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Inspection carried out on 18 January 2018

During a routine inspection

This inspection took place on 18 January 2018 and was announced.

This service provides personal care and support to eight younger adults living in ‘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. This service is also a domiciliary care agency. It provides personal care to people living in their own homes. This supported living and domiciliary care agency meets the needs of people with learning disabilities, autism or people with more complex health needs such as epilepsy. The service is run from an office in Chatham.

A registered manager was 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 last inspection report for GUTU was published on 12 July 2017 following a comprehensive inspection which took place on 9 May 2017. At that inspection, we found six breaches of the legal requirements set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in relation to Regulation 9, Person centred care; Regulation 11, Need for consent; Regulation 12, Safe care and treatment; Regulation 17, Good governance; Regulation 18, Staffing; Regulation 19, Fit and proper persons employed. We asked the provider to take action to meet the regulations.

When we completed our previous inspection on 12 July 2017, we also recommended that the provider ensures people’s wishes and preferences were documented and respected. At this time this topic area was included under the key question of Caring. We reviewed and refined our assessment framework and published the new assessment framework in October 2017. Under the new framework this area has been included under the key question of Effective. Therefore, for this inspection, we have checked that this recommendation has been met in the Effective domain.

At this inspection, we found sufficient improvements had been made. At the last inspection, the provider was also the registered manager. At this inspection the provider had employed an experienced manager who had become the registered manager. This had assisted the provider to make improvements to the service and meet the Regulations set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The new registered manager had been recruited with experience of managing learning disability services and for people who had behaviours that could cause harm to themselves or others. Although they were based in an office, the registered manager spent time each week in each service, getting to know people and staff and offering support where needed.

The registered manager involved people in planning their care by assessing their needs based on a person centred approach. People could involve relatives or others who were important to them when they chose the care they wanted. The care plans developed to assist staff to meet people’s needs told people’s life story, recorded who the important relatives and friends were in people’s lives and explained what lifestyle choices people had made. Care planning told staff what people could do independently, what skills people wanted to develop and what staff needed to help people to do.

The registered manager was a train the trainer for the organisation in relation to the Mental Capacity Act 2005 (MCA). The provider understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA). Staff received training about this.

Staff assessed and treated people as individuals so that they understood how they planned people’s care to maintain their safety, health and wellbeing and choices. Risks were assessed within the service, both to individual people and for the wider risk from the environment people lived in. Actions to minimise risks were recorded. Staff understood the steps they should take to minimise risks when they were identified. The provider’s health and safety policies and management plans were implemented by staff to protect people from harm.

The registered manager and the provider had demonstrated a desire to improve the quality of the service for people with a learning disability by listening to feedback, asking people their views and improving how the service was delivered. People, their relatives and staff felt that the service was well led. They told us that managers were experienced, understood people’s needs, were approachable and listened to their views. The provider and registered manager continued to develop business plans to improve the service.

People were often asked if they were happy with the care they received. The provider offered an inclusive service. They had policies about Equality, Diversity and Human Rights. People, their relatives and health care professionals had the opportunity to share their views about the service either face-to-face, by telephone, or by using formal feedback forms.

The provider met their legal obligations by displaying their last inspection rating in their offices and on their website.

Recruitment policies were in place. Safe recruitment practices had been followed before staff started working at the service. The provider recruited staff with relevant experience and the right attitude to work with people who had learning disabilities.

New staff and existing staff were given an induction and on-going training which included information specific to the people’s needs in the service. Staff were deployed in a planned way, with the correct training, skills and experience to meet people’s needs.

The provider trained staff so that they understood their responsibilities to protect people from harm. Staff were encouraged and supported to raise any concerns they may have. Incidents and accidents were recorded and checked by the provider to see what steps could be taken to prevent these happening again. Staff were trained about the safe management of people with behaviours that may harm themselves or others.

Staff received supervision and attended meetings that assisted them in maintaining their skills and knowledge of social care.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. Pictures of healthy food were displayed for people and dietary support had been provided through healthy eating plans put in place by dieticians. Staff supported people to maintain a balanced diet and monitor their nutritional health.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health.

The quality outcomes promoted in the providers policies and procedures were monitored by the management in the service. Audits undertaken were based on cause and effect learning analysis, to improve quality. All staff understood their roles in meeting the expected quality levels and staff were empowered to challenge poor practice.

Management systems were in use to minimise the risks from the spread of infection, staff received training about controlling infection and carried personal protective equipment like disposable gloves and apron’s.

Working in community settings staff often had to work on their own, but they were provided with good support and an ‘Outside Office Hours’ number to call during evenings and at weekends if they had concerns about people. The service could continue to run in the event of emergencies arising so that people’s care would continue. For example, when there was heavy snow or if there was a power failure at the main office.

Inspection carried out on 9 May 2017

During a routine inspection

We inspected this service on 09 May 2017. The inspection was announced.

GUTU is a domiciliary care agency which provides personal care and support for adults in their own homes. The provider who runs the service is Time 4 U Ltd. The service provides care for people living in the Medway area. At the time of our inspection they were supporting 13 people who received support with personal care tasks, five of these people received support in supported living properties.

The service had 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 provider did not follow safe recruitment practice. Gaps in employment history had not been explored to check staff suitability for their role.

Risks to people’s safety and wellbeing were not always managed effectively to make sure they were protected from harm. Risk assessments had not always been completed to address risks and measures had not been put in place to mitigate risks.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. The provider was not aware of the concerns we found at the inspection.

People’s medicines were not always well managed and recorded. There was no evidence that medicines records had been checked and audited, we found gaps on people’s medicines records.

People’s care plans did not always detail their life history and important information about them. Some care plans did not detail what people’s preferred names were. One care file did not contain a care plan at all, which meant that staff did not have the necessary information to provide appropriate care and support.

The provider’s training records contained gaps and omissions which did not tally with staff training certificates. Training had not been provided to staff in relation to meeting people’s assessed needs.

Staff had not received training in relation to the Mental Capacity Act (MCA). Staff were aware of how to support people to make decisions. There were no capacity assessments to demonstrate that people had been assessed to have capacity to make a particular decision.

There were enough staff deployed to meet people’s needs. However, the provider and registered manager did not have adequate systems in place to plan and allocate staffing to ensure that people’s care needs were met.

The provider’s record keeping was inaccurate and incomplete.

People told us staff were cheerful, kind and patient in their approach. Staff treated people and their families with dignity and respect.

Staff received support from the management team, they were encouraged to complete work related qualifications.

Some people received support to prepare and cook meals and drinks to meet their nutritional and hydration needs.

People were supported by staff to be as independent as possible.

People were given information about how to complain and how to make compliments. Complaints had been dealt with appropriately. People’s views and experiences were sought through meetings and surveys.

People gave us positive feedback about the support they received. People had received medical assistance from healthcare professionals when they needed it. Although action had been taken to respond to people’s changing needs, such as contacting people’s GP to request visits, pharmacies, paramedics and district nurses records did not always show that this had been done.

Staff were given clear information about how to report abuse. The safeguarding policy gave staff all of the information they needed to report safeguarding concerns to external agencies. Staff had a good understanding of what their roles and responsibilities were in preventing abuse.

Staff showed us that they understood the vision and values of the organisation; all staff gave examples of providing support to enable choice, control, rights and independence. Feedback gained from people and their relatives evidenced that staff put this in to practice whilst they delivered care and support. However the provider was not meeting their aims and objectives because of the concerns and issues we found during the inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.