Archived: Stars Social Support

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.

The Stars Social Support is a domiciliary care agency. It provides personal care to people in their own houses and flats in the community. At the time of inspection 27 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.

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

The provider had not created strong systems to promote people's safety in terms of the recruitment of suitable staff. Some risk assessments did not detail what care and support people needed to reduce risk to them. Medications were not managed safely. For some staff medication training was out of date and observations of competence had not been completed. People told us they felt safe and relatives told us they thought their relatives were safe when staff visited.

The service had not made enough improvements following the last inspection. Some governance systems such as audits had been implemented. However, they had failed to identify where improvements were required, and failed to identify the concerns highlighted during the inspection. The registered manager understood the regulatory requirements, however, they needed to improve their knowledge around key requirements. People spoke highly of the management team, commenting they were approachable and supportive. People told us they thought the service was well-led.

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 requires improvement (published 8 May 2019). The provider did not complete an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 13 February 2019. Breaches of legal requirements were found. The provider did not complete an action plan after the last inspection to show what they would do and by when to improve fit and proper person employed and good governance.

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has deteriorated to inadequate. 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 Stars 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, good governance and fit and proper person employed 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

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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.

Stars Social Support is a domiciliary care agency providing personal care to people in their own homes. At the time of this inspection it was providing services to 81 people.

People’s experience of using this service:

• People told us staff were kind and caring. They were positive about how they were treated by staff. People told us they were in control of their day to day routines and staff supported them to remain independent. Staff asked people for consent before providing care, however improvements were required in how the service recorded when people consented to their care or when they lacked the mental capacity to make the decision themselves;

• People felt safe in the presence of care staff. However, some staff recruitment records did not contain all the information required by regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014; fit and proper persons employed. New staff received an induction to the service, which included time shadowing an experienced staff member. We fedback to the provider to start recording staff inductions so they can clearly evidence when key learning objectives were met;

•The service supported access to other community health professionals as required. Staff supported people safely with their medicines, though some minor improvements were required with the quality assurance systems which promoted safer medicine administration;

• Staff received a range of training and people thought staff had the right skills and experience to care for them effectively. Most staff were supported in their role through regular supervision meetings with their line manager. The provider had recently introduced an electronic system which monitored staff training and supervision commitments and flagged when these became overdue. This system was relatively new so its efficacy needed to be tested over time. We have made a recommendation about recording staff meetings;

• People were informally asked for feedback about the service and they told us they were confident they could raise any concerns with staff or the manager. We have made a recommendation about expanding the provider’s stakeholder feedback processes. Some people and their relatives said the office communication was poor at times, in particular when communicating changes to people’s rota schedules;

• The provider had recently started to overhaul people’s care plans to improve the quality of information it included about a person’s care and support needs, thereby increasing the likelihood of them receiving person-centred care. We looked at a sample of the new format care plans and they were much improved over the previous version. However, as the service was less than 10% through this project we need to see this improvement implemented service wide. People and their relatives told us they were consulted about their care, though the service was not always recording these discussions during care reviews.

• At the last inspection the service was in breach of Regulation 17. At this inspection the service had not made enough improvements to meet the requirements of this regulation and therefore was in continued breach of Regulation 17.

• The service met the characteristics of good in the key question of caring. The registered manager had plans in place to improve other areas of the service. The provider had not ensured adequate steps were taken to address all issues previously raised at the last inspection;

• More information is in the full report.

Rating at last inspection:

At the last inspection the service was rated good (published 1 February 2017). The service was rated requires improvement in the well-led domain with one breach of Regulation 17.

Why we inspected:

This was a planned inspection based on the rating awarded at the last inspection.

Enforcement:

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 continue to monitor this service. We will check improvements have been made by completing a further inspection in line with our re-inspection schedule for those services rated requires improvement.

Stars Domiciliary care agency provides support to children and adults with disabilities who live in their own homes. The service was supporting 59 people at time of inspection.

The service had a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found that people’s care was delivered safely and in a manner of their or their representatives, choosing. People were supported in a way that reflected their wishes and assisted them to remain as independent as possible. Staff were aware of signs of potential safeguarding issues and knew how to raise them both internally and externally.

Staff were well trained and encouraged to look for new ways to improve their work. Staff felt valued by the registered manager and this was reflected in the way they talked about the service, the registered manager and other staff. Staff were not receiving regular formal supervision but the registered manager had put in place steps to address this with staff. Staff had access to informal and ad hoc supervision and told us they felt supported.

People who used the service were initially assessed and then matched up with suitably trained staff to support their needs, and if people requested changes to how support was delivered these were facilitated quickly. People and relatives were complimentary of the service, and felt included and involved by the staff and registered manager. Where people had specific needs, staff attended training before starting work with them to ensure they had the correct skills and competencies in place. We saw that staff had access to very comprehensive induction training.

The service had not always formally sought and confirmed people, or their representatives, consent when assessing and devising their care. People and relatives we spoke with told us that staff sought their consent verbally before delivering any care. From talking to staff and checking other care records we could see that the best interests’ decision making process had been followed, but that the provider’s records did not support the clear recording of the process and final agreement.

There were high levels of contact between the office and senior staff and people with those staff seeking feedback and offering support as people’s needs changed. People and their relatives were able to raise any questions or concerns with the service and were confident these would be acted upon. No one we spoke with had any issues or complaints about the service they received.

Staff worked to keep people involved in their local community and in activities that mattered to them where possible. Relatives thought that staff were caring and supportive and sought their advice and support with the permission of the person.

The service had not always identified and acted promptly upon issues such as the failure to regularly supervise staff, to ensure that consent was correctly recorded and record keeping of the use of best interest’s decision making was in place.

The registered manager was seen as an experienced leader by staff, people using the service and peoples relatives. The registered manager was trusted and had created a strong sense of commitment to meeting people’s diverse needs, supporting their staff and developing a better service. The registered manager had recently taken steps to increase management support and to develop and IT solution to help reduce paperwork and improve their ability to collate and analyse quality data.

We found a breach of regulation in relation to good governance. You can see the actions we have asked the provider to take at the end of the report.

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. People's comments included, 'I tell them [staff] where I want to go' and 'They ask me what I want to do'

People experienced care, treatment and support that met their needs and protected their rights. People said about the service, 'They're brilliant, happy with everything', 'They really are good' and 'Very pleased with them."

Where people were assisted and/ or prompted with their medication, people we spoke with did not have any concerns. Staff were appropriately trained in handling medication and risk assessments were in place where applicable.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The provider had appropriate and effective recruitment procedures in place.

The provider had an effective system to regularly assess and monitor the quality of service that people received.

We spoke with six relatives on the telephone on the 31 October 2012 and they were happy with the quality of care that their relative had received. Their comments included: 'Very good, the same carer and very reliable.' 'Its going really well I have got no complaints.'

We saw that where people were able they signed their support plans. Relatives we spoke with told us that they had signed the support plan documentation on behalf of their relative. They told us they were involved in their relatives supporting planning.

We found that staff were clear about what their roles and responsibilities were and what action they would take if they saw or suspected any abuse. People told us that they felt "safe". They all said that if they had any concerns or worries they would speak to their relative or staff.

We saw evidence that staffing levels were appropriate and that staff had received training and were supervised.

We found that most relatives who had raised issues in the past were satisfied with the outcome. Two relatives we spoke with told us that they had not been fully satisfied with the outcome of their complaint but had decided not to pursue the complaint further.