Continuum Care (Cornwall)

Continuum Care (Cornwall) provides supported living care for people with learning disabilities and domiciliary care for older people living in Falmouth, Camborne and Redruth areas of Cornwall.

At the time of our inspection 10 people were receiving supported living care and approximately 25 people were receiving personal care in their own homes from the domiciliary service. The 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

Supported living service

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.

Right Support:

The model of care maximised people’s choice control and independence. In each of the settings we visited people were able to choose what to do each day and staff respected those decision and choices. Staffing levels reflected people’s needs, and where additional staff were required to enable people to safely engage with more risky or challenging activities this was arranged. People were encouraged to do as much as possible for themselves and had been supported to gain the skills necessary to enable them to gain voluntary work placements.

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; the policies and systems in the service supported this practice. Staff and managers communicated with people effectively and supported people to make meaningful decisions and choices. Where people lacked capacity and there were restrictive care practices in place these practices had been reported to the local authority for authorisation by the court of protection.

Right Care:

Staff cared for the people they supported and understood their role in ensuring people were protected from all forms of abuse and discrimination. Staff took evident pleasure and pride in describing people’s recent achievements.

Right Culture:

The supported living service was well staffed. Relatives and health professionals were complimentary of the positive impact the service had on people’s welling, communication and quality of life.

Domiciliary care service

The provider had experienced challenges in relation to the recruitment of staff able to drive for the domiciliary care service. As a result, the provider was not currently accepting new packages of domiciliary care.

Staff rotas included appropriate travel time and people told us their carers normally arrived on time and stayed for the full duration of each visit. Missed visits had occurred infrequently and the service learned from these instances and identified the need for additional processes to be introduced in order to reduce the risk of visits being missed in future.

Staff in both divisions of the service staff were recruited safely and were well supported by their managers.

Quality assurance processes were effective and both divisions of the service regularly received compliments about the quality of care provided. The service communicated effectively and people and relatives knew how to contact the registered manager if necessary.

Medicines were managed safely and there were appropriate infection control procedures in place.

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 the service was Good published on (4 June 2021). At this inspection the services rating has remained Good.

Why we inspected

This inspection was prompted by information we had received which indicated there had been a significant change in how the service operated, as the number of people receiving supported living care had significantly increased. As a result, we undertook a focused inspection to review the key questions of Safe, responsive and Well-led only.

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.

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

Recommendations

We have recommended the provider seeks advice on how to ensure information is accurately transcribed into medicines administration records.

Follow up

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

Continuum care (Cornwall) is a domiciliary care agency which provides support to people in their own homes. It operates in Falmouth and Truro and the surrounding areas. At the time of the inspection the service was supporting 50 people. It consists of two parts, a traditional domiciliary care service that provides short regular visits to predominantly older people living in their own homes and a supported living service which provides longer visits to support people with learning disabilities and autism.

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

At our last inspection we found some of the services records lacked detail and guidance for staff. At this inspection we found improvements had been made. Recording of people’s medicines had more detail to support staff and training had been put in place. Auditing procedures had been reviewed and a more robust system was now in place.

People received visits on time and if any delays occurred people were informed by the service. People told us, “Arrive on time unless emergency with someone before me and then they ring to say” and “About the same time each day, expected time, they come, no missed calls”. People using the supported living service told us they were very happy with the support they received. One person told us, “Go out most days with [support worker]. I get on with them all.”

There had been gaps in staff training during the COVID-19 pandemic and the restrictions had meant some training had been delayed. This was being addressed by the manager. A training plan was in place for all staff. Training had resumed in April and the plan was to ensure all training updates would be completed by September 2021. Training was designed to be specific to the needs of people each staff would be supporting. For example, staff working in the supported living service had training in managing the needs of people with autism or had a learning disability.

Records showed people’s needs were assessed and recorded and external advice was regularly sought to help ensure the support people received met best practice. People told us they felt safe whilst receiving support from the service. Staff understood their responsibilities to keep people safe and report any concerns. The provider had ensured there were sufficient records and checks in place to maintain and promote people’s safety.

People told us they received the right support with food and drink, medicines and any healthcare needs. Records showed that any problems were highlighted and dealt with promptly.

Staff were aware of the government guidance on the use of personal protective equipment (PPE) such as masks, gloves and aprons. The service made available COVID-19 testing kits for all staff. We advised the provider continues to promote this as good practice.

Staff were recruited safely. The service had continued to recruit throughout the COVID-19 pandemic, to ensure there were enough staff to cover for sickness or for staff who needed to shield or self-isolate.

People were generally satisfied with the governance of the service. Staff told us communication with the management team had improved and they felt well supported.

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; the policies and systems in the service supported this practice.

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.

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

Right support:

• The model of care and setting maximised choice, control and independence. People were supported to use community activities when they chose. Staff provided personalised opportunities to take part in community activities. A person told us they were being supported to do things that interested them when they were at home.

Right care:

• People were complimentary of the support provided. They told us staff understood their needs and they were confident that staff had the knowledge and skills to provide personalised support.

Right culture:

• There was good oversight of the service from the management team. Staff told us they were able to access management support when they needed to. This meant there were opportunities to ensure support was provided in line with the service’s ethos and values.

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 requires improvement published 31 July 2020. This was a targeted inspection to look at specific concerns we had received. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. At this inspection enough evidence was found to meet the breach of Regulation 12 because the service had improved how its managed risk and recruited staff.

This service was previously inspected and rated requires improvement in May 2019 (Published 15 June 2019) when it was found improvements were required in relation to people's safety and the service's leadership.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

The inspection was carried out to follow up on the action we told the provider to take at the last inspection. As a result, we carried out this focused inspection to review the key questions of Safe, Effective and Well-led only.

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. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Follow up

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

This targeted inspection was completed in response to information of concern related to people's privacy and dignity that was reported to the Commission. As a result, we reviewed the service’s risk management procedures, staffing arrangements and incident investigation processes to ensure people receiving supported living care were safe.

The service’s risks management procedures were appropriate and designed to ensure people’s safety. Individual areas of risk had been identified and staff were provided with specific training and guidance on how these risks should be managed.

All incidents had been documented and investigated by the registered manager, to identify any areas of learning or changes that could be introduced to improve the quality of support people received. Records showed that learning from incidents had led to people’s care plans being updated so all staff were aware of people’s current support needs.

The service was well staffed and all planned support visits had been provided during the COVID-19 pandemic. The service’s recruitment practices were now safe and all necessary checks had been completed to ensure staff were suitable for employment in the care sector. Staff had received appropriate training and were confident they had the skills and knowledge necessary to meet people’s support needs. They told us, “I have all the support I need”, “[The registered manger] had a very cautious approach to putting you to work on your own. He definitely didn’t leave you until you were completely ready.”

People and relatives felt the service was safe and had impacted positively on people’s wellbeing. A relative told us, “We are seeing really positive changes in [persons name’s] communication and we can’t thank them enough for that. One person said, “I feel safe with them, they do what I need them to do.”

Staff told us they were well supported by their managers and had received regular supervision and support. Staff comments in relation to the service management included, “They are really on the ball. [the registered manager] is a fair guy always ready to listen and open to suggestions”, “I am very impressed with the company and the fact that [the registered manager] and [care manager] work with the clients and understand their needs” and “[the managers] are very nice people, very caring and thoughtful. They do look after us very well”.

Rating at the last inspection

This service was previously inspected in May 2019 when it was found improvements were required in relation to people’s safety and the service’s leadership.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the

service. The inspection was prompted in part due to concerns received about service’s systems for the management of risk, staffing arrangements and incident investigation processes. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to investigate specific concerns or follow up on Warning Notices during the COVID 19 pandemic. 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.

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.

People’s experience of using this service: Care plans were in place and covered a wide range of areas including communication, mobility, health history and descriptions of routines where these were important to people. Medicine care plans lacked detail and were not completed in line with the relevant national guidelines.

Some people had been identified as being at risk due to their health or living situation. Risk assessments were developed to inform staff but these lacked guidance and did not consistently reflect people’s circumstances.

During the inspection we identified three members of staff who were working without the appropriate background checks in place. We raised this with the registered manager who assured us these staff would be taken off the rota until the checks had been completed.

There had been a recent turnover of staff and more staff were being recruited at the time of the inspection. Visits were being covered by existing staff with occasional support from agency workers. The registered manager frequently covered shifts and was well known and liked by people using the service.

People told us visits were not missed or late without their prior knowledge and agreement. They were highly complimentary of the service provided and of the registered manager. Staff were caring and supportive in their approach. One person commented; “They have never, never been disrespectful.”

Staff told us they were well supported by the registered manager and senior care worker. Team meetings were held regularly and management were described as approachable. One member of staff told us; “One of the best bosses I’ve ever worked for, he listens and is fair.”

Systems to audit, monitor and develop the service were not sufficiently embedded or consistently followed. For example, there was no training matrix in place and audits had failed to highlight the need to complete pre-employment checks.

Rating at last inspection: Due to the small size of the service we did not award a rating at the previous inspection. (Last report published November 2018)

Why we inspected: This was a scheduled inspection which was planned to enable us to rate the service.

Enforcement: Please see the ‘action we have told the provider to take’ section towards the end of the report

Follow up: We have asked the provider to produce an action plan addressing the areas of concern found at this inspection. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected Continuum on 3 November 2018, the inspection was announced in advance. This was because the service is small and we needed to be sure someone would be available to talk with us. This was the first time the service had been inspected.

The owner of the agency was the registered manager. 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 and associated Regulations about how the service is run.

There were no other staff employed at the service at the time of the inspection and the registered manager was providing care with occasional support from a volunteer. The volunteer had the appropriate checks in place to verify they were suitable for the role. Two new employees were in the process of having pre-employment background checks completed. Plans were in place for new employees to complete an induction and initial training before they started to deliver care independently.

People were protected from identified risk. The registered manager knew people well and was aware of the support people needed to help keep them safe. There was a safeguarding policy and people had access to contact details of external agencies if they wanted to raise any concerns. One person was having limited support with medicines and this was documented in their care plan.

Care plans contained clear descriptions of people’s routines where this was important to them. The care plans were relevant to people’s individual circumstances. Copies were made available to people in their homes.

People and their relatives were largely positive about the caring approach of the registered manager. They told us they felt in control of arrangements for their care and support and would be able to ask for any changes if necessary.

The registered manager had a clear vision for the development of the organisation. In our conversations with the registered manager, people and relatives, there was a recurrent theme of the flexible approach to care and support.