Precious Homes Bedfordshire

Updated 11 August 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Precious Homes Bedfordshire provides care and support to people living in one ‘supported living’ setting (Treow House), so they can live as independently as possible. The service also provides a community outreach (domiciliary care) service to people living in their own houses and flats.

In both cases, people’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living or domiciliary care; this inspection looked at people’s personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We carried out 2 visits to the service, both were unannounced.

Inspection activity started on 4 May 2023 and ended on 12 July 2023. The Expert by Experience spoke to people using the service and relatives, by phone, on 4 May 2023. The inspector visited people living at Treow House on 8 and 18 June 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with, or observed the support provided to, 7 of the 9 people using the service who received personal care; to understand more about their experience of the care provided.

We spoke with 6 relatives, 1 professional who works with the service and 19 members of staff including: the registered manager, 2 deputy managers, 1 senior support worker, 12 support workers, the operations manager, the managing director of operations and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

In addition, we received written feedback from a further 5 professionals, 6 more support workers and the head of quality.

We reviewed a range of records including care, risk management and medicine records for 8 people using the service. We also looked at a variety of records relating to the management of the service, including policies and procedures, staff files in relation to recruitment and staff supervision, complaints and compliments, audits, and meeting minutes. Review of this information allowed us to corroborate our findings, and ensure the care and support provided to people was appropriate for them.

Updated 11 August 2023

About the service

Precious Homes Bedfordshire (AKA Treow House) is a domiciliary care agency and supported living service, providing personal care for adults with a learning disability, autistic people, and people with mental health needs, in their own homes.

Treow House comprises of 22 one-bedroom flats, with a shared communal living room and garden. Staff also support individuals in their own homes through an 'outreach support in the community' service.

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. At the time of this inspection the service was supporting 21 people. Of these, 9 people were receiving personal care.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Although improvements had been made, the service was not yet able to demonstrate they were consistently meeting the underpinning principles of Right support, right care, right culture:

Right Support:

Daily records demonstrated improvements in the way some staff recorded the care and support provided. However, there were still entries that lacked personalised information and read as a list of tasks carried out by staff. Senior staff were checking these regularly to address this.

Staff enabled people to access routine and specialist health and social care support in the community. However, more work was needed to ensure people received good oral healthcare.

People’s care and support plans reflected their range of needs, and this promoted their wellbeing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Improvements had been made to learn lessons from incidents; to see how they might be avoided or reduced in future.

Staff helped people to live in a clean and well-maintained environment that met their sensory needs.

Staff supported people to make decisions following best practice in decision-making.

Senior staff carried out regular spot checks and audits to support with making sure people received their medicines in a safe way and as prescribed.

Right care:

Further work was needed to ensure all staff had the skills to communicate with and understand people who had individual ways of communicating such as using body language, sounds, Makaton (a form of sign language), pictures and symbols.

People did not consistently receive care which focused on their aspirations, quality of life, and followed best practice.

Some people did not yet routinely take part in activities. New activity planners had been introduced to support people to try new activities which enhanced and enriched their lives.

Staff had identified potential goals for people, however, there was little evidence of people’s involvement, progress, or measurable steps to achieve their goals. More work was needed to ensure people were supported to increase their independent living skills too.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to people’s individual needs.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

There were enough staff to meet people’s needs, and to keep them safe.

Right culture:

Work was in progress to ensure people were consistently supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

The service was not always proactive in enabling people and those important to them to provide feedback and develop the service.

Throughout the inspection the registered manager and senior team spoke openly and honestly about what had been achieved since the last inspection and what still needed to be done. They were open to feedback and acted on this in a timely way.

An improved recruitment process had been introduced to ensure staff were suitable to work with people.

The provider had recently introduced a new auditing system to check the quality of the service provided to people. The new system included all the areas CQC assess when inspecting services.

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

We carried out a comprehensive inspection in July 2022 (published 4 November 2022). We found multiple breaches of regulation and the service was rated requires improvement. The provider completed an action plan after the inspection to show what they would do and by when to improve.

We undertook a further targeted inspection* in November 2022 (published 17 December 2022); to check the most urgent breaches, which related to using medicines safely, preventing and controlling infection, learning lessons when things go wrong and supporting people to access healthcare services and support, had been met. We found improvements had been made in all these areas and the provider was no longer in breach of those regulations.

*Targeted inspections are used to check urgent concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

During this inspection we checked all the remaining breaches from the July 2022 inspection and rechecked the breaches we looked at during our November targeted inspection.

We found improvements had been made in all areas and the provider was no longer in breach of any regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last comprehensive inspection.

The last rating for this service was requires improvement. The service remains rated requires improvement and has been rated requires improvement for the last 2 consecutive inspections.

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

Follow up

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