pm. They have never missed a call but won’t give me a time.” Other comments included, “they are fairly punctual”, “carers are often late” and “schedules given to carers don’t seem to correspond with what has been agreed.”
People we spoke with did not know the name of the manager, but there was generally positive feedback about communication with the office. One person told us, “The staff and carers are pleasant and friendly…I’m happy with the office.” Another person told us, “If I have concerns, my relative deals with the office for me. A lady comes out and asks me questions about the support I’m getting and if I need anything from my plan changing”. People also confirmed they were contacted for feedback as part of quality assurance monitoring.
We also gathered feedback from people and families using extra care services. People told us they felt safe and spoke positively about the support they received. People used an alarm system to call for assistance when staff weren’t present. We heard staff responded promptly to the alarm. People received support from regular staff, and we heard staff understood people’s needs and preferences. One person told us, “They do everything they are supposed to do for me, I like all the girls.” At one site we visited, people knew there was a new manager and one person said, “She pops in to see me”. Another person at the same site told us the manager acted quickly when they requested an earlier morning visit, to ensure they received pain relief medicines at the right time.
People spoke positively about safe care received within supported living settings. This helped people achieve good outcomes. People felt there were enough staff to support them and told us they felt supported in relation to medicines and managing the risks associated with COVID-19 infection. Some people’s routines and preferred activities had been impacted by the pandemic, with one person commenting, “It’s difficult to set goals. College finished early.” However, people told us the service had supported them during this period. One relative told us, “[person’s name] used to go to a day centre. They definitely get one to one support three days a week and since he’s been in hospital, he needs extra help. They’ve done really well.” Another person described the activities they now access and enjoy, advising, “I like shopping, television and music. I go to college to do maths, English and cookery.”
We found risks in relation to people’s care and support were not always clearly identified within records. We also identified concerns in relation to the recording of medicines support. We made recommendations the service develop their approach in relation to risk assessments and medicines recording. The service responded to our feedback immediately to confirm they were taking action to address the concerns we found.
We found records in relation to people’s care and support were not always person-centred. Some records contained contradictory or incorrect information. The language used within care plans was not always person-centred. The service was responsive to our feedback and immediately confirmed they would work to make improvements. This included plans to revise staff training and review the content and wording of all care plans and risks assessments.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was able to demonstrate how they were meeting the underpinning principles of right support and right culture. We did not look at the component of right care as part of this inspection.
Right support:
• Model of care and setting maximises people’s choice, control and independence.
Right care:
• We did not inspect the Caring domain as part of this inspection and did not look at all the components in relation to right care.
Right culture:
• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 29 June 2019).
Why we inspected
The inspection was prompted in part due to significant expansion of the service since our last inspection. We were aware of increased numbers of safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service remains Good. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.
The service responded immediately to our feedback and commenced action to address the issues we identified. This included updating policies, revising staff training materials and reviewing how medicines administration, care plans and risk assessments were recorded. The service improved information given to people receiving discharge to assess care, to include a summary of the care support in place and approximate visit timescales.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for CCS Homecare Services Limited on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.