We undertook an announced inspection of Heston Care Services on 19 December 2017. We told the provider two days before our visit that we would be coming because the location provides a supported living service for people in their own homes and staff might be out visiting people. This service provides care and support to people living in one ‘supported living’ setting, so that they can live in their own home 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.
At the time of the inspection the service was providing support through the supported living service for two people but only one person received care that comes under the Regulated Activity of Personal Care. Therefore we are only able to refer to the care provided and records of that one person.
This was the first inspection since the provider registered the location with the Care Quality Commission (CQC) in September 2016.
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 had a recruitment process in place but appropriate references were not always requested from the most recent employer and a record of references obtained by telephone were not recorded to provide an audit trail that appropriate recruitment processes had been followed. This meant the provider could not ensure new care workers were suitable and had the appropriate skills and knowledge for the role.
Risk management plans were not in place to provide care workers with guidance on how to reduce risks when providing support and to promote people’s safety.
The provider had a procedure for the administration of medicines but records did not clearly identify who had administered medicines which increased the risk of medicines not being administered as prescribed.
The provider did not have processes in place to ensure care was provided within the principles of the Mental Capacity Act 2005 and to help protect people’s rights.
Care worker had regular support with the registered manager but the training provided was not structured.
Information was not provided for people using the service in an accessible format such as using clear, plain English or pictures to meet their communication needs.
The provider stated they completed a ranged of audits but the outcomes were not recorded. It was therefore not clear what the findings of the audits were and what areas had been identified for improvement.
Regular meetings were held with external professionals involved in providing support but notes were not made of the discussions to provide an audit trail and to maintain a record of the decisions made.
We found breaches of regulations in relation to need for consent, safe care and treatment, good governance, staffing and fit and proper persons employed. You can see what action we told the provider to take at the back of the full version of the report.
The provider had procedures to record and investigate incidents and accidents, safeguarding concerns and complaints so learning took place and to prevent reoccurrence of similar issues.
The number of care workers required to provide appropriate support was identified through the local authority referral so people were cared according to their support plan.
An assessment of the person’s support needs had been completed before they started to receive support.
Care workers understood how to maintain a person’s privacy and dignity when providing support.
Support plans identified the person’s religious and cultural supports needs to assist the care workers in providing appropriate care to meet these needs.
Support plans were developed including information on the person’s background, support needs and activities they enjoyed.