Archived: Destiny Care Support

Updated 23 July 2022

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

Two Inspectors, and an Expert by Experience carried out the inspection. 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

This service provides care and support to people living in one ‘supported living’ setting, 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 looked at people’s personal care and support.

The service did not have a manager registered with the Care Quality Commission. This means that the provider was legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before 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. This information helps support our inspections. We reviewed recent safeguarding incidents and spoke to professionals involved in the service. We used all of this information to plan our inspection.

During the inspection

We spoke with four people who used the service and three relatives about their experience of the care provided. We communicated verbally with four people during face to face informal chats in their home. We spoke with five members of staff including support staff, agency staff and live in staff.

We reviewed a range of records. This included four people’s care records and five medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 23 July 2022

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

Destiny Care Support is a supported living service providing personal care to seven people with a learning disability at the time of the inspection. The service can support a maximum of 10 people. The service is located in a large residential building set on a quiet rural lane.

People’s experience of using this service and what we found

People had not been protected from the risk of harm. Risks to people from the environment had not been safely managed. People had a range of health needs such as around choking and fluid intake but these were not being managed safely.

Staff had not been recruited safely. We asked the provider to take immediate action to provide assurance that all staff working at Destiny Care Support had the necessary checks and suitability to work at the service.

Staff did not have the skills and competencies to carry out their role. For example, one person at risk of choking needed staff that were trained in dysphagia [swallowing difficulties] but no staff working at the service had this. Staff had not had regular supervision or appraisals. People were not having their fluid levels monitored effectively.

People were not being supported to maximise their independence. For example, staff had been writing people’s care plans and writing the menu. People told us they were not involved in cooking their main meal, despite some people being interested in cookery.

People did not have goals or plans to learn new skills in place. People with communication needs did not have visual planners when these could help them. Activities for people were not person centred.

The provider did not have sufficient oversight of the service and governance systems were not effective in driving improvement. There was no manager registered with CQC in day to day control of the service, as they had left at short notice prior to our inspection.

People had mental capacity assessments and where necessary best interest decisions were made where people lacked capacity. The policies and systems in the service supported this practice.

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.

People had been protected from abuse and staff understood their role in safeguarding people. People told us they liked the staff and were happy living at Destiny Care Support.

Right support:

• The model of care and setting did not always maximise the choice people had, and peoples independence was not enhanced.

• The provider’s office where they managed the support from was located in the same main building as people’s rented accommodation. This may make it difficult for people to choose support from another provider, although their tenancy allows this.

• People did not have identified goals and aspirations and staff did not consistently support people to achieve greater confidence and independence. The service had not routinely sought paid or voluntary work, leisure activities and widening of social circles.

• The service was located in a rural setting on a secluded lane and accessing the community often required staff support, which meant some people had to wait to access activities or shopping. Other people could access the community independently via taxis or local transport links.

Right care:

• Care was not person-centred and had failed to promote people’s dignity and human rights.

• People did not always receive their care in a way that empowered them or promoted their independence.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives.

• The provider had not been alert to the culture within the service and had not spent enough time with staff and people and discussing behaviours and values.

• The culture in the service was not always positive. Staff told us that morale was low and they were unable to say what the vision and values of the service were.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 11 November 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvements had been made and the provider remained in breach of regulations.

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about the environment and the fitting of specialist equipment. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to, person centred care, safe care and treatment, good governance, staffing and notifying CQC of significant events at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.