During an assessment under our new approach
Date of Assessment: 20 February to 16 March 2025. We visited the service’s office on 24 February and on 11 March 2025. We carried out this assessment in response to concerns raised regarding the management of the service. The service is a care at home service, potentially providing support to younger adults over the age of 13, and adults of all ages living with dementia, mental health conditions, physical disabilities, and people with a learning disability. However, there was no person using the service under the age of 18 or with a learning disability or autism, presently receiving the regulated activity of personal care. There were 12 people receiving support with personal care when we assessed the service.
We assessed all 33 Quality Statements under all 5 Key Questions of: Safe, Effective, Caring, Responsive and Well Led. This assessment showed areas of good practice, as well as areas that needed to improve. Our overall rating for this service is Good.
The provider now had a good learning culture and people could raise concerns. Managers were now investigating incidents thoroughly. Safety investigation processes were now in place, but they had not yet been used in practice and so were not embedded in the service culture. The provider had not always worked well with people and healthcare partners to maintain safe systems of care. They had not always maintained continuity of care. The service had not effectively managed being both the accommodation provider and support provider under the service type of Supported Living. People were protected and kept safe. Staff understood and managed risks. The facilities and equipment met people’s needs, were clean and well-maintained and any risks mitigated. There were enough staff with the right skills, qualifications and experience. Managers made sure staff received training and regular appraisals to maintain high-quality care. The provider was previously in breach of the legal regulations in relation to safe recruitment practices and providing adequate training to staff. Improvements were found at this assessment and the provider was no longer in breach of these regulations. Staff managed medicines well and involved people in planning any changes.
People were involved in assessments of their needs. Staff reviewed assessments taking account of people’s communication, personal and health needs. Care was based on latest evidence and good practice. People had enough to eat and drink to stay healthy. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving services. The provider monitored people’s health to support healthy living. Staff made sure people understood their care and treatment to enable them to give informed consent. Staff involved those important to people and took decisions in people’s best interests where they did not have capacity. However, leaders’ knowledge of the Mental Capacity Act 2005 (MCA) and how this worked in community settings was not thorough. Leaders had learning plans in place to improve their knowledge in this area.
People were treated with kindness and compassion. Staff protected their privacy and dignity. They treated them as individuals and supported their preferences. People had choice in their care and were encouraged to maintain relationships with family and friends. Staff responded to people in a timely way. The provider supported staff wellbeing. However, where staff were delivering complex care, which caused emotional demand on staff the service leaders agreed more individual support would be given to these staff. People were involved in decisions about their care. Staff always supplied appropriate, accurate and up-to-date information. However, they had not previously considered the value of delivering information in formats that were tailored to individual needs. Service leaders said they would plan to provide information more tailored to individuals needs in future. People knew how to give feedback and were confident the provider took it seriously and acted on it. The service was easy to access and worked to eliminate discrimination. People received fair and equal care and treatment. Staff worked to reduce health and care inequalities through training and feedback. People were involved in planning their care and understood options around choosing to withdraw or not receive care.
Leaders and staff had a shared vision and culture based on listening, learning, human rights and trust. However, leaders had limited knowledge of some legislation and national guidance, specifically regarding the rights of people living in the community who lacked capacity to consent. The provider had not always had clear responsibilities, roles, systems of accountability or good governance. The provider was previously in breach of the legal regulation in relation to having effective systems and processes operating in the service. Improvements were found at this assessment and the provider was no longer in breach of this regulation. We were assured that effective systems and processes were now in place, but are still to embed into the operation of the service. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. However, on some issues leaders lacked knowledge and / or experience. They demonstrated during the assessment their plans to obtain this knowledge to use in the operation of the service. Staff felt supported to give feedback and were treated equally, free from bullying or harassment. People with protected characteristics felt supported. Staff understood their roles and responsibilities. Managers worked with the local community to deliver the best possible care and were receptive to new ideas. There now was a developing culture of continuous improvement with staff given time and resources to try new ideas. While we did identify some shortfalls during this assessment, service leaders were responsive to our findings. We were assured service leaders had the ability to overcome the issues where their knowledge and experience was limited and to embed the new culture of learning and improvement in the service.