Archived: Head Office (Omega Homes Ltd)

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.

Head Office (Omega Homes) is a domiciliary care agency and 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 the Longfield and Gravesend area of Kent. 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.

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 six people diagnosed with learning disabilities and autistic spectrum disorder at the time of the inspection.

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’s experience of using this service:

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; staff recognised that people had the capacity to make day to day choices and supported them to do so. People were encouraged to be independent. People were engaging in the community.

Risks to people’s safety had not always been identified. Risk assessments did not have all the information staff needed to keep people safe. The provider had not always reported and arranged repairs with the landlord and maintenance had not always been undertaken in a timely manner.

Medicines were not always managed safely. Medicine administration records (MARS) were not always complete and accurate and did not always show that people received their medicines as prescribed. Where people had ‘as and when’ medicine such as pain relief there was information for staff such as how often the medicines could be taken and when it may be needed. Medicines were stored safely.

People were not always supported to have maximum choice and control of their lives. Staff supported 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 consent forms which relatives had signed. There were no capacity assessments in place to evidence that the person had been asked about the decision. There were no records that best interest meetings had taken place with relevant people to discuss what would be in people’s best interests.

The provider had not always made adequate records when recruiting staff to demonstrate that they had carried out thorough pre-employment checks. This is an area for improvement. There were suitable numbers of staff on shift to meet people’s needs.

Accidents and incidents had appropriately been recorded and reported and actions had been taken. The accident and incident forms had not always been updated by a member of the management team to detail that action had been taken. This is an area for improvement.

Information about people’s health needs and their preferences for support were not always clear. Some people had a diagnosis of epilepsy. Their keeping healthy plans and hospital passports did not detail that they had a diagnosis of epilepsy. We made a recommendation about this.

Some people living at one of the supported living services did not have any assessment documentation to evidence that their needs had been assessed prior to moving to the service. we made a recommendation about this.

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 always 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, medicines management, consent and planning care and treatment we had identified and timely action had not been taken to address the issues and concerns their audits had found.

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 attending health appointments.

The service continued to provide 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. People were supported to manage their emotions and had positive behaviour support strategies in place. People were supported to feedback on their experiences and contribute to planning their own support in ways which were suitable for their communication needs. For example, through using pictures, stories and electronic communication.

Staff were kind and caring and had the skills, learning and training they needed to support people. People were encouraged to increase their independence. The service supported people to maintain family relationships.

The service met the characteristics of Requires Improvement in most areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: At the last inspection on 16 August 2016 the service was rated Good (the report was published on 13 September 2016).

Why we inspected: This inspection was a scheduled inspection based on previous rating.

Enforcement: You can see what action we told the provider to take at the back of the full version of this report. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up: We will visit the service again in the future to ensure they have made changes to the quality of the service.

Omega Homes is a domiciliary care agency which provides supported living service to younger adults. Care was delivered to younger adults with learning disabilities, and physical disabilities. 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. At the time of the inspection, the service was providing support to four people who lived in the same house. The service was currently operated from the premises where the four people lived.

There was a registered manager employed at the service. 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 registered manager and staff had received training about the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) and understood when and how to support peoples best interest if they lacked capacity to make certain decisions about their care. Staff understood the processes to follow if they felt a person’s normal freedoms and rights were being significantly restricted.

People were protected against the risk of abuse. Staff had had training and recognised the signs of abuse or neglect and what to look out for. Management and staff understood their role and responsibilities to report any concerns and were confident in doing so. Staff told us they knew what to do if they needed to whistle blow, and there was a whistleblowing policy available.

People had varied needs and the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy for example, by facial expressions, a smile to the registered manager, and staff who were supporting them. Staff were attentive and interacted with people in a warm and friendly manner. Staff were available throughout the day, and responded quickly to people’s requests for help.

There were enough staff with the skills required to meet people’s needs. Staff were recruited using procedures designed to protect people from the employment of unsuitable staff. Staff were trained to meet people’s needs and were supported through regular supervision and an annual appraisal so they were supported to carry out their roles.

There were risk assessments in place for the environment, and for each person who received care. Assessments had been updated and were individual for each person. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People and their relatives were involved in planning their own care, and staff supported them in making arrangements to meet their health needs. Staff contacted other health and social care professionals for support and advice, such as doctors, speech and language therapist (SALT) and dieticians.

People had access to GPs and other health care professionals. Prompt referrals were made for access to specialist health care professionals.

People could easily access food and drink and snacks during the day. People were involved in shopping. Staff knew people that lived in the service well and were engaged in meaningful and fun conversations with people. Staff encouraged people to be as independent as possible.

Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities. People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

People were aware that they could complain and they knew who to talk to if they were worried or concerned about anything. The registered manager said there had been no complaints made in the last twelve months.

The registered manager had sought the views of people living in the service as well as relatives. The results of these surveys were positive.

The provider and registered manager regularly assessed and monitored the quality of care to ensure standards were met and maintained. The providers and registered manager understood the requirements of their registration with the CQC.