Care Organiser

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.

Care Organiser is a domiciliary care service providing personal care to people in supported living schemes across London. At the time of the inspection 25 people were receiving personal care in 9 schemes. 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 Support: Model of Care and setting that maximises people’s choice, control and independence

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

Right Care: Care is person-centred and promotes people’s dignity, privacy and human rights

People received the right support in relation to risks, such as those relating to a learning disability, although risks relating to evacuating individuals at night had not always been recorded. There were enough staff to support people. The provider checked staff were suitable to work with people through recruitment checks although checks of gaps in employment histories could be improved. Staff received training in infection control practices, including the safe use of personal protective equipment (PPE). People received the right support in relation to their medicines and the provider had oversight of this through electronic systems and audits.

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

The provider had not always notified CQC of significant events as required by law. The concerns we found had not always been identified by the provider which meant their oversight could be improved. The registered manager and staff understood their roles and responsibilities, although improvements could be made in relation to the areas where we found concerns. The registered manager engaged and consulted well with people using the service, relatives, and staff. Staff were well supported by the provider.

We did not inspect the key questions of effective, caring and responsive. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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 the service was requires improvement with a breach relating to notifications to CQC (report published February 2022).

Why we inspected

This inspection was prompted to check improvements had been made since our last inspection.

Enforcement

We have identified a breach in relation to submitting notifications as required by law. Please see the action we have told the provider to take at the end of this report. Having a breach meant the highest possible rating for this inspection is requires improvement,

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.

Care Organiser provides care and support to people 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. The Care Quality Commission (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. Not everyone who used the service received personal care.

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

The provider had not always notified CQC of all significant incidents, such as allegations of abuse, as required by law. The registered manager told us this was an oversight and they would improve going forwards. Staff did not always have access to accurate records about people because two set of care plans were in place for each person on the first day of our inspection. Although the provider had resolved this by the second day of our inspection this meant people had been at risk of harm due to inaccurate records previously. The provider had followed their action plan to improve in relation to all of the breaches we found at the previous inspection. Although there were a range of audits in place at the service, the notifications breach and concern regarding records meant the provider’s oversight of the service should be improved.

A registered manager was in post who had overseen the schemes for more than a decade. They were supported by managers at each scheme and their own teams, plus quality assurance officers. The registered manager understood their responsibilities, but increased oversight of Autumn Leaves is required to ensure compliance with the regulations. Staff understood their day to day responsibilities.

People were protected from the risk of avoidable harm because risks were appropriately assessed. Medicines were safely managed by staff. The provider operated safe and effective recruitment practices to ensure staff working with vulnerable people were suitable. There were enough staff to support people safely. The provider followed best practice in relation to infection control and prevention and management of risks relating to COVID-19.

Staff received regular and frequent supervision and appraisal to support them. People were supported to have maximum choice and control of their lives in the least restrictive ways possible and in their best interests; the policies and systems in the service supported this practice. The provider had carried out decision-specific mental capacity assessments relating to areas to do with finances and medicine.

Staff understood and met people’s needs and preferences relating to eating and drinking. People received a choice of food which was served hot and in sufficient quantities. People’s day to day healthcare needs were met.

Staff supported people in a caring manner and knew the people they were caring for well. People liked the staff and we observed staff were kind and responsive towards people, treating them with dignity and respect. People were encouraged to be involved in their care. Care was personalised to meet people’s needs and preferences, although the provider had not ensured staff had reliable records to refer to. The provider could provide information to people in alternative formats to meet people’s communication needs if required. The provider investigated and responded to any concerns or complaints and people were encouraged to complain.

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.

Autumn Leaves were able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The provider was not fully compliant with the regulations, as set out in this report. which meant they were not fully complaint with the principles. In addition, the size of this scheme was much larger than best practice guidance. However, the scheme manager explained how the service offered several flats where people could live independently. In addition, the need for this scheme had been agreed by the commissioners and people had a choice in living there and in receiving care from an alternative provider.

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 (2 July 2019) and there were five breaches of regulation. 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 had improved to meet four of the previous breaches but there was repeat breach in relation to good governance and an additional breach in relation to notifications.

Why we inspected

This was a planned inspection based on the previous ratings and concerns raised by a relative regarding poor care.

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

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.

The overall rating for the service is requires improvement. We have identified one breach in relation to notifications. The overall rating for the service is requires improvement. You can see what action we have asked the provider to take at the end of this full report in relation to the notifications breach.

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.

Care Organiser provides care and support to people 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. The Care Quality Commission (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. Not everyone who used the service received personal care. At the time of this inspection 23 people who used the service were receiving personal care.

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

The provider had not taken action to identify and reduce specific safety risks to people and staff from COVID-19. Not all staff were using personal protective equipment (PPE) in a safe way. However, settings were clean and hygienic as staff cleaned at regular intervals to help reduce infection risks.

Recruitment practices were unsafe as the provider had not made sure checks on staff’s suitability to support people were thorough and robust.

Assessments of people’s needs had not always been thorough. This had led to care and support packages ending early at one of the supported livings settings.

Records did not adequately reflect for some people their consent and agreement to practices that might impact their autonomy and independence. However people told us staff sought their consent before providing care and support.

The provider’s current governance arrangements were not effective as they had not picked up issues we found at this inspection. There had been no management oversight of accidents and incidents or in ensuring actions to reduce risks to people and staff from COVID-19 had been achieved.

People said they were safe at the service. Staff had been trained to safeguard people from abuse. There were enough staff to support people. Staff understood identified risks to people’s safety and wellbeing and what action to take to support people to stay safe.

People’s records reflected their needs and preferences for how care and support was provided. The majority of staff knew people well and understood how the needs and preferences of people should be met.

People were supported to stay healthy and well and to take their prescribed medicines. Staff made sure people could access support from healthcare professionals when needed. People were involved in planning and preparing meals. Staff encouraged people to make healthy food and drink choices and checked they were eating and drinking enough to meet their needs.

Staff received training and supervision to help them meet people’s needs. Most staff felt motivated and well supported. Some staff felt less so. Senior managers were taking action to improve this after our inspection.

People spoke positively about their experiences of the service. The provider sought their views about how the service could improve and had arranged for new activities and events people could do in light of national restrictions on social distancing and lockdown.

Feedback from relatives and healthcare professionals was mixed. Some spoke positively about the care and support provided to people but others had less positive experiences. Senior managers were taking action to improve this after our inspection.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to fully demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The majority of people who used this service lived in small households in residential homes in the community. They could come and go as they pleased and, outside of periods of national lockdown, could have visitors and engaged in a variety of community activities. They had their own bedrooms and their support was tailored to their individual needs and preferences. Staff knew people well and how to support them to live their own individual lifestyles.

However at one of the supported living settings, opened in May 2020, people’s experiences were different. The setting had formerly been a care home and still bore the hallmarks of this. Signage displayed outside indicated this was a setting where care was being provided which did not help support people’s right to dignity, privacy and independence. Some care and support packages at this scheme had ended as assessments of needs had not been robust which meant staff had been unable to meet these people’s needs and preferences. The provider’s values were focussed on people leading confident, inclusive and empowered lives. However at this setting staff were not empowering people to do as much as possible for themselves in relation to their personal care or to independently access some parts of the premises.

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 8 February 2018).

Why we inspected

We carried out an announced focussed inspection of this service on 16, 17 and 23 February 2021. The inspection was prompted in part due to concerns received about one of the supported living settings. The concerns were about the quality and safety of the support provided to people, staffing and management and leadership at this setting. A decision was made for us to inspect and examine those risks.

We also looked at infection prevention and control measures under the safe key question. We look at this even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.

After this inspection the provider wrote to us to tell us what action they had taken to mitigate risks. This included undertaking a review of recruitment practices, carrying out risk assessments with staff with underlying health conditions, introducing a new ‘incident and accident analysis’ process, updating the referral assessment process, and appointing a new service manager to provide additional support and oversight at one of the supported living settings.

Enforcement

We have identified breaches in relation to person-centred care, dignity and respect, safe care and treatment, good governance and fit and proper persons employed.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request a monthly 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Care Organiser provides care and support to people living in nine ‘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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. At the time of our inspection 41 people were using the service.

There is a Registered Manager at this location. 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.

People’s needs were met by staff; however, the way staffing levels was commissioned needed to improve. Staff underwent a recruitment checks to ensure they were suitable to work with people.

Staff were trained to protect people from abuse. They knew the signs to recognise abuse and the procedure to report any concerns. They also knew how to escalate their concerns to external agencies should it not be addressed internally.

Risks to people were identified and actions put in place to minimise harm and keep people safe. People received their medicines as prescribed and the management of medicines was safe. Records of incidents were maintained and actions put in place to reduce reoccurrences. Lessons learnt were shared with staff. Staff were trained and followed good infection control procedures.

Staff and the registered manager understood their roles and responsibilities under the Mental Capacity Act (MCA) 2005. 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 support this practice. People consented to their care before they were delivered.

People’s care needs were assessed and care plans developed on how identified needs would be met. Staff were supported through an induction, supervision, appraisal and training to provide effective support to people. People were supported to meet their dietary and nutritional requirements. Staff supported people to access health and social care services to maintain good health. The service supported people when they moved between services to ensure their needs were met.

People were treated with compassion, kindness and their privacy and dignity was always respected. People had choice about how they wanted their day-to-day care delivered and staff respected their decisions. People were encouraged to maintain their independence as much as possible. The service promoted people’s religious beliefs and culture and supported them to maintain these.

People’s care and support was planned, documented and delivered in a person-centred way. It reflected their choices, preferences, personalities, needs and individuality. People received support from staff to meet their needs and achieve their goals. People were supported to engage in the activities that they enjoyed. People were supported to socialise, learn new skills, and maintain relationships with family. People and their relatives knew how to complain about the service should they need to.

People and their relatives told us they were happy with the service. Staff told us they received the direction and leadership they needed.

The service had a registered manager that complied with their registration requirements. The service carried out various checks to assess the quality of care provided to people. They put action plans in place to improve shortfalls identified. The service worked in partnership with other organisations to improve the service.