Background to this inspection
Updated
12 May 2023
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 Health and Social Care Act 2008.
Inspection team
This inspection was carried out by 2 inspectors.
Service and service type
This service provides care and support to people living in ‘supported living’ settings, 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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
The first day of the inspection was unannounced. We then gave a short period of notice before visiting 2 of the supported living settings. This was so people who used the service could be told about the inspection and consent obtained for us to visit and speak with them.
Inspection activity started on 2 March 2023 and ended on 24 March 2023. We visited the provider’s head office on 2 March 2023. We visited 2 of the supported living settings on 9 and 14 March 2023.
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 used all this information to plan our inspection.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with 2 people who used the service and 2 relatives about their experience of the care provided. We spoke with 9 members of staff including the nominated individual, the head of governance, the registered manager, 1 team manager, 2 deputy team managers, 1 senior support worker and 2 support workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We received written feedback from a further 12 support workers. We received additional feedback from 2 professionals who work closely with the service.
We reviewed a range of records. This included 5 people’s care records and medication records. We looked at 6 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. We looked at training data and quality assurance records.
Updated
12 May 2023
About the service
PIPS Office is a supported living and outreach service providing personal care to adults with learning disabilities, mental health needs and autistic people. People lived in their own accommodation in multiple locations across Teesside, County Durham and North Yorkshire.
Not everyone who used the service received personal care. The Care Quality Commission (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.
At the time of our inspection, the service supported 25 people with personal care.
People’s experience of using this service and what we found
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.
Right Support:
People’s medicines were not always safely managed. Medicine records were not always accurate and clear guidance was not always in place to help staff support people to take their medicines safely.
Staff supported people to have the maximum possible independence, choice and control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.
The provider used effective infection, prevention and control measures to keep people safe, and staff supported people to follow them. People were supported by staff who were recruited safely and who had appropriate inductions.
Right Care:
Systems to safeguard people from the risk of abuse were in place. However, areas of oversight needed to be more robust, to ensure the provider was doing all they could to identify and deal with concerns at the earliest stage possible. We have made a recommendation about this.
People’s care, treatment and support plans reflected their range of needs, and this promoted their wellbeing and enjoyment of life. People told us they were happy and liked the staff teams supporting them. People we visited appeared settled, relaxed and comfortable.
Right Culture:
Governance processes were not always effective in identifying issues and driving improvement. Quality assurance audits were not always comprehensive enough or had not always been completed accurately.
The management team was visible in the service, approachable and took a genuine interest in what people, staff, family, advocates and other professionals had to say. Positive improvements had been observed in people’s quality of life and staff were passionate and enthusiastic about person-centred support.
The provider sought and encouraged feedback from staff, people supported and relatives. The provider and staff worked well with other professionals. The provider was responsive to the inspection feedback and put actions in place immediately.
For more details, please see the full report which is on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was good (published 27 March 2020).
At the last inspection we recommended that the provider seeks further support and guidance from a reputable source, about effective systems to monitor the service. At this inspection we found effective systems were still not in place to ensure robust and consistent oversight of the service.
Why we inspected
The inspection was prompted in part due to concerns received about the quality of the support provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
You can see what action we have asked the provider to take at the end of this full report.
The provider has taken immediate action to mitigate the risks identified.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for PIPS Office on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to the safe management of medicines and oversight at this inspection.
Please see the action we have told the provider to take at the end of this report.
We have made a recommendation about reviewing safeguarding procedures and processes to ensure they are robust.
Follow up
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.