Miss Sunita Larka t/a Direct Care and Support Services

Miss Sunita Larka t/a Direct Care and Support Services provides personal care for people who live in supported living accommodation. The people who use the service have a learning disability and/or autism. At the time of our inspection 22 people were using the service living in various supported living settings, including a self-contained flat. People rented their room from a private landlord and used shared facilities such as a kitchen and living room. Not everyone who used the service received personal care. CQC only inspects where people receive personal care and only 8 people received 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

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.

Right support

Staff supported people to have the maximum possible choice, control and independence and they had control over their own lives. Care was delivered to people in a person-centred way, taking into account any protected characteristics. Risks to people were assessed well and staff followed clear guidance to keep people safe. Staff administered medicines to people safely and followed best practice. People were protected from risks relating to infection control.

Right care

Staff understood how to protect people from poor care and abuse. The service worked well with other organisations to ensure people received the care they needed. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff were recruited through processes to check they were safe to work with vulnerable people.

Right culture

The provider consulted well with people using the service, their relatives and staff to gather their feedback and involve them in the running of the service. Staff at all levels understood their roles and responsibilities including the legal responsibility to report significant incidents to the CQC. The provider had good oversight of the service to identify any concerns and resolve them promptly. Oversight had improved since the last inspection. A manager was in post who was registering with the CQC.

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, published on 18 March 2021. The rating has now improved to good because of the findings of this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

Follow up

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

Miss Sunita Larka t/a Direct Care and Support Services is a 'supported living' service providing personal care to people living with a learning disability or autism in the community. The service has five houses located in residential streets. Three to six people live in each house. There is also an annexe flat which one person can live in alone. The service can support up to 20 people. At the time of our inspection there were 19 people being supported by the service. People have their own bedrooms and share the rest of the house with each other. Each home has staff on duty during the day and a sleep-in member of staff on duty at night.

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 people do receive personal care, we also consider any wider social care provided.

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

People did not always experience a service that was safe. People did not always have detailed and robust individual risk management plans that gave staff all the information needed to protect people from harm.

Medicines were not always managed safely. The expiry date of medicines was not always checked, meaning there was a risk of medicines not working. Giving ‘when required’ medicines did not follow best practice, which meant people could potentially be given these medicines incorrectly or more frequently than necessary. 'When required' medicines are medicines which are only needed in specific situations, such as when a person may be experiencing pain.

People were not always protected from the risk of COVID-19 infection. The provider was not always following national guidance for COVID-19 infection prevention and control. Although the provider had clear reasons for this, they were unable to provide us with evidence of an ongoing risk assessment process that considered individual risks to people and staff.

There was not always evidence the provider had learned from incidents. This meant people’s risk assessments had not always been updated to show how staff could prevent or manage similar incidents in the future. The provider’s quality checks were not always appropriately followed up with action to improve the safety and quality of the service. Checks had failed to identify the issues with medicines.

Other aspects of the service were safe. There were enough staff to support people safely. The provider had procedures to make sure they recruited people who were safe to work with people.

The service had an open, person-centred culture and people appeared relaxed and happy. People and staff had regular opportunities to feed back. Staff were clear about their roles. The provider shared information with people in a way they could understand.

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. People led varied lives and engaged with a variety of community activities. Some people attended college and some people had jobs.

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 able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People lived in small households in residential homes in the community. They could come and go as they pleased, have visitors whenever they liked and engaged in a variety of community activities. People had their own bedrooms and the support people received was individual to their needs and preferences. The staff knew people well and supported them to express their views and to attend college or have jobs. People lived their own individual lifestyles.

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 05 December 2019).

Why we inspected

The inspection was prompted in part by notification of a specific incident. At the time the incident was subject to a police investigation. As a result, this inspection did not examine the circumstances of the incident. The police investigation concluded there was no case to answer and the police closed their investigation.

The information CQC received about the incident indicated concerns about the management of safeguarding people. We undertook a focused inspection of the Key Questions Safe and Well-led to examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

This report only covers our findings in relation to the Key Questions Safe and Well-led.

We also looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections 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.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Miss Sunita Larka t/a Direct Care and Support Services 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.

We have identified breaches in relation to safe care and treatment, good governance, not notifying CQC of incidents and the provider’s lack of knowledge and understanding.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Miss Sunita Larka t/a Direct Care and Support Services provides personal care to people who live in supported living accommodation. The service specialises in supporting people with physical, learning or sensory disabilities. 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 our inspection the service was supporting two people living in a supported living setting and one person who lived more independently in the community, with their personal care and support.

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

People were safe using this service. Staff knew how to protect people from abuse or harm. They were given the information they needed to help reduce risks to people's safety and wellbeing. Staff followed current practice when providing personal care and when preparing and handling food which reduced hygiene risks. There were enough staff to support people. The provider undertook checks on staff they employed to make sure they were suitable to support people.

People and their representatives were involved in planning the care and support people needed. People’s care plans set out how their needs should be met by staff. Staff were given relevant training to help them meet these needs. The provider made sure staff had regular opportunities to review and improve their working practices to help them provide effective support to people.

Staff used people’s preferred method of communication to engage with them. This helped them to develop good understanding of people's needs, preferences and wishes. Staff were warm and friendly and knew people well. They asked people for their consent before carrying out any care or support and respected their wishes and choices about how this was provided. People were encouraged to be as independent as they could be. People were helped to learn and maintain the skills they needed for independent living.

Staff supported people to participate in activities and events of their choice. People were helped to build new relationships and to maintain existing relationships with the people that mattered to them. 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.

Staff helped people stay healthy and well. People were encouraged to eat and drink enough to meet their needs and to take their prescribed medicines. Staff made sure people could access healthcare services when they needed to. Staff worked well with other healthcare professionals to ensure a joined-up approach to the care and support people received.

People and their representatives were happy with the care and support provided by staff. The provider had arrangements in place to fully investigate any complaints, accidents and incidents involving people. This included keeping people involved and informed of the outcome.

People, their representatives and staff were encouraged to have their say about how the service could improve. The provider used this feedback along with other checks, to monitor, review and improve the quality and safety of the support provided. They worked proactively with other agencies and acted on recommendations to improve the quality and safety of the service for people.

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.

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 1 July 2017).

Why we inspected

This inspection was planned based on the previous rating of ‘Good’.

Follow up

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned in line with our inspection schedule or in response to concerns.

At the last Care Quality Commission (CQC) inspection in February 2015, the service was rated ‘Good’. At this inspection we found the service remained ‘Good’. The service demonstrated they met the regulations and fundamental standards.

People continued to be safe. Staff received training and support to help them protect people from the risk of abuse or harm. The provider ensured there was up to date guidance for staff to follow to minimise identified risks to people's health, safety and welfare. There were enough staff to keep people safe. The provider maintained appropriate arrangements to check the suitability and fitness of new and existing staff to support people.

People had a current support plan which set out how their care and support needs should be met by staff. These were reviewed regularly. Staff received relevant training so that they had the necessary skills to meet people’s needs effectively. Staff communicated with people using their preferred methods of communication. This helped them to develop good awareness and understanding of people's needs, preferences and wishes.

Staff supported people to be as independent as they could possibly be. People were encouraged to learn and maintain skills they needed for independent living. They were also supported to access services and support in the community to acquire new skills and learning such as attending college courses and volunteering opportunities.

People were supported to eat and drink enough to meet their needs. They were encouraged to stay healthy and helped to access healthcare services when they needed this. People that had medicines prescribed to them, received these promptly. Staff encouraged people to participate in activities and to maintain relationships with the people that mattered to them.

Staff were caring and treated people with dignity and respect. They asked people for their consent before carrying out any care or support and respected their wishes and choices about how this was provided. Staff ensured people’s privacy was maintained particularly when being supported with their personal care needs.

The provider and senior staff team provided good leadership. People and staff said they were approachable and managed the service well. The provider had strengthened management arrangements to improve accountability and support for staff at the individual schemes.

People and their relatives were happy with the quality of support received. They were encouraged to provide feedback about how the service could be improved. This was used to make changes and improvements that were required. The provider continued to maintain arrangements for dealing with complaints if people became unhappy or dissatisfied with the service.

Checks and reviews of the service continued to be made by senior staff and, along with learning from incidents and events, was used to improve working practices and processes so that people experienced good quality care and support.

Further information is in the detailed findings below.

We spoke with two people using the service at this inspection and two members of staff. We discussed the recruitment process with the registered provider and deputy manager. We checked employment records for five members of staff.

We found that recruitment processes had been strengthened and the required checks and information was available for staff working at the agency. This meant that people using the service were more fully protected from staff who may not be suitable to work with vulnerable adults.

People using the service told us they took part in interviews of new members of staff and enjoyed the experience. One person said, 'I would like to do that again.'

We visited Fairview House and met with five of the six people living there. People we spoke to were pleased with the service they received. One person told us they liked 'everything' about their supported living arrangements.

People told us they would talk to staff if they had any worries or concerns. People felt that staff listened to them and were very helpful.

People using the service had personalised support plans, which were current and outlined their agreed care arrangements. This meant staff had the information they needed to meet people's individual needs.

Since our last inspection, staff told us that there had been improvements. They had attended more training which supported them in their role. The agency's quality monitoring systems had been strengthened which meant that the provider knew what was working well and what needed improving. At this inspection however we found that there were inadequate arrangements to ensure that staff were appropriately recruited.

People were treated with dignity and respect. People told us that they were encouraged to take part in various leisure and social and activities of their choice, and to be independent. Some comments were; 'I'm very happy here" and 'I go out a lot and have things to do in the house." People said that they did not have any concerns about the service and knew who to contact if they did have any complaints or problems.

We found that records of people's care and support needs were not being regularly maintained, reviewed and monitored. The provider did not have adequate quality assurance systems in place to check that the quality of the service being delivered was meeting people's needs. There were insufficient arrangements to ensure that staff were appropriately trained and supervised to meet people's needs and carry out their role. The registered manager was not fully aware of the government standards of quality and safety which may have an impact on the quality of care that people receive from the agency.