Background to this inspection
Updated
11 February 2022
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 Health and Social Care Act 2008.
Inspection team
The inspection was carried out by one inspector 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 provides care and support to people living in four ‘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.
The service did not have a manager registered with the Care Quality Commission. The manager had been in post for three months and had applied to become registered with CQC.
Notice of inspection
We gave the service less than 24 hours’ notice of the first day of the inspection. We contacted the service because it 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 29 December 2021 and ended on 18 January 2022. We visited one of the supported living properties on 5 January 2022 and the location’s office on 17 January 2022.
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 and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with eight relatives by telephone to ask for their views and experiences of the service. We sent emails to 28 members of staff to request feedback; four replies were received. We observed practice and spoke with staff and people who use the service in the setting we visited.
We looked at a range of records including care plans, staff meeting minutes, service monitoring and audit reports, accident records, staff recruitment files and records of complaints and compliments.
Updated
11 February 2022
About the service
Aylesbury Supported Living Scheme provides support for 27 adults with learning and physical disabilities across four sites in the Aylesbury and surrounding areas. Each property blends in with other housing in the area and is indistinguishable as a care setting. At one of the sites, night time support is provided by another service which is separate to The Fremantle Trust. This is a contractual arrangement with Buckinghamshire Council. People are supported in individual flats and shared houses which are owned by a housing association. People’s care and housing are provided under separate contractual agreements.
People’s experience of using this service and what we found
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.
Based on our review of the Safe and Well-led key questions, the service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People were not always supported to manage their weight and food choices. There was the potential for people to develop health conditions related to obesity. People’s views may not always have been sought about the quality of their care, as there were no checks to make sure processes to do this were followed. We have made a recommendation regarding engagement with people and providing them with feedback about actions taken.
People did not receive safe care. Safeguarding concerns had not always been referred to the local authority. Improvements had not been made in relation to on-going concerns about poor medicines practice and people could not be confident their medicines would be given according to their prescriptions.
There were poor infection prevention and control measures in place. Standards of cleanliness were not sufficient, placing people at risk of infection.
People could not be confident appropriate actions would always be taken when things went wrong. Records of distressed behaviour were not always recorded and trends in accidents were not always analysed, to prevent recurrence.
We had not always been informed of incidents which are notifiable. This meant we could not be assured appropriate action was taken in response to these occurrences, to keep people safe.
Monitoring of the service had not been effective in identifying areas of poor practice, to make sure people received safe care. There was a deterioration in standards of care since the previous inspection.
People were cared for by staff who had been recruited appropriately. There was mixed feedback from staff about the support they received from managers.
A community professional spoke positively about the service. Their feedback included “The staff have been working hard to support someone whose needs have changed significantly over the last couple of years and have adapted their support as his needs have increased.” Another person told us “All the tenants are cared for on an individual basis, not all treated the same and this is always taken into consideration when they are providing activities. Independence is promoted and encouraged and the tenants are empowered to do as much as possible for themselves.”
Relatives spoke positively about standards of care and the support their family members received. Comments included “So fortunate to have such a caring team, they are like family,” “The care (the person) gets is first class” and “They look after (name) very well.”
Rating at last inspection
The last rating for this service was good (report published 12 January 2018).
At our last inspection, we recommended the service followed best practice by ensuring all staff had been trained and rehearsed in what to do in the event of a fire. At this inspection, we found the provider had made improvements. We also recommended the service followed best practice when handwriting medicines records, to ensure accurate instructions were provided. We did not see any handwritten entries on the sample of records we checked.
Why we inspected
We received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of Sate and Well-led only. 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 good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of the 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 Aylesbury Supported Living Scheme on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 breaches in relation to safeguarding people from abuse, ensuring people receive safe care and treatment, notification of incidents and governance of the service 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.