We carried out a review of the data available to us about Supporting Solutions Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Supporting Solutions Ltd, you can give feedback on this service.
Supporting Solutions Ltd is a domiciliary care service. At the time of our inspection 28 people received personal care and support. Support was provided for people living in Crich and the surrounding villages. Not everyone using this service received the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.
People’s experience of using this service and what we found
People were supported to have their medicines when these were needed. However, improvements were needed to ensure all information about the how to provide this support was recorded. We have made a recommendation about medicines management.
People felt safe when being supported. The staff knew how to protect people if they suspected they were at risk of abuse and how to report concerns. Risks had been identified and staff understood how to support people to reduce risk and protect them from potential harm, without restricting their rights. Recruitment checks were completed to ensure where new staff were employed they were of good character and sufficient staff were available to meet people's support needs and provide their care.
People had been involved with developing their care plan, which included details of how they wanted to be supported. 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.
Staff received an induction when they started working in the service and training to ensure they understood how to provide care for people safely. People maintained responsibility for their own health and staff knew when people’s health changed and when they needed support to remain well. People were assisted to maintain their preferred diet safely.
People received care from a small team of staff who they had developed good relationships with. People complimented the staff team for the care and support they provided, and staff knew what was important to people. People’s independence was promoted, and their privacy and dignity were upheld.
People received personalised care and support and had a personalised care plan which recorded how they wanted to be supported. People knew how to make a complaint and were encouraged to give regular feedback about the service they received.
Infection control was managed well and the provider had the necessary guidance available to respond to coronavirus and other infection outbreaks effectively.
Quality monitoring systems had been developed to help ensure a safe service was maintained. The staff and management team were clear about the values of the service and the purpose of the services provided.
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 Inadequate (published February 2020) 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 February 2020. 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 was a planned inspection based on the previous rating.
Supporting Solutions Limited is registered as a domiciliary care agency providing the regulated activity ‘personal care’ to people who live in their own homes in Crich and surrounding areas. At the time of the inspection visit there were 51 people using the service.
The service was providing different levels of support to 47 people. Not everyone who used the service received personal care. At the time of inspection 46 people were receiving personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and nutrition. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
People did not receive safe care and were not protected against avoidable harm, abuse, neglect and discrimination due to inadequate staffing numbers. Risks assessments were not put in place in to reduce risks. People’s medicines were not managed safely as related records were not checked for errors and omissions. Recruitment practices were not safe, as the provider did not ensure staff employed had adequate references and safety clearances in place before commencing work with vulnerable people.
We found some people were not supported to have choice or control over their lives and were not supported in the least restrictive way possible. We found a person had been restricted in their own home, which was against Deprivation of Liberty (DoLS) principles. Some staff received training that enabled them to have the skills and knowledge to provide effective care however there were shortfalls in staff training and some had not had induction training to fully prepare them for their roles. Staff supported people with their nutrition and hydration, however, care plans and risk assessments did not provide staff with clear guidance on the risk around the consistency of food and when it was safe to leave people with food and drinks.
People who received care and support were not always fully respected or had dignified care. People and family members, when appropriate, had not actively been involved in developing their care and on most occasions had no care plan.
Brief information was in place to guide staff what care people required. However, this was not consistent and did not provide staff with people’s full support needs or their preferences in how they wanted their care delivered. Complaints had not been recorded or responded to in such a way that we could ascertain if this had been done in a timely manner.
The provider had not implemented the recommendations from the last inspection in 2016. This had resulted in there being no reliable systems in place to continuously monitor the quality of the service. Though the management team were open and honest about the shortfalls in the service and were working with outside agencies to improve the care, they had not understood where systems were failing due to the absence of any regular monitoring of the systems and staff providing care. The provider failed to provide a culture that was inclusive, or person centred. They continued to take on additional care packages that they and the staff were unable to cover adequately. Communication with the staff team was poor. Staff told us they felt pressured to take on extra care calls, which led to people being placed at risk.
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. The last report was published 31 August 2016.
Why we inspected
This was a planned inspection based on the previous rating.
We have found 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.
The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.
Enforcement
We have identified breaches in relation to Regulation 9 (Person Centred Care), Regulation 10 (Privacy and Dignity), Regulation 11 (Need for Consent), Regulation 12 (Safe Care and Treatment), Regulation 13 (1) (Safeguarding Service Users from Abuse and Improper Treatment), Regulation 17 (Good Governance), Regulation 18 (Staffing), Regulation 19 (Fit and Proper Persons Employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 at this inspection.
Please see the action we have told the provider to take at the end of this report. 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.
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 6 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.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The service is a domiciliary care service registered to provide personal care to people in their own homes. On the day of inspection the service was providing personal care to 23 people.
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.
Although we saw evidence of checks taking place and appropriate response to complaints we found the service lacked a formal structured process of quality assurance with few management systems and plans in place. This meant it was not easy for the registered manager to identify where improvements were required or where they were doing well. We recommended the service develops a management and quality assurance system, which will help them access and analyse information and data that could help improve their service.
However, we found people were cared for safely by staff who had been trained and understood how to protect people from harm or abuse. The registered manager followed safe recruitment practice and ensured all necessary recruitment checks had been completed before staff worked alone with people. People received their medicines on time and as prescribed. People told us they felt safe with the staff from Supporting Solutions.
People were very happy with how staff cared for them and felt they had the skills and knowledge to care for them effectively. Staff received the necessary training and guidance they required to care for individual needs. They understood the principles of mental capacity and consent and considered this when caring for people. People were supported to have regular meals and drinks of their choice and to access community healthcare services where required, to maintain their health and wellbeing.
The staff at Supporting Solutions were kind, compassionate and developed positive caring relationships with people, based on mutual respect and dignity. Staff were passionate about improving the quality of people’s lives and promoted their independence, choice and rights. People told us they were very happy with the care they experienced and repeatedly told us they would recommend the service to others.
Staff clearly knew people personally. They understood the individual needs of people and respected their preferences and ‘how they liked things done’. People contributed to their care plans and were involved in reviews of care when their needs changed. The registered manager regularly sought feedback on the quality of care and responded quickly to changing need.
People and staff told us there was visible and accountable management of the service and the registered manager was ‘always available’ for support or guidance. There were strong links with other health and social care services, particularly the district nurses, which enabled a holistic response to people’s needs. Staff were motivated to provide high quality care and to improve their practice.