Background to this inspection
Updated
7 November 2020
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
The inspection was carried out by one inspector.
Service and service type
This service provides personal care and support to people living in seven ‘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.
This service is also registered to provide domiciliary care. Face2Face’s ‘outreach’ service provides support to people living in their own houses and flats. People using the outreach service were not in receipt of personal care at the time of the inspection; Therefore, this inspection did not include the domiciliary care service.
The service did not have a manager registered with the Care Quality Commission, but an application had been submitted by the manager. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection. 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 25 August 2020 and ended on 10 September 2020. We visited the office location on 26 and 27 August 2020.
What we did before the inspection
We reviewed information we had received about the service since the last 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 requested documents related to infection control and management of the service from the provider. We took this into account when we inspected the service and made the judgements in this report.
We used all of this information to plan our inspection.
During the inspection site visit
We visited one supported living house and spoke with two people who used the service about their experience of the care provided. We observed two staff members while they were supporting people at the house. We spoke with four members of staff including the manager / area manager, service manager, peripatetic manager and quality auditor. We reviewed a range of records. This included four people’s care records and three people’s medication 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 rotas and incident records were reviewed.
After the inspection site visit
We spoke with three people’s relatives about their experience of the care provided. We spoke with a further five members of staff including two senior care workers and three care workers. We continued to seek clarification from the provider to validate evidence found. We looked at training data, polices, business continuity plans and quality assurance records, including those related to coronavirus. We received feedback from five professionals who regularly visit the service.
Updated
7 November 2020
About the service
Face2Face is a supported living and domiciliary care service providing personal care and support to adults with learning disabilities and/or mental health needs. At the time of the inspection five people using the service were receiving the regulated activity of personal care. These five people lived with others who received support which is not regulated.
People’s experience of using this service and what we found
Systems in place to monitor the quality and safety of the service people received had been improved. However, more work was needed to ensure these systems were fully effective in addressing shortfalls. Lack of consistency in management of the service had meant advice from health care professionals about the support people needed had not always been followed-up as expected. People, relatives and staff were positive about the provider and the support people received from staff.
The service was safe. Improvements had been made to medicines management and review of incidents and accidents, to ensure people received a safe service. Health care professionals were involved in reviewing people’s support needs.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People’s opportunities to follow their goals and live as full a life as possible had been impacted by COVID-19. The service had reviewed restrictions on people’s activities and movements in line with national guidance.
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.
When people’s capacity to consent to their care and support was in question, capacity assessments had been carried out. Where people’s liberty was restricted, the provider had informed the local authority who had commissioned care and updated them regularly.
The provider worked openly with others and reported incidents to external agencies as required.
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 29 July 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do to improve and by when. At this inspection we found not enough improvement had been made and the provider was still in breach of the regulations.
The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
We carried out an announced inspection of this service on 12 and 18 June 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when, to improve safe care and treatment and governance.
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 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 stayed the same. 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 Face2Face 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 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 one breach in relation to good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.