Individual Care Services

Individual Care Service provides personal care to people in their own homes and 24-hour shared supported living services. Care and support are provided to people living with a learning disability and other support needs including autism and health conditions. At the time of our inspection visit, the service was providing personal care to 42 people.

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

At the last inspection governance systems and management oversight of the service was inadequate. At this inspection the provider had made significant progress in improving their systems and processes to maintain oversight of the service and was no longer in breach of regulation. However, the system to identify important appointments for people to attend was not as effective as it should be, this meant important health appointments had been missed.

At the last inspection people had not always received care that was safe. Risks were not always identified, and support plans did not contain enough information for staff. At this inspection improvement had been made. People had care plans and risk assessments that had been reviewed and now contained the information needed for staff to provide safe care. Systems for staff to record and report safeguarding concerns had been improved.

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.

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 outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion.

People’s access to important information was being improved by the provider. Changes were being made to make information more accessible for people to understand and there was a fresh emphasis by the provider on ensuring staff had the training and resources to understand the needs of people with learning disabilities.

Their was an emphasis on promoting people’s independence and people told us that they felt well supported and cared for by staff.

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 15 October 2021) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 15 October 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Individual Care Service provides personal care to people in their own homes and 24-hour shared supported living services. Care and support are provided to people living with a learning disability and other support needs including autism and health conditions. At the time of our inspection visit 42 people were supported by the provider and each received a regulated service.

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

Governance systems, management and provider oversight of the service were inadequate. Systems and processes designed to identify areas of improvement were ineffective because audits and checks had not identified the concerns we found.

People did not consistently receive safe care. Risks associated with people's care were not always identified, managed or mitigated. The provider had not effectively assessed staff had the skills, knowledge or experience they needed to provide care and support which ensured people living at the service were safe.

Systems and processes to support people from the risks of abuse were not always effective.

The provider had accepted offers of support and training from the local authority around COVID-19.

Staff did not always have important information about people’s health conditions. People's support plans did not always contain detailed or accurate information to help staff support people safely. Some information was out of date and posed potential risks of harm to people.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support least restrictive practices. Where restrictive practices were used the provider had not always acted in line with the Mental Capacity Act 2005.

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 provider was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right Support – the providers model of care and setting did not maximise people’s choice, control and independence.

Right Care – care was not consistently person-centred and did not always promote people’s dignity, privacy or human rights.

Right Culture – the ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services led confident, inclusive and empowered lives.

This was because the provider’s systems and processes failed to identify shortfalls in the right support, right care and right culture. We, and the local authority, have identified to the provider where improvements are needed.

People and relatives shared some positive experiences of their care with us and we observed some positive interactions between staff and people supported. However, improvements were needed to ensure this was everyone’s experience.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good. (Report published 17 June 2019).

Why we inspected

We undertook this focused inspection because emerging risks had been identified by us and other professional bodies including the Local Authority and visiting healthcare professionals. We had also received information of concern from staff and members of the public prior to our inspection visit, in relation to the management of risks at supported living services. As a result, we planned a focused inspection to review the key questions of Safe and Well Led only. However, during our inspection we found improvements were needed in other key questions and included Effective, Caring and Responsive and have therefore reported our findings in all five key questions.

We have found evidence that the provider needs to make improvements.

You can see what action we have asked the provider to take at the end of this full report.

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 our 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 identified breaches in relation to the risks associated with people's care and management oversight of the service. The provider had not ensured effective systems and processes were in place to monitor the quality of the service and drive improvement.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will work with the 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.

Special Measures

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 six 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.

People’s experience of using this service:

People remained happy with the care and support they received. They had developed positive relationships with staff who kept them safe from harm or abuse.

Staff had the knowledge and skills to support people in the way they wished. Respecting their individuality and encouraging them to remain as independent as possible.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive ways possible; the policies and systems in the service supported this practice.

People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with people’s personal preferences. The risk management plans mitigated any risks identified.

People were encouraged to pursue their interests and live as full a life as possible. They were involved with activities within the community.

People were protected against the risk of infection and received their medicines on time.

There were enough staff to support people in the way they wished, and staff had undertaken recruitment checks which assured people were cared for by suitable staff.

People were supported to maintain good health and nutrition. Information was provided to people in an accessible format to enable them to make decisions about their care and support.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

The service had a positive ethos and an open culture. The registered manager was approachable, understood the needs of people, and listened to staff and relatives.

There were effective systems in place to monitor the quality of the service and drive improvements.

The service met the characteristics for a rating of “good” in all the key questions we inspected. Therefore, our overall rating for the service after this inspection was “good”.

Rating at last inspection: Good (report published August 2016). The rating has remained the same.

Why we inspected: This was a planned inspection to check whether the service had remained Good.

Follow up: We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

There was 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.

The service is provided for younger adults who may live with learning disabilities, autistic spectrum disorder, a physical disability or dementia, at thirteen different houses. At the time of our inspection, fifty-seven people were receiving an assisted living service, but only nine people received assistance with personal care, which is the regulated activity covered by the Health and Social Care Act 2008, that we regulate.

People were safe and were protected from the risks of abuse. Staff were trained in safeguarding and understood the action they should take if they had any concerns that people were at risk of harm. The registered manager checked staff’s suitability to deliver personal care in people’s own homes during the recruitment process.

Care plans included risk assessments for people’s individual health and wellbeing and described the actions staff needed to take to minimise the identified risks. Staff understood people’s needs and abilities because they read the care plans and shadowed experienced staff when they started working for the service.

The registered manager assessed risks in each person’s home and advised staff of the actions they should take to minimise the risks. People’s medicines were administered safely because the provider’s medicines policy included training staff and checking that people received their medicines as prescribed.

Staff received training and support that enabled them to meet people’s needs effectively. Staff had opportunities to reflect on their practice and consider their personal career development.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Records showed that people, their families and other health professionals were involved in making decisions about their care and support. Staff understood they could only care for and support people who consented to being cared for.

Staff referred people to healthcare professionals for advice and support when their health needs changed, and supported people to follow the health professionals’ advice.

People told us their care staff were kind and understood them well, so they felt like friends. The provider asked people about their preferences, likes and dislikes for care and support during their initial assessment of needs.

People told us staff respected their privacy, dignity and independence, and they were supported to life the lives they wanted. People knew any concerns or complaints would be listened to and action taken to resolve any issues.

People were encouraged to share their opinions about the quality of the service through one-to-one conversations with a member of the management team.

The staff and management team shared common values about the aims and objectives of the service. People were supported and encouraged to live as independently as possible, according to their needs and abilities.

The provider’s quality monitoring system included regular checks of people’s care plans and staff’s practice. When issues were identified the provider took action to improve the quality of the service people received.