Background to this inspection
Updated
14 July 2021
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 Care Act 2014.
Inspection team
This inspection was conducted by two inspectors 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 is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
This service also 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.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider would be in the office to support the inspection.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority, professionals who work with the service 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.
The provider was not asked to complete a provider information return prior to this inspection. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.
During the inspection
During the inspection we spoke with seven people who used the service and three relatives by telephone. We spoke with five staff members. This included the registered manager, acting area co-ordinator, and three care staff. We spoke with the consultant who had been employed by the provider to support the service to improve. We looked at full care records for four people receiving support. We looked at training, recruitment and supervision records for staff. We also reviewed various policies and procedures and the quality assurance and monitoring systems of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We visited a supported living service and spoke to two people living there. We looked at training data and quality assurances records. We sent a letter to the nominated individual with a summary of our concerns and asked them how they would address them. We reviewed their response and actions.
Updated
14 July 2021
About the service
Star’s Social Support is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. At the time of inspection 26 people were receiving support.
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.
Star’s Social Support also provide support to people living in supported living. Support was provided to five people across three separate properties. These consisted of a five bedroom, a three bedroom and a two-bedroom property, each containing a staff sleeping room.
People’s experience of using this service and what we found
There was a lack of provider oversight which meant risks to people's safety had not been responded to appropriately and timely. There was no governance framework to monitor the quality and safe delivery of care and treatment. The provider's monitoring systems were not effective as internal audits did not identify the issues we found on inspection. The manager had a good working relationship with staff and external professionals to ensure people received appropriate care and support.
People did not always receive safe care. People’s medicines were not managed safely, effective systems were not in place to ensure errors were identified. Staff had not always been recruited safely into the service. Recruitment files had missing information relating to how the service had sought assurances staff were suitable to work with vulnerable people. The service had failed to assess people for risks that would put them at harm.
People did not always receive care and support from suitably skilled staff. Some staff had not received training around people’s specific needs, and the support staff received was inconsistent. Despite these concerns, people were happy with the service they received and spoke positivity about the caring nature of staff. Assessments were carried out to ensure people’s needs could be met. People were not 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 support this practice.
Elements of peoples care records were personalised, however, not all information was present to support staff to get to know people and provide care in accordance with their preferences. There was no evidence of people having been involved in reviewing their records, and records were not always updated in a timely manner.
People told us staff were kind and they received support from the same core group of staff, which promoted good continuity of care.
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 always able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support;
People received care in a supported living setting which maximises people choice, control and independence. People were supported to manage their own needs and affairs as much as possible.
Right care;
Even though records were not always person centred, the people who received care confirmed the care they received was person centred, promoted their dignity and privacy. However, staff did not always follow or act in line with the MCA and code of practice.
Right culture;
Staff and management were respectful and aware they were supporting people living in their own home.
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 29 October 2020). At this inspection not enough improvement had not been made and the provider was still in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Star Social Support 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 safe care and treatment, consent and 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
The overall rating for this service is ‘Inadequate’ and the service remains 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.