Background to this inspection
Updated
12 August 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 Health and Social Care Act 2008.
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
Three inspectors, a specialist advisor 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 three ‘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 service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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. At the time of our inspection there was not a registered manager in post. A new manager and deputy manager had been recruited and were due to start in April 2022.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us.
Inspection activity started on 23 March 2022 and ended on 13 April 2022. We visited the location’s service on 24 March, 30 March and 13 April 2022.
What we did before the inspection
We reviewed information we had received about the service. We sought feedback from the local authority, local safeguarding team and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan our inspection. 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.
During the inspection
We spoke with two people who used the service and two relatives about their experience of the care provided. We spoke with the regional manager, the operations manager and 10 members of care staff. We reviewed a range of records, this included four people's care records. We looked at three 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.
Updated
12 August 2022
About the service
Affinity Trust Specialist Support Division North is a supportive living service registered to provide personal care for people who have learning disabilities. Affinity Trust Specialist Support Division North accommodates 15 people across three separate sites, each of which has separate adapted facilities. At the time of our inspection seven people were using the service.
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 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.
The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right Support
People were not supported in having choice and control over aspects of their lives. Staff were restrictive and did not promote the best interests of the people using the service. Risks to people were not always recognised, assessed and managed safely. Systems in place did not always protect people from abuse and improper treatment. The provider had not always acted to manage risks. People's needs were not always assessed to consider what they wanted and needed.
Right Care
Staff did not always offer people choice or involve them when supporting with activities or meals. Some staff were knowledgeable about the people they supported and had established good rapport and therapeutic relationships, one relative said, “I like the staff, they know [them] so well”. However, the service relied on agency staff who did not always know the people.
Right culture
The ethos, values, attitudes and behaviours of leaders and care staff did not ensure all people using the service could lead confident, inclusive and empowered lives. People were not supported to regularly identify, or review, on-going individual aspirations and life goals. There was a lack of management support to assist staff in improving practice. Staff told us that morale had been low and they had felt the impact of poor staffing. One staff member said “I just feel undervalued”.
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 May 2021 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns raised by stakeholders regarding safeguarding and leadership. A decision was made for us to inspect and examine those risks.
We looked at infection prevention and control measures under the Safe key question. We look at this to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement and Recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to safe care and treatment, person- centred care and good governance at this inspection. We have made recommendations for the provider to improve staff training, supervision and use feedback from people, relatives and staff to inform improvement within the service.
This is based on the findings at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Affinity Trust Specialist Support Division North on our website at www.cqc.org.uk.
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.