Background to this inspection
Updated
18 October 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection was carried out on 17 and 19 July 2018. Two adult social care inspectors carried out the inspection on the first day which was unannounced. The second day of the inspection was announced and was carried out by one adult social care inspector.
Before the inspection we reviewed information available to us about this service. The registered provider had completed a Provider Information Return (PIR). The PIR is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed notifications that had been sent to us. A notification is information about important events which the provider is required to send us by law.
As part of our inspection we spoke with two people who used the service, two people’s relatives in person, four people’s relatives over the phone, one visiting health care professional, the registered manager, the regional director, the locality manager, and seven other staff.
We also received feedback from the local authority quality monitoring team and spoke with four people’s social workers.
We looked at a range of records including medication records, care records, staff recruitment, training, supervision and appraisal records. We also looked at records relating to health and safety and quality assurance.
Updated
18 October 2018
This service provides care and support to people living in a ‘supported living’ setting, 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. At the time of the inspection 12 people were receiving support from the provider with their personal care all of whom lived in their own home at the location address. The service specialised in supporting people living with mental health conditions, a learning disability and autism.
At the last inspection in January 2017 the service was rated Good.
This inspection took place on the 15 and 17 July 2018. The first day of the inspection was unannounced and the second was announced.
We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.
There was a registered manager in post. 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 management and leadership of the service was not effective. The provider had systems to assess the overall quality of the service which had identified shortfalls in the delivery of care and the management of the service. Action plans had been devised to address the areas of concern but had not led to improvements being made. Therefore, shortfalls had been allowed to continue. These included the completion of care records, completion of medication administration records (MARS), the provision of staff training, staff induction, staff supervision, staff appraisals, the monitoring of health and safety issues, and the recording and monitoring of accidents and incidents. In addition to these shortfalls we identified other areas of concern that the providers own systems had not identified.
People’s needs had been assessed before they began using the service and people and their relatives had been consulted about their preferences for how they wanted their care delivered. However, records had not always been updated when people’s needs had changed and some contained conflicting information. Therefore, staff did not always have access to the guidance they needed to provide safe and effective care.
The provider had not ensured that people’s capacity to make decisions and consent to their care and treatment had always been assessed. Staff told us some people lacked capacity to make some decisions and others had fluctuating capacity however capacity assessments had not always been completed. Staff told us that care was delivered to some people in their ‘best interests’ however there was little evidence to show how these decisions had been made or who had been involved in making these decisions. Therefore, the provider was not working within the principles of the Mental Capacity Act (MCA).
The provider had not ensured that procedures in place for people to receive their medicines safely were always followed. There had been many errors in 2017 and 2018 where people had not received their medication as prescribed. Care records contained conflicting information about people’s medicines and people’s MAR had not always been accurately completed.
The provider has not ensured that there were always sufficient numbers of adequately trained and competent staff on duty. Most people received the support they needed most of the time. However, the lack of effective management of the staff duty rota had resulted in some people experiencing missed calls or having to share their one to one support staff with another person. In addition to this staff had not all received the training supervision and support they needed to provide effective care.
People were not always treated with dignity and respect and their privacy and confidentiality was not always respected. One person told us senior management had entered their home without permission and we saw records containing private information was not always stored securely.
The registered manager shared their office with an administrator and other staff providing little privacy for conversations of a sensitive and private nature. Records containing people’s personal information and other records relating to the on-going management of the service were left out on desks in the office and displayed on the walls in full view of visitors.
There was a backlog of many incidents and accidents going back several months that had not been entered onto the providers own quality assurance systems. Therefore, the provider could not be assured appropriate action had been taken to prevent reoccurrence or be sure relevant external bodies such as the local authority and CQC had been informed.
The provider had not ensured that communication was effective or that complaints were always responded to promptly. Relatives told us communication with management was poor with one relative referring to the communication and administration at the service as “Shambolic”. The providers systems in place to record and respond to concerns and complaints. However, complaints and concerns received verbally had not been recorded and relatives told us they had to raise concerns multiple times before any corrective action was taken.
Most relatives felt their loved one’s regular staff were kind and caring, had a good understanding of their needs and treated them well. Staff told us and records confirmed that people were supported to maintain their independence and spend their time as they wished. Some people were also supported to go on holiday.
Recruitment practices were safe. Appropriate identity and security checks had been completed before staff started work.
We found eight breaches of regulations. You can see what action we told the provider to take at the back of the full version of the report.