We had not previously inspected this service. This comprehensive inspection took place on 24 and 25 May, 23 and 28 June 2017. The first day of the inspection was unannounced. The provider was given notice on subsequent days because the location provides a domiciliary care service and we needed to be sure that the manager would be available. We also arranged to visit people in their own homes to observe the care provided.
The service was providing care and support to six people living in their own homes, Forest Close and Ormiston, so that they could live as independently as possible. People supported by the service lived with a learning disability and some with autism.
At the time of our inspection the service did not have a registered manager. 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 manager had been overseeing the service since November 2016 and had started the process of registering with the Care Quality Commission to ensure the provider would meet the conditions of their registration.
During this inspection we identified breaches against two of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. Regulation 19 Fit and proper persons employed was not met. Pre-employment checks had been carried out in line with the provider’s recruitment processes. However, these fell short of regulatory requirements for staff working with vulnerable adults. Where staff had previously worked in health or social care, checks did not always include evidence of their conduct in these roles or verifying their reason for leaving, to ensure they were of good character.
Regulation 12 Safe Care and Treatment was not met. People were not always supported by staff who had the knowledge and experience to support them safely and effectively. When incidents occurred these were investigated but the action taken was not always robust or timely enough to reduce future risks.
You can see what action we told the provider to take at the back of the full version of the report. We also recommended the provider consider reviewing the mix of temporary and permanent staff on each shift and seek guidance about the frequency of supervision meetings for new staff.
The provider was recruiting more staff and making training and support available to ensure staff would develop the skills they needed. Key worker sessions were being introduced to ensure people had regular meetings with their key support worker to capture their feedback about their care and activities.
Staff and relatives gave us mixed feedback about the leadership in the service. Some were complimentary of the provider. Others told us improvements were needed to the communication in the service and to ensure concerns would always be responded to in a timely manner.
The provider had systems in place to monitor the quality of the service provided to people. They identified that improvements were needed during their audit of the service in May 2017. We saw the concerns they identified were similar to the ones we found at this inspection. However, the manager had not identified the extent to which one person’s community involvement and opportunity for social interaction had been compromised. The provider was working on a service improvement plan with commissioners. Time was needed before we could evaluate the effectiveness of the provider’s action plan in making and sustaining the required improvements.
Staff were caring and motivated to support people to enjoy meaningful activities and relationships. People’s likes and dislikes were respected and they were assisted to communicate their wishes. Where appropriate, people’s relatives were involved in decision-making and care reviews.
People were supported to maintain good health. A variety of health professionals were involved in assessing, planning and evaluating people's care and treatment.