Sandwell Community Caring Trust

About the service

Sandwell Community Care Trust is located in West Bromwich in the West Midlands. It is a charity run trust and supports people who live in their own home. It is registered to provide personal care to people who have a learning disability and autistic people. At the time of the inspection Sandwell Community Care Trust provided support to 150 people.

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

Right Support

The service had not always supported people in a safe way when staff tested positive for COVID-19. On two occasions staff who had tested positive for COVID-19 had isolated with people in their own homes. One staff member had isolated with a person who had recently tested positive for COVID-19 and another staff member with a person who was displaying symptoms of COVID-19. Although the provider had completed a risk assessment and made a best interest decision this meant staff were working without a break and everything possible had not been done to minimise the risk of infection. This increased the risk to people of receiving unsafe care. When we discussed our concerns, the management team gave us assurances this would not happen again.

People were supported by staff to pursue their interests. Lots of people and relatives told us about holidays they had been on and activities they carried out. One person told us, “I go line dancing, Zumba, swimming, bingo, yoga and walks.” Another person liked technology and enjoyed going on their iPad and laptop. We observed staff helping them to update their laptop after they had been having difficulties so they could use it again.

Right Care

People’s care, treatment and support plans did not always accurately reflect their needs. In some people’s care plans, there was different guidance for staff on how to support people, and it wasn’t clear which one was the correct one. However, staff did know people’s needs well.

People received personalised care and staff understood and responded to people’s individual needs. People and most relatives spoke very highly of the support received, their comments included, “They make me feel everything is in hand,” “Couldn’t wish for better care and service” and “I would give 10 out of 10 as it’s what I need to live a full life.”

Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. People and most relatives told us they felt safe.

Right culture

The management team were making changes to ensure they were a reflective organisation with a learning culture to ensure people received good quality care and support. This culture needed to be further embedded to ensure they reflected on decisions and involved other professionals as appropriate.

Staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. Staff listened to people and supported them to do the things they liked to do. People told us about different activities and holidays they had undertaken supported by staff.

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.

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 inadequate (published 23 November 2021) and there were breaches of regulation. The provider completed an action plan and sent monthly reports to show what they would do and by when to improve. At this inspection we found improvements had been made to consent to care, safeguarding and staff competency and training. However, enough improvement had not been made in governance and we identified a breach of safe care and treatment.

The service has been in Special Measures since 21 September 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.

Why we inspected

We carried out an announced focused inspection of this service on 10 June 2021. Breaches of legal requirements were found. The provider completed an action plan and monthly reports after the last inspection to show what they would do and by when to improve consent, safeguarding, governance and staffing.

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 changed from inadequate to requires improvement. 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 Sandwell Community Caring Trust 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 monitor the service and will take further action if needed.

We have identified a breach of regulation in relation to safe care and treatment. Please see the action we have told the provider to take at the end of this report.

We have identified a continued breach of regulation relating to governance. We will continue to monitor the improvement within the service through existing conditions we have placed on the providers registration. This includes the provider sending a monthly report of the action they are taking to make improvements within the service.

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

Sandwell Community Care Trust is located in West Bromwich in the West Midlands. It is a charity run trust and supports people who live in their own home. It is registered to provide personal care to people who have a learning disability or may have a physical disability. At the time of the inspection Sandwell Community Care Trust provided support to 150 people.

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

A safeguarding concern had not been reported to the relevant authority without delay. Risks were assessed but guidance to staff was not always clear. Some improvements were needed to ensure good infection prevention and control practices. People and relatives told us they felt safe. A consistent staff group supported people who knew their needs well.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There were no mental capacity assessment or best interest decisions in place and the MCA policy was unclear on staff and managers responsibilities.

Staff had not received up to date training and competency assessments to ensure they had the necessary skills to support people. The service worked with other professionals to support people with complex health needs to remain living in the community.

Audits had not been robust to identify the concerns and shortfalls we found on the inspection. The provider had not always followed good practice guidance and legislation to ensure people received good quality care. People and most relatives felt able to raise concerns with the management team and were positive about the care they received.

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 some of the underpinning principles of Right support, right care, right culture.

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 Good (published 9 April 2019).

Why we inspected

We received concerns in relation to the providers understanding of obtaining consent and the principles and codes of conduct associated with the Mental Capacity Act 2005. We were made aware of an incident where Sandwell Community Caring Trust failed to apply these principles for the people they were caring for. We reviewed information we held about the service and identified concerns related to staff training and safeguarding. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only.

We reviewed the information we held about the service. No 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 Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well Led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sandwell Community Caring Trust 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 breaches in relation to safeguarding, staff competency and training, consent to care and governance at this inspection. In response we issued a warning notice, imposed conditions on the provider's registration and asked them to send a report that says what action they are going to take.

Follow up: 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.

People’s experience of using this service: People we spoke with told us they felt safe with the staff that support them. Dependent on a persons assessed needs people who used the service live in their own homes either alone or as a small group. Each property has been adapted to meet individual need. All are supported be as independent as possible.

203 staff are employed across the service and suitable arrangements were in place to protect the people and keep them safe.

People were supported to have maximum choice and control of their life and they were supported in the least restrictive way possible.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

Staff spoken with respected and understood a person’s right to privacy and promoted their independence. People who used this service in the main had active social lives and staff supported them to positive experiences and opportunities. Staff told us people that used the service enjoy many community activities and holidays.

The registered manager and other managers spoken with showed respect and kindness towards people. They were passionate about their role and told us everything we do was centred around the individual. People were involved in making decisions about their care.

We met a number of people who used the service all were relaxed and we saw people were comfortable with their support worker. It was evident there was trusting relationships.

The people’s nutritional needs were met and they chose what they would like to eat and drink. People were provided with advice on health choices to maintain their health and well-being and the management team and staff knew when to refer to other health professionals.

There was a complaints procedure which was made available to people. People told us they would discuss any concerns or worries with their support worker. The advocacy service is used should anyone need support to express themselves.

Rating at last inspection: Good (08 February 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. Ongoing monitoring included information that quality had improved. We checked this in looking at the quality and safety of the service.

Follow up: The next scheduled inspection will be in keeping with the overall rating. We will continue to monitor information we receive from and about the service. We may inspect sooner if we receive concerning information about the service.

For more details please see the full report which is on the CQC website at www.cqc.org.uk

The manager was registered with us as is required by law. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Medicines were given appropriately.

We found that there was a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs, and people were kept safe.

People were able to raise any concerns they had and felt confident they would be acted upon.

People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005.

People were supported to take sufficient food and drinks and their health needs were met.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible.

People, their relatives and staff spoke positively about the approachable nature and leadership skills of managers.

Structures for supervision allowing staff to understand their roles and responsibilities were in place and staff felt well supported by managers.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were effective.

Quality assurance audits were undertaken regularly and senior management supported unit managers and staff well.

Notifications were sent to us, which informed us of any incidents or accidents that had occurred within the service. This enabled us to be clear on how such events were dealt with and how steps had been taken to minimise any future risks.

All people we spoke with were complimentary about both the service that they received and the staff. No one made any negative comments or raised any issues of concern. One person told us "I think everything is ok. I like where I live and I like my staff. Another person said 'They look after me and I feel safe'. Staff told us that they enjoyed their work and that they felt people using the service were well looked after. One staff member said "I have worked for other care providers before. In comparison everything about this one is better. The people are all well looked after and the staff are well supported ". Relatives used words such as, 'Tremendous', 'Excellent' and 'Very good' to describe that service provided. One relative said, 'I never worry. I know that they are being very well looked after at all times. The staff are all brilliant'.

During the time we spent with people we saw that staff treated them with respect and dignity. All people we spoke with told us that choices were offered and their views had been taken into consideration.

People's needs had been assessed by a range of health professionals including specialist doctors and the optician. This meant that staff had enabled people to have their health care needs monitored and met.

We saw that people's home environment was comfortable, safe and well maintained. We saw that equipment that was needed to prevent risks and meet people's needs was available.

Staff were supported to ensure they had the skills and knowledge to meet the needs of the people living there. One person said, 'The staff are very good.'

We found that systems had been used to monitor how the service had been run and people had been encouraged to give their views about the service provided.

During the time we spent with people we saw that staff treated people with respect and dignity. People told us that choices were offered and their views had been taken into consideration.

People's needs had been assessed by a range of health professionals including specialist doctors and the optician. This meant that staff had enabled people to have their health care needs monitored and met.

We found that recruitment process were robust which meant that people were protected from unsuitable staff working for the service.

We found that systems had been used to monitor how the service had been run and people had been encouraged to raise concerns.