Active Care Group Supported Services

Updated 24 February 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

The inspection team consisted of 4 inspectors, a specialist advisor with professional experience in the management of medicines and an Expert by Experience. 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 was providing regulated care and support to people living in six ‘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 a new manager had been in post for four months and had applied to register. Since the inspection, this person has successfully completed the registration process and is now the registered manager.

Notice of inspection

We gave the provider 24 hours’ notice that inspection activity was commencing. This was because we wanted to meet with people living in their own homes and we needed to understand people’s level of capacity to be able to consent to this. We made both short notice announced and unannounced visits to the settings across a twenty-four-hour period.

Inspection activity started on 2 November 2022 and ended on 7 December 2022.

What we did before the inspection

We reviewed information we had received about the service and sought feedback from the local authority and other professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We visited 5 of the 6 settings where people received a regulated activity. We visited some settings multiple times to follow-up on specific issues or concerns. This included an overnight visit to one setting. During the course of our inspection activity, we spoke with 26 people and 18 relatives about their experiences of using the service. Some people we met were not able to verbally communicate with us and we communicated with them using a symbol-based communication tool to tell us of their experience. We are improving how we hear people's experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use this symbol-based communication tool. We checked that this was a suitable communication method, and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves.

We also interviewed 23 members of care staff, including the service managers at each setting. We undertook a remote review of recruitment with the provider’s onboarding manager and spoke individually with two managers from the organisation’s quality team. We communicated regularly with the registered manager and nominated individual during the inspection period. The nominated i

Updated 24 February 2023

About the service

Active Care Group Supported Services provides support for autistic people, people with learning disabilities, physical disabilities or mental health needs. People's care and housing are provided under separate contractual agreements, although we have highlighted within this report that the separation between these two elements had not been made clear to people. 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 this inspection, the service was providing support within the regulated activity of personal care to 36 people across six ‘supported living’ settings. The settings included accommodation in both small shared houses and larger blocks of flats.

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

People were not always supported to have maximum choice and control of their lives and despite staff having a good understanding of people’s capacity, support was not always delivered in the least restrictive way possible and in their best interests; the policies and systems in the service did not consistently support best practice.

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:

The quality of support that people received across the different settings was not consistent. At one setting, people did not always receive the care they needed to live safe, happy and fulfilling lives.

There were not always enough staff on duty. In addition to staffing shortages, some of the settings relied on high levels of temporary staff who did not always have the skills and experience to meet people’s needs and expectations. Recruitment processes were safe, and the provider was taking active steps to increase number of staff and ensure that staff were deployed effectively.

Staffing issues had a significant impact on the way people received their care. People and their families told us that staff did not always have the time to provide support in a way that increased people’s skills and promoted their independence.

There were systems in place to support people with their healthcare needs, and managers were working hard to build more positive working relationships with other professionals to ensure people received the care they needed.

Right Care:

People did not consistently receive care that was person-centred. Whilst staff understood the importance of individualised support, the challenges with having enough experienced staff meant that often they had to prioritise the needs of the group, rather than the individual.

People at one setting told us that some staff had not treated them with respect or kindness. Where those individuals were able to be identified, immediate action was taken to ensure people were safeguarded. Other staff were praised for their commitment and dedication to doing the right thing.

Right Culture:

The culture varied across the settings. At one setting, people did not feel listened to or valued. They told us they had given up raising complaints because nothing ever changed. At other settings, despite the staffing challenges, people felt engaged and informed about what was going on. This led to the feeling a greater sense of control over their lives.

The new registered manager and senior leadership team were working hard to change the culture across all settings, they were already aware of many of the issues people raised with us and were working hard to implement the changes that were needed.

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 11 November 2021 and this is the first inspection.

The last rating for the service under the previous provider was Good published on 27 November 2020.

Why we inspected

The inspection was prompted in part due to concerns received about staffing levels and the safety of people’s support. As the service had not previously been inspected under the new provider a decision was made for us to carry out a full inspection to provide a rating.

We found evidence 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 provider fully engaged with the inspection process and has already provided evidence of immediate action that has been taken to mitigate the risks identified.

Enforcement

We have identified breaches in relation to person-centred care, safeguarding, the safety of medicines, management of risks, staffing and good governance. Please see the action we have told the provider to take at the end of this report.

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 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.