10 December 2019
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 Care Act 2014.
The inspection team consisted of one inspector.
Service and service type
This service is a respite service. It provides accommodation and personal care to people on a temporary basis. CQC regulates both the premises and the care provided, and both were looked at during this inspection.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 24 September 2019 and ended on 4 October 2019. We visited the office location on 24 September 2019 and made telephone calls to relatives on 4 October 2019.
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. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We observed four people who used the service and spoke with four relatives about their experience of the care provided. We spoke with three members of staff including the registered manager and three care staff.
We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at staff meetings and quality assurance records.
10 December 2019
About the service
Cypress Road is a respite service providing personal care to four people at the time of the inspection. The service supports up to 30 people over the course of a year with varying amounts of respite.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
There was a lack of effective provider oversight. The concerns identified in the audits had not been addressed quickly enough and demonstrated a lack of rigour. This is a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 good governance.
Risk management needed to be more robust as it relied on staff’s knowledge and length of time in service rather than being documented in full. Staffing levels were sufficient but the lack of drivers impacted on people at weekends when activities were more limited.
The registered manager was trying to develop improvements but there was a lack of overall direction for the service as they were sharing their time between two services. The vision for the service was unclear. The internal environment was tired, but plans were in place with the building’s owner to refurbish. Rooms were adaptable and could be altered according to people’s needs and wishes. The outside area was very accessible and geared for people’s sensory needs.
We observed positive interactions between people and staff. Staff were friendly, supportive and attentive, and respectful of people’s dignity. Staff felt supported and said they access to training and supervision, although the latter was not always individual. Communication between staff was good and work practices were reviewed and reflected on which showed a culture of wanting to change and improve. Medicines management was safe.
Staff could recognise possible signs of abuse and knew how to report such concerns. 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.
Care documentation reflected people’s needs but the service needed to consider how to better involve people and make records more accessible as they had for other parts of the service. Quality assurance systems did assess overall service delivery but had demonstrated reduced levels of performance due to pressures on time. However, all issues had been addressed at the point of inspection.
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 25 March 2017).
Why we inspected
This was a planned inspection based on the previous rating.
We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.
We have identified a breach in relation to provider oversight at this inspection.
Please see the action we have told the provider to take at the end of this report.
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.