Crimson Hill Support

Crimson Hill Support is a supported living and domiciliary care service which provides support to people in their own homes. The service provides support to people with a learning disability and/or autistic people in Somerset. They also provide a respite ‘short stay’ service for people.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection 13 people were receiving personal care.

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

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

People had plans in place to guide staff on how to support them if they became anxious or upset, the plans were not always regularly reviewed or updated. Records demonstrated staff were not always using appropriate restraint on people. The service recorded when staff restrained people, improvements were needed to ensure staff learned from those incidents and how they might be avoided or reduced. People were not always 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 fully support this practice. Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcome. People were able to pursue their chosen interests.

Right Care

Staff were aware of the signs of abuse and they were aware of how to report any concerns through the appropriate channels. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. Staff promoted equality and diversity in their support for people. Improvements were required to ensure risks to people were fully assessed and mitigated.

Right Culture

The systems to monitor the quality of the service were not fully effective in ensuring shortfalls were identified and actioned. Staff turnover had been high, which meant people were supported by agency staff, this was improving. Staff understood people well and were responsive to their needs.

People and those important to them, were involved in planning their care. Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. Staff valued and acted upon people’s views.

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 good (published 04 April 2018).

Why we inspected

We received concerns in relation to safeguarding. During the inspection we identified safeguarding concerns relating to the use of restraint. You can see what action we have asked the provider to take at the end of this full report.

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. 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 Crimson Hill Support on our website at www.cqc.org.uk.

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.

At our last inspection, we rated the service good. At this inspection, we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection, we found the service remained Good.

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.

People told us they felt safe. Staff understood how to recognise and report signs of abuse or mistreatment. Staff had received training on how to recognise the various forms of abuse, which was regularly updated and refreshed. The provider carried out risk assessments to identify any risks to people using the service and to the staff supporting them. There was a lone working policy, which staff knew about. Safe recruitment processes were completed.

There were sufficient numbers of staff available to keep people safe. There was a stable staff team which provided people with continuity of care. The rota recorded details of people’s visit times and which staff would provide the visit. The registered manager or team leaders were on call outside of office hours and carried details of the rota, telephone numbers of people using the service and staff with them.

Staff supported people safely with their medicines if required. Staff followed good infection control practice. Staff knew the reporting process for any accidents or incidents. Records showed that the provider had taken appropriate action where necessary, and made changes to reduce the risk of a re-occurrence of an incident. The service had suitable processes to assess people’s needs and choices, the registered manager went out to assess people prior to a package of care commencing to check the service could meet the person’s needs.

Staff had appropriate skills, knowledge and experience to deliver effective care and support. All new staff completed the Care Certificate. The Care Certificate is an identified set of national standards that health and social care workers should follow when they are new to working in the care sector. Records showed staff received comprehensive training, which enabled them to carry out their roles effectively. Staff received regular supervision and appraisal from the registered manager and team leaders. Staff completed food hygiene training, they knew about good practice when it came to nutrition and hydration.

Staff asked people for their consent before delivering care or support and they respected people’s choice to refuse care. Care records showed that people signed a contract of care where they gave their consent to the care and support provided. All the people we spoke with said they had been included from the beginning in every aspect of planning their care.

The provider was responsive to people’s needs. Staff supported people, and involved them, (as far as they were able), to draw up and agree their own support plan. All the relatives we spoke with said they had very good communication with all staff at every level and were involved in their relative’s care.

The agency worked closely with health and social care professionals to ensure each person received a support package tailored to meet their individual needs. We spoke with professionals, who told us they could contact the provider by phone or email and they got a response straight away.

The provider sought people’s feedback and took action to address issues raised. There was a system in place to manage and investigate any complaints. People had information about how to make a complaint in their care records and in their home. It was also available in an ‘Easy read’ format. The provider recorded incidents and accidents for patterns of behaviour. They used this information to consider any changes in a person’s support needs and how staff could meet those needs.

There was a management structure in the service, which provided clear lines of responsibility and accountability. Staff were highly valued by the provider and their contributions were appreciated and celebrated.

There were effective quality assurance arrangements at the service in order to raise standards and drive improvements. The service’s approach to quality assurance included completion of an annual survey. There were strong links with the community. Health and social care professionals

told us the agency was well managed. The provider had ensured they complied with all relevant legal requirements, including registration and safety obligations, and the submission of notifications.

Further information is in the detailed findings below