Archived: Face2Face

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.

Face2Face is a domiciliary care service that provides personal care to people with learning difficulties and mental health needs. At the time of this inspection 31 people were being supported under the regulated activity. Further people were using the service, but they did not receive the regulated activity of personal care. The service supported people across seven supported living services and in their own individual homes under the outreach part of their service.

People’s experience of using this service:

The management of medicines was not always safely undertaken. We found that people’s medicines were recorded inconsistently in care plans documents and not all records were updated when reviewed.

We reviewed the incidents recorded and saw that there was not always enough information recorded on how a reoccurrence of the incident would be prevented and the lessons learnt.

Not everyone’s capacity had been assessed or consent evidenced for some practices that restricted their liberty.

We identified that four incidents of physical abuse between people using the service had not been notified to CQC.

The providers systems to monitor the quality of care and support that people received had not always been effective.

People’s care records showed relevant health and social care professionals were involved with people’s care. Information was available in easy read format on people’s specific health conditions.

People and their relatives were happy with the care and support received and praised the staff for their kind and caring nature.

People were encouraged to make choices in their everyday life.

Staff told us they felt supported by the management and that they were approachable.

Rating at last inspection:

Good (report published 16 December 2016)

Why we inspected:

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

Follow up:

We have told the provider they must take action to improve the service. We will ask the provider to send a report of actions on how they will make changes to ensure the service improves their rating to at least Good.

Face2Face is a supported living and domiciliary care service that supports people with learning difficulties and mental health needs. At the time of our inspection there were 29 people being supported by the service.

Face2Face 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.

People were at risk of receiving care from unsuitable staff because robust recruitment procedures were not always being applied. We have made a recommendation about staff recruitment. Medicines were generally managed safely.

We received positive feedback from health and social care professionals, such as “they have a good track record of working with our more able individuals who may have additional mental health needs”.

Sufficient staffing levels were maintained and staff were supported through training and supervision to maintain their skills and knowledge to care for people living with dementia. Risks to people’s safety were identified, assessed and appropriate action taken. People had positive relationships with the staff team.

People were treated with kindness, their privacy and dignity was respected and they were supported to develop their independence and keep in contact with relatives. People were involved in the planning and review of their care and were supported to engage in suitable activities of their choice. People had positive relationships with the staff.

Staff received support to develop knowledge and skills for their role. The management team was accessible to people using the service and staff. Staff spoke positively about their work with people. Systems were in place to check the quality of the service provided.

Through looking at care plans of six of the 18 people supported we saw that people's needs were assessed and plans drawn up and implemented to meet those needs. One person told us "I keep my care plan at home and staff tell me what they write in it".

We found the provider had in place systems to protect people from abuse and had acted appropriately and quickly in responding to concerns regarding abuse. Staff members were able to tell us how they would respond in the event of abuse being suspected, witnessed or alleged.

People told us they liked the staff supporting them. One staff member we spoke to told us that teamwork and consistency within the staff team was good. We found the provider employed enough qualified, skilled and experienced staff to meet people's needs.

We found the provider had in place systems to assess and monitor the quality of service that people receive. The provider told us they thought it was essential to keep trying to improve how people were cared for and supported.

One parent had said 'all I can say is praise, praise, praise. Praise for the staff who are understanding of our son's needs and delivering a good service'. Another parent said 'it is wonderful to see our daughter so at ease with her carers and able to discuss anything. It was good to see that she could choose her own keyworker'.

We reviewed two care files for people using the service. The care files are kept by the people themselves and were very comprehensive. They were person centred and had appropriate care plans and risk assessments. Each person also had their own action plan of activities they wanted to do. For example one person wanted to go do Disneyland, have new wardrobes and start counselling. The staff were able to support this person to achieve their goals.

We spoke to two people who use the service and they told us 'the staff are really nice and caring, they all help me and involve me in the care I need'.