Choices Healthcare Ltd Suffolk

A supported living service can be shared accommodation or single household properties where people with a learning disability and/or autistic people receive personal care and support to enable them to live as independently as possible. CQC only inspects where people receive a regulated activity of 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 care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked only at people’s personal care and support.

At the time of this inspection they were 24 people who received personal care and they were being supported by live in care staff in their own homes.

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

At the previous inspection we found shortfalls in safeguarding people, recruitment, safe care and treatment and governance and oversight in the service. We took enforcement action which included a Warning Notice due to a breach of regulation 17 and the concerns identified with the governance and oversight in the service.

This was a targeted inspection to follow up on the Warning Notice and check improvements had been made to mitigate the risk. We inspected but did not rate the key question of well-led and found that the provider had engaged with relevant partner agencies, was committed to developing the service, the level of risk had reduced and the specific concerns identified in the Warning Notice had been met.

However, the service remained in breach of the regulation as progress to make all necessary improvements to their governance and oversight arrangements was ongoing and due to some personnel changes this had impacted on the delivery timescales.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right Support, Right Care, Right Culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

At our previous inspection we made a recommendation that the provider fully assesses the care and support provision at the service to embed the principles of right support, right care, right culture into care planning and delivery.

At this inspection we noted the provider was updating all their care plans and reviewing their exisiting training on learning disability and Autism for staff with consideration being given to staff receiving relevant training for their role. This included The Oliver McGowan Mandatory Training on Learning Disability and Autism. This is the government’s preferred and recommended standardised training for health and social care to undertake.

Right Care:

Improvements had been made to the provider’s systems to assess and manage risks safely for people and were ongoing to support people to have maximum choice and control of their lives and for staff to support them in the least restritctive way possible and in their best interests; the polices and systems in the service to support this practice were also being reviewed.

Right Culture:

Systems for auditing had been introduced but needed further development to consistently evidence and document the actions taken and where applicable lessons learnt. The provider was working to establish an open and transparent culture in service, discussing the outcomes of the last inspection and their improvement plans with staff, people, and relatives.

Overall feedback about the care people received was positive and on occasion where people had an issue the provider had acted appropriately to address this. People and relatives shared that the handover process when the live in carers changed over was not always a smooth transition and communication was still mixed at times from the office but moving in the right direction.

We noted that the provider was taking action to address the inconsistencies raised with handover and communication but it was too soon to assess the effectiveness of this during this inspection.

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 21 January 2023). We found breaches of the regulations and we issued the provider with a Warning Notice. At this inspection we found the Warning Notice had been met, level of risk had reduced, but the provider remained in breach of the regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to regulation’s 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We inspected but did not rate the key question of well-led. The overall rating for the service remains requires improvement based on the findings of last inspection.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Choices Healthcare Ltd -Suffolk on our website at www.cqc.org.uk.

Follow up

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.

About the service

Choices Healthcare Ltd Suffolk provides personal care to people who live in their own home. The service supports older people as well as autistic people and people who have a learning disability. The service mainly provides live in care staff to people in their own homes. They also have a supported living service which recently had people living in it but was not active at the time of the inspection.

A supported living service can be shared accommodation or single household properties where people with a learning disability and/or autistic people receive personal care and support to enable them to live as independently as possible. CQC only inspects where people receive a regulated activity of 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 care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked only at people’s personal care and support.

At the time of this inspection they were 35 people who received personal care and they were being supported by live in care staff.

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

At this inspection we found shortfalls in safeguarding people, recruitment, safe care and treatment and governance and oversight in the service.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. We have made a recommendation the provider fully assesses the care and support provision at Choices Healthcare Ltd Suffolk to embed these principles.

Right Support:

The Mental Capacity Act was not fully understood. We found shortfalls in records and practice, which did not support shared decision making. People were not always supported to have maximum choice and control of their lives. Staff did not consistently 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.

People were not always supported by a staff team who were safely recruited.

Care staff received an induction and ongoing training, they felt supported in their role.

Right Care:

Processes to safeguard people from the risk of abuse were not robust. Not all safeguarding concerns had been escalated properly to CQC. There was mixed feedback regarding communication from the service and with raising a concern.

Care and support was not always person-centred and did not promote people's dignity, privacy and human rights. Risks to people were not always assessed and managed safely.

Right Culture:

The service was not always open and transparent. Systems to monitor the quality and safety of the service were not wholly effective. The provider had not identified the inconsistencies we found during the inspection.

Improvements were needed to the overall governance, management and oversight arrangements of Choices Healthcare Ltd Suffolk.

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 (published 15 June 2018).

Why we inspected

This inspection was prompted in part due to concerns received about staffing, quality of care and safeguarding concerns. A decision was made for us to inspect and examine those risks. 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 and Recommendations

We have identified breaches in relation to safe care and treatment, recruitment, safeguarding 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

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

When we inspected on 16 April 2018 there were five people using the service. This was an announced inspection. The provider was given up to 48 hours’ notice because the location provides a domiciliary care service and we wanted to be certain the registered manager and key staff would be available on the day of our inspection. This service was registered in 4 May 2015.This was their first inspection.

Not everyone using the service from 19b receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene, medicines and eating. Where they do we also take into account any wider social care provided.

A registered manager was 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.

Overall the feedback was positive about the approach of the care workers and the service provided. Relatives told us that the care workers were kind and compassionate, promoted people’s independence and respected their privacy and dignity.

Care staff knew what actions to take to protect people from abuse. The provider had processes in place to identify and manage risk. People’s risk assessments were regularly reviewed and amended to meet changing needs.

Improvements had been made and were ongoing to ensure people’s care records reflected individualised personalised care.

Care workers knew the people they provided care to well and were able to describe how to meet people's needs effectively. Where care workers had identified concerns in people’s wellbeing there were systems in place to contact health and social care professionals to make sure they received appropriate care and treatment. Where required people were safely supported with their dietary needs.

Recruitment checks were carried out with sufficient numbers of care workers employed, to maintain the schedule of visits and provide continuity of care for people. Where we identified gaps in the recruitment processes the management took swift action to address this. Care workers received supervision and training to support them to perform their role.

Where people required assistance with their medications, safe systems were followed. Care workers were provided with training in infection control and food hygiene and understood their responsibilities relating to these areas. Systems were in place to reduce the risks of cross infection.

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

People and, when appropriate, their relatives were involved in discussions about their care planning and given the opportunity to provide feedback on the service. They were also supported to raise complaints should they wish to.

At the time of the inspection no one using the service was receiving palliative care. However the registered manager assured us that people would be supported to receive a comfortable, dignified and pain- free death.

Feedback from relatives and care workers was positive about the management arrangements at the service. However they described inconsistencies with communication due to personnel changes at the office. Improvements had been made and were ongoing to address this, these need to be fully embedded into the service.

Systems were in place to monitor the quality and safety of the service provided. Processes enabled the management team to monitor accidents, adverse incidents or near misses. These helped to identify any themes or trends, potential learning and continual improvements in safety.

Recording and documentation in these areas had recently been improved. However this was not yet fully embedded into practice and had not identified the inconsistencies we found during this inspection.