Transparent Care Limited

About the service

Transparent Care Limited is a supported living service providing personal care in shared houses and bungalows across a wide geographical area. At the time of the inspection the service supported 71 people with a learning disability, autism or living with mental ill health.

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

The service worked with people’s funding authorities to identify people who needed a Court of Protection derivation of liberty y authorisation to keep them safe. There was no system to track the progress of applications to ensure outcomes were known and shared with staff teams. We have made a recommendation about this.

People’s care plans contained detailed information about many aspects of their physical and emotional needs, however, protected characteristics such as gender identify and sexuality were not captured. We have made a recommendation about this.

The service supported people to have the maximum possible choice and independence and they had control over their own lives.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Right Care

The service did not consistently identify or report safeguarding concerns. The registered manager had acted to improve this through increased monitoring systems. Other concerns were reported appropriately and the service worked well with other agencies to protect people from poor care and abuse in these cases. We have made a recommendation about safeguarding.

We received feedback that some agency staff were not appropriately skilled or demonstrate the right values to meet people’s needs and keep them safe. The service was aware of these concerns and we saw evidence they were acting to improve this. We have made a recommendation about agency staff.

Other staff demonstrated commitment and compassion towards people and received mandatory and specific training to benefit people. The service had taken action to ensure refresher training was planned where this had lapsed in some cases during the COVID-19 pandemic.

The service did not consistently ensure assessments documented all identified risks to people. Some health and safety checks such as water safety were not robust. Safe medicines systems were not always implemented by staff. We have made a recommendation about this. The service took action to address these short falls. In practice, staff were knowledgeable about risks to people and took action to mitigate risk with people.

We found most people could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. Some people’s activity opportunities were discontinued due to COVID-19 restrictions; the service was in the process of supporting people to source and access other opportunities in the community.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right Culture

The ethos, values, attitudes and behaviours of leaders and staff ensure that people using the service lead inclusive and empowered lives. We received mixed feedback about the leadership team. Some felt managers were supportive and valued their input, others felt managers were not doing enough to address their concerns. We raised this with the registered manager who shared their action plan to address concerns.

The service acknowledged that quality assurance monitoring systems had lapsed during the COVID-19 pandemic whilst the service focused on managing risk. There was a clear commitment from the registered manager to drive improvement and we saw evidence of recent progress. We have made a recommendation about quality monitoring to ensure improvements are sustained.

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 (29 December 2017).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. The inspection was prompted in part due to concerns received about staffing, governance and the management of risk to people. A decision was made for us to inspect and examine those risks.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Transparent Care provides care and support to people living in supported living settings 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. Transparent Care provides a service to adults who have a primary diagnosis of a learning disability to enable them to enjoy an independent life in their own home supported by the services Domiciliary Care Registration. Transparent Care support people in 10 supported living services which are in various areas of the country. We were able to visit one home which was local to us.

The service had a registered manager in post. 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.

Relatives we spoke with told us they felt their family member was safe and received good care. One relative told us, “The service is absolutely fantastic.” Another comment we received was, “I can’t fault the care [she] receives.” Staff told us the service was good to work for. One member of staff said, “This is a brilliant organisation and is the first job in care that I have worked at that is relatively stress free.”

Staff received training in safeguarding. They told us they would not hesitate to report any concerns they had. We were told that someone was always at the end of the phone if staff wanted to discuss anything.

Safe recruitment procedures were carried out. Files we saw contained relevant documentation required to ensure only suitable staff were appointed. Staff received appropriate induction, training and supervision. Support was on-going and an essential part of continuing development. Staff told us if anyone needs specific support the training was provided. We saw examples of this in the training matrix. For example, sensory loss and vision training was completed by some staff that supported people with sensory loss.

Medicines were managed safely and charts for the administration of medicines were completed. However, PRN protocols were not in place to direct staff. We have made a recommendation regarding this.

Complaints were taken seriously and relatives told us they knew how to make a complaint. An easy read format was available for people who needed this.

The service had effective monitoring systems in place to drive improvements and ensure the safety of people being supported. Personal emergency evacuation plans were in place in the event of an emergency such as a fire.

People had access to healthcare services to maintain good health. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the polices and systems in the service support this practice.