Background to this inspection
Updated
16 September 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 was completed by one inspector. One day was spent at the office location and six days were spend offsite reviewing evidence and making telephone calls.
Service and service type
This service provides care and support to people living in a ‘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 had a manager 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
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We were not able to speak with the people who used the service. We spoke with one relative about their experience of the care provided and two professionals who have regular involvement with the people who use the service. We spoke with five members of staff including the provider, registered manager, and care workers.
We reviewed a range of records. This included two people’s care records and multiple medication records. We looked at four 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.
Updated
16 September 2021
About the service
Constance Health and Social Care is a supported living and domiciliary care service providing personal care. They can provide support to young people, people with learning disabilities or autistic spectrum disorder, people with a mental health diagnosis and people with a physical disability. At the time of inspection, the service was supporting two people.
Not everyone who uses a supported living service receives 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
Peoples identified risks were not always assessed and mitigated. These included significant risk of harm people posed to themselves and risks associated with their health conditions. Government guidance in relation to COVID-19 was not always followed. Medicines were not always managed safely. Staff were not recruited safely.
The provider failed to ensure that monitoring and governance systems and processes were established and operating effectively to ensure compliance with the regulations. Feedback from professionals had not always been acted on.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; however, the policies and systems in the service did not always support this practice.
There was conflicting information in peoples care plans about their choices and decision-making ability. However, relatives and professionals fed back positively about the staff team. The staff team were kind and compassionate when they spoke about people.
People’s identified communication needs had not always been fully explored. However, relatives and professionals said they felt people’s needs were being met and their care was tailored to them. No complaints had been raised but relatives and people had not been given a copy of the complaint’s procedure.
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 not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care and the setting did not always show how people’s choice, control and independence were maximised. Staff were caring but did not have the required training and oversight to ensure their approach was always in line with best practise guidance.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 14/01/2021 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about assessment processes, risks associated with self-harm, staff training, staff recruitment, unsafe medicine practices and lack of access to care plans. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.
The registered manager took some actions to reduce the risks to people using the service following our inspection site visit.
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 safe care and treatment, fit and proper persons employed and governance 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
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 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.