Cross House

Regus House, Headzpace, provides personal care and support to children and young adults in their own homes and flats within the community. Many of the young people have learning disability, autism or both and/or mental health needs.

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. At the time of our inspection, there were 7 people using the service, 1 person was using the regulated activity of personal care.

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.

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

Right Support: Staff gave people care and support in a safe environment. Risks to people's health and safety were managed without compromising their independence. We have made a recommendation about positive behaviour support planning. There were enough staff to make sure people received care and support when they needed it. Staff were trained and supported to carry out their job safely and effectively. 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; the policies and systems in the service supported this practice.

Right Care: The care was person-centred and promoted people's human rights. People's needs were appropriately assessed before they moved to the service. The service worked together with health and social care professionals and relatives to ensure people's needs could be met and their health and well-being maintained. Staff understood how to protect people from poor care and abuse. Staff were appropriately trained on how to recognise and report abuse and they knew how to report safeguarding concerns.

Right Culture: The provider promoted a person-centred environment and people experienced good outcomes. Relatives spoke positively about the management team and staff. People received good quality care, and support because trained staff could meet their needs and wishes. Staff understood people's needs in relation to their strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. This enabled people to receive compassionate and empowering care that was tailored to their needs. Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. The management team were committed to the continuous improvement of the service. We have made a recommendation that the provider review and develop their restraint policy to ensure this is sufficiently robust and in line with current guidance.

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

We carried out an announced comprehensive inspection of this service on 16 March 2022. Breaches of legal requirements were found under safe care and treatment and good governance. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. 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 remained requires improvement This is based on the findings at this inspection.

This service has been in Special Measures since 23 December 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Regus House on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Regus House is a supported living service providing support and personal care to young people with a learning disability, autistic people and people who need support with distressed behaviours. People using Regus House receive care and support within their own, individual supported living houses.

The Care Quality Commission inspects the care and support the service provides to adults but does not inspect the accommodation they live in. CQC only inspects where people receive personal care, this is help with tasks related to personal hygiene, medicines and eating. At the time of our inspection, two people were receiving support with personal care.

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

Right Support:

The provider had improved records and practices relating to one person's restrictions around their care and support. People's care plans included some mental capacity assessments. These required further development as they were not decision specific. People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support this practice. Some people who were unable to consent to restrictions did not have these assessed under the Mental Capacity Act 2005 as required. We have made a recommendation about how decisions are made for people whilst the provider waits for local authority commissioners to provide this information.

The provider had made some improvements to ensure information in people's care and support plans included the guidance staff needed to provide effective care. Improvements included the identification and management of risks. Further improvements were required to ensure records were person centred and accurate.

The provider had improved staff awareness and understanding of safeguarding and the reporting of incidents. Further improvements were needed as policies were not reflective of adult safeguarding procedures and low level minor incidents and 'near misses' were not always recorded or analysed. The provider had reviewed and developed staff training. Staff spoke positively about the training and support they received.

Right Care:

People were at risk from not receiving their medicines as prescribed. Staff were not consistently following best practice in administering and recording medicines. The provider had failed to implement the required improvements to medicine records since our last inspection.

The provider had developed and improved positive behavior support and interventions for people using the service. Positive behavior support plans required further development to ensure these were fully person-centred. People told us they were happy with the staff who supported them.

Right Culture:

Quality monitoring systems continued to be insufficient to identify shortfalls and drive continuous improvement in the service. The provider was not proactive in ensuring improvements and changes were made through timely action.

Stakeholders continued to express concern around the poor response of the registered manager and provider to requests for information. We experienced a lack of response following requests for supporting information following our inspection visit. This remains a concern from our previous inspection.

People told us they were able to raise concern and complaints about their care and support with the management team. There were no formal systems to ensure people were fully engaged and consulted about the service.

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)

We carried out a comprehensive inspection (published October 2021) and rated the service as requires improvement. We found two breaches of the regulations and issued a warning notice. We carried out a further focused inspection (published December 2021) and rated the service as inadequate with four breaches of the regulation. The service was placed in special measures.

Why we inspected

The inspection was prompted in part due to concerns received around the governance and leadership of the service. As part of this inspection, we reviewed the warning notice requiring the provider to be compliant with Regulation 17, Good governance. We have found evidence that the provider needs to make improvements. Please see the safe and well led section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 two breaches in relation to safe care and treatment and good governance at this inspection.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.

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 alongside the provider and 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.

Regus House is a supported living service providing personal care to people age 18 and over. 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.

CQC only inspects the service being received by people provided with 'personal care', this is help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the time of this inspection two adults who had a range of care needs including learning disabilities and autistic spectrum disorder were using the service. Of these, both were receiving personal care.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability 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.

Based on our review of key questions Safe, Caring and Well led, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

People were not always adequately supported to have choice and control of their lives and they were not always provided with enough details to support their decision making. Improvements were needed to ensure the care plans provided consistent and clear guidance to staff on how to support people. People's feedback was requested but not always listened to and acted on.

As a result of the above shortfalls people were at risk of their human rights not being upheld.

Right care:

Staff did not always understand how to safeguard people from abuse and avoidable harm and safeguarding incidents were not reported to CQC.

We found concerns about restraint practices and lack of guidance for staff on how to use restrain as a last resort. Furthermore, not all staff when the use of restraint is appropriate, this put people at risk of methods that could cause harm rather than de-escalate situations. We asked the provider to mitigate the safeguarding risks we found during this inspection immediately. The provider sent us evidence of how the risk was addressed.

The management of medicines was not always safe. Preemployment checks were carried out to make sure staff were safe to work at the service.

Right culture:

Not all staff received training to carry out their roles safely. We received mixed feedback from people and health professionals' regarding the staff's skills and ability to meet people's needs at all the times. Staff did not always display the skills and knowledge to meet people’s needs. Records did not give a clear picture of incidents, triggers, or any analysis of learning to improve the service. People did not always feel they had choice and control within their homes. People did not always have choice in who provided their care.

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 requires improvement (published 7 October 2021) and there were breaches in Regulation 11 (Need for Consent), Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and we issued requirement notices and warning notice. At the time of this inspection the provider was still within the time frame of becoming compliant with the regulations.The provider is due to be compliant with the Notice by 31 December 2021. We did not follow up the notice as part of this inspection.

The service rating has deteriorated to Inadequate.

Following this inspection, the service has been placed in Special Measures.

Why we inspected

We received concerns in relation to safeguarding service users from abuse and improper treatment. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No new 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 has changed from requires improvement to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, caring and well led sections of this report.

You can see what action we have asked the provider to take at the end of this full report.

The provider has taken actions to mitigate the urgent risks and we asked for an action plan on how they will address the other concerns we identified.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Regus House on our website at www.cqc.org.uk.

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 a new breach in relation to safeguarding service users from abuse and improper treatment, and two continued breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 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.

Regus House is a supported living service providing personal care to people age 18 and over. 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.

CQC only inspects the service being received by people provided with 'personal care', this is help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

At the time of this inspection two adults were using the service who had a range of care needs including learning disabilities and autistic spectrum disorder. Of these, both were receiving personal care.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability 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 some of the underpinning principles of Right support, right care, right culture.

Right support:

People were generally supported to have choice and control of their lives however they were not always provided with enough details to support their decision making. Mental Capacity Assessments and Best Interest Decisions were not always in place. Further improvements were needed to ensure the care plans provide consistent and clear guidance to staff on how to support people. Further improvements were needed to increase the management’s understanding of mental capacity. People's feedback was requested, listened to and acted on, to improve the service.

Right care:

Staff understood how to safeguard people from abuse and avoidable harm, however not all safeguarding incidents were reported correctly to CQC. Staff were trained to administer medicines; however, the management of medicines was not always safe. People’s independence was not always promoted because people were not always made aware of their rights. Staff understood the importance of good hygiene and the prevention and control of infection. Checks were carried out to make sure staff were safe to work at the service.

Right culture:

Staff received training to carry out their roles, however we received mixed feedback from health professionals’ regarding the staff’s skills and ability to meet people's emotional needs at all the times. People were adequately supported with the physical needs, staff made sure people had enough to eat and drink, and if anyone became unwell, staff knew how to access health care services to support people's health and wellbeing. Professionals who work with the service told us the management was not always prompt in responding to the request for information and reports. Staff spoke highly about the management however; we found several areas requiring improvement during this inspection. The provider's systems for checking the quality of the service had not identified all of the concerns we found. This meant that further work was needed to make sure everyone using the service always received a high quality and safe service.

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 19/03/2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about the poor quality of care and concerns about the management. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the well led section of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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 two breaches in relation to safe care and treatment and good 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

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.