GUTU

About the service

GUTU, also known as Time 4 U, is a domiciliary care agency. The service was providing personal care to 25 people at the time of the inspection across Medway and Kent. The service provides supported living to people with physical disabilities, learning disabilities, autism and/or mental health needs. People live in their own houses and flats. Some people lived in small shared houses and some people lived alone.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

Right Care

Risk assessments did not always have information staff needed to keep people safe.

People's care was person centred and met their assessed needs. Support plans were in place which detailed how staff should support people. Relatives said, “Staff are amazing. The care is fantastic”; “They absolutely respect him” and “They are very caring staff and very much know what they are doing, they have great empathy.”

Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough staff to meet people's needs and keep them safe.

Right Culture

The provider had quality monitoring processes in place. These were not always robust and had not always identified concerns and improvements in the service identified during the inspection.

Since the last inspection, people, their relatives and staff had been encouraged and supported to provide feedback about the service. Most people and staff felt listened to.

Right Support

Staff supported people to achieve their aspirations and goals and assisted people to plan how these would be met. Relatives said, “They are very good at making sure she is as independent as possible; she washes herself, takes her plates in. They have improved her self-management, she hoovers and is keeping her space tidy, she is very proud of her flat. Her needs are being met” and “They are encouraging independence. He takes his own medication, under supervision, he has his own front door key, he cleans the bath, although he is a reluctant participant.” The service had systems and processes in place to safely administer and record medicines use. Medicines were administered in line with the prescription.

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 19 August 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We carried out a focused inspection of this service on 29 June 2021. Breaches of legal requirements were found. This inspection was carried out to follow up on action we told the provider to take at the last inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for GUTU on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk management and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

GUTU, also known as Time 4 U, is a domiciliary care agency. The service was providing personal care to 16 people at the time of the inspection across Medway, Kent and Milton Keynes. The service provides supported living to people with physical disabilities, learning disabilities, autism and/or mental health needs. People live in their own houses and flats. Some people lived in small shared houses and some people lived alone.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People told us they were happy with the service they accessed. One person told us, “The staff are very respectful to me.” A relative said, “There are the best people and they persevere through the difficult stuff.” And, “They seem to be fine and [my relative is] happy with the carers.”

Since the last inspection improvements had been made at the service. However, there were areas where improvement continued to be needed.

Improvements were needed to be made to areas of infection prevention and control. Staff were not undertaking all the regular COVID-19 tests in line with Government guidance and the providers policies. Although staff knew people well there were areas of people’s support plans that needed improvement as they did not always include up to date, accurate person-centred information.

Management oversight of some areas such as staff training needed to be improved. Auditing continued to need improvement to drive forward improvements and ensure sustained service quality. People were involved in planning their care. However, some relatives expressed that they were not always as involved as they wanted to be.

Where there were risks to people’s health staff new how to support people. However, people’s emergency evacuation plans needed to include more information. Medicines administration had improved. However, we identified concerns relating to the storage of one person’s medicine as it was not stored securely.

There were enough staff to support people and people told us they received their support as planned. Staff had been recruited safely. The management of incidents and accidents had improved. Where incidents had occurred, appropriate action was taken. People were referred to the provider’s positive behaviour support specialist when required.

People were supported to access the community and engage with activities. There was a complaints process in place. Where complaints have been received, they had been responded to. People had the opportunity to discuss their wishes for end of life support.

People and their relatives as well as staff were invited to undertake surveys where they could express their opinions about the service. Where people have raised issues, these had been addressed. The service worked in partnership with other health and social care services to improve outcomes for people. Staff were happy at the service and received regular supervision.

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 this practice.

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.

Based on our review of Safe, Responsive and Well-led. The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• The model of care and setting maximises people’s choice, control and independence. People made choices about their care and support. People were supported to undertake day to day activities for themselves as appropriate.

Right care:

• Care was person-centred and promoted people’s dignity, privacy and human rights. Staff knew people well and understood their needs, likes and dislikes. People’s support was person centred and people told us they were happy with the support they received. There was a positive culture at the service.

Right culture:

• The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. Staff felt supported and motivated in the role which had a positive impact on the support they provided to people.

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 23 April 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made. However, the provider was still in breach of regulations. The last rating for this service was requires improvement (published 23 April 2020). The service remains rated requires improvement. This is the second consecutive inspection the service has been rated Requires Improvement.

Why we inspected

We carried out an announced comprehensive inspection of this service published on 23 April 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, good governance and notifying CQC of important events as required by law.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for GUTU on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19-19 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 safe care and treatment and Good Governance. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.

GUTU is a domiciliary care agency. It provides personal care to adults with learning disabilities, mental health needs 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.

GUTU provides care and support to people living in 14 ‘supported living’ settings across Medway, Kent and Milton Keynes, so that they can live as independently as possible. 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 property. 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.

Not everyone using GUTU 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 24 people 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 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

Risks to people had not always been identified to ensure staff had the guidance necessary to follow a specific plan to prevent harm. The provider had a system in place to log and record accidents and incidents. However, it was not always clear what actions had been taken after accidents or incidents to reduce the risks of the same issue occurring again. After the inspection, a process was put in place so that the management team could refer people through to the positive behaviour specialist. The provider ensured people were protected by the prevention and control of infection.

Medicines were not always managed safely. One person had not received all the medicines they needed to stay well. Medicines stock did not always balance. Protocols were not always in place to detail how people communicated pain, why they needed the medicine and what the maximum dosages were.

Some people required staff support to manage their finances. Records of financial transactions did not always add up. Staff had not reported and flagged up with their managers that there were discrepancies in the finances. This is an area for improvement. However, staff knew how to spot signs of abuse and mistreatment. The provider had effective safeguarding systems in place to protect people from the risk of abuse. Staff had confidence in the management team and provider to appropriately deal with concerns.

Although support plans and guidance were in place to describe the basic care and support people needed, they did not always include important information individual to the person. For example, one person was dairy intolerant and their support guidance regarding food did not list this. This put the person at risk of harm. This is an area for improvement.

Audits and checks completed by the management team were not robust. They had not always picked up the issues we have found during the inspection in relation to medicines and risk management. The provider had not always notified us of specific incidents relating to the service in a timely manner. During the inspection, staff referred to people’s homes as units when we spoke with them and daily records referred to people ‘returning to the unit’. The provider and management team told us they had been made aware of this through their own quality audit systems and were working to address this through training and guidance with staff. Relatives told us they would recommend the service to others. One relative said, “I would say [the service is] gold standard. They are great there.” Staff felt well supported by the management team.

Staff had been recruited safely to ensure they were suitable to work with people. There were suitable numbers of staff to provide the care and support to people. Staff continued to receive training, support and supervision to carry out their roles. People told us they felt safe with staff. People and their relatives told us they had regular staff supporting them.

Prior to people moving in to the supported living services their needs were assessed. The assessment included making sure that support was planned for people’s diversity needs, such as their religion, culture and expressing their sexuality.

People were supported to eat and drink to maintain a balanced diet and good health. People received appropriate support to maintain good health. People were supported to attend regular health appointments, including appointments mental health teams, specialist nurses and their GP.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People had only good things to say about the staff. They told us they found staff to be kind and caring. Staff respected people’s lifestyle choices and supported them to be who they wanted to be. People were supported to express their views in a way which suited them. Staff treated people with dignity and respect. People were supported to maintain important relationships and gain independence.

People and their relatives felt that they received appropriate care and support to meet their needs. People had information about how to complain should they wish to. The complaints information was available in easy to read formats to help people understand. People were given information in a way they could understand. People took part in a wide range of activities to meet their needs. The service was not supporting anyone at the end of their life; the people receiving support were younger adults. However, some people had clear plans and directions in place for their future needs.

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 07 February 2018).

Why we inspected

The inspection was brought forward due to concerns received about the culture within the service and safeguarding concerns. A decision was made for us to inspect and examine those concerns.

We found no evidence within the inspection to confirm these concerns. However, we did find other areas of concern.

Enforcement

We have identified two breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to management of medicines and management of risks (Regulation 12) and systems and processes to assess, monitor and improve the service (Regulation 17) at this inspection. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 in relation to failure to notify CQC of incidents. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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.

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.

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.