Background to this inspection
Updated
13 August 2021
The inspection
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.
Inspection team
The inspection was carried out by two inspectors.
Service and service type
This service provides care and support to people living in two ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
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 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us.
Inspection site visit activity started on 28 April 2021 and ended on 5 May 2021. We visited the Southfleet supported living location on 28 April 2021 to see the registered manager, people and staff; and to review care records and policies and procedures. We visited the Gravesend supported living location on 29 April 2021 to meet with people, staff and view care and support records. We made telephone calls to staff and relatives between 29 April 2021 and 5 May 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We reviewed the information we held about the service including previous inspection reports. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
We contacted health and social care professionals to obtain feedback about their experience of the service. These professionals included local authority commissioners and local authority safeguarding coordinators and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Healthwatch told us they did not have any information about the service. A local authority care manager provided feedback. We used all of this information to plan our inspection.
During the inspection
We spent time with five people who received a service. We also spent time speaking with two people. We spoke with three people's relatives. Some people were not able to verbally express their experiences of staying at the service. We observed staff interactions with people and observed care and support in communal areas.
We spoke with six staff including; support workers, senior support workers, the deputy manager, and the registered manager. We reviewed a range of records. This included three people's personal care records, care plans and people's medicines charts, risk assessments, staff rotas, staff schedules, three staff recruitment records, and meeting minutes. 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 registered manager to validate evidence found. We looked at training data and quality assurance records.
Updated
13 August 2021
About the service
Head Office (Omega Homes) is a supported living service. It provides personal care to younger adults with learning disabilities, and physical disabilities living in their own houses which were supported living environments. People needed help with day-to-day tasks like cooking, shopping, washing and dressing and help to maintain their health and wellbeing. People had a variety of complex needs including mental and physical health needs.
Head Office (Omega Homes) provides care and support to people living in two 'supported living' settings, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.
The service had two supported living properties in Gravesend area of Kent, one in Southfleet and one in Gravesend. In these premises people each had their own bedrooms, but shared the kitchen, dining room, lounge, laundry and the garden. There was an office at each site and a sleep-in facility for staff to provide overnight support.
Not everyone using Head Office (Omega Homes) receives 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. The service was providing personal care to seven people diagnosed with learning disabilities and autism at the time of the inspection.
People’s experience of using this service and what we found
Risks to people's safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. Medicines management had improved; however, medicines were not always stored securely.
People were not always supported to have maximum choice and control of their lives. Staff did not always support them in the least restrictive way possible; the policies and systems in the service did not always support this practice. Some people's care files showed mental capacity assessments and best interest decision making had not always been carried out with relevant people. One person had an alarm fitted to their door which they had not consented to, their relatives and other health and social care professionals involved in their life had not been informed or involved in the decision making.
Accidents and incidents had appropriately been recorded. However, the accident and incident forms had not always been updated by a member of the management team to detail what action had been taken. Relevant people had not always been informed of accidents and incidents which included notifiable events such as a serious injury and safeguarding concerns.
Information about people's health needs and their preferences for support were not always clear. Some people had a diagnosis of epilepsy. Their support plans, keeping healthy plans and hospital passports did not always detail that they had a diagnosis of epilepsy and how staff should support them if they had a seizure.
When people’s needs had changed their assessments and support plans had not always been updated and amended to detail their current assessed needs. Support plans and supporting documentation were not always individualised and person centred. Which meant that people may receive care and support which did not meet their needs.
The service was not well led. The registered manager knew people well and people were comfortable communicating with them. The registered manager and provider had carried out the appropriate checks to ensure that the quality of the service was maintained. However, the audits and checks were not robust. They had not captured the issues relating to risk management, consent and planning, care and treatment we had identified.
There were suitable numbers of staff on shift to meet people's needs. Staff had been safely recruited and pre employment checks had been carried out.
The provider ensured people were protected by the prevention and control of infection. Staff had completed the relevant training. People and staff had access to enough personal protective equipment (PPE).
There was a positive atmosphere at the supported living services. People were happy, and staff engaged with people in a kind and caring way. People were busy when we visited, engaging in activities and undertaking daily living tasks as well as meeting up with relatives in the community.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
This service was not able to consistently demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right support:
The size and structure of the service was in line with the principles of Right support, right care, right culture. Staff did not always deliver care in a person-centred way that offered people choice, control and independence.
Right care:
The service was not always consistent when providing effective support to people living with a learning disability and or autism. People were provided with good support to communicate; staff knew people well and understood their communication. Staff were kind and caring. People were encouraged to increase their independence. The service supported people to maintain family relationships.
Right culture:
People continued to be supported to feedback on their experiences in ways which were suitable for their communication needs. For example, through using pictures, stories and electronic communication.
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 3 June 2019). There were four breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve.
At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.
Why we inspected
This inspection was carried out to follow up on action we told the provider to take at the last inspection.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to management of risks and staff skills to ensure people are supported safely, safeguarding people from abuse, capacity and consent, assessment and planning of care and support needs and effective systems and processes to monitor and improve the service at this inspection. We also identified a breach in relation to failing to notify CQC about incidents.
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.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.