Archived: Pathway for Care

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.

Pathway for Care is a supported living service providing personal care to people with a learning disability and/or autism. Support was provided across 4 different supported living settings where people had their own flats or rooms. As part of our inspection we visited 3 of the supported living settings. 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 17 people were receiving a regulated activity.

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

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This was due to the principles of the Mental Capacity Act 2005 not being consistently followed.

Although the care and support people received had improved, work was still required to ensure records were maintained and staff had up to date guidance regarding people’s care. Audits had not fully identified concerns regarding records of people’s care. In other areas we found quality assurance systems had led to improvements in the support people received. People’s medicines were securely stored and administered safely, and good infection prevention and control measures had been implemented.

People were protected from the risk of abuse as staff were aware of their safeguarding responsibilities. Staff had received additional training and had been supported to better understand risks to people’s safety and wellbeing. Along with a more robust approach to incident reviews, this had led to a reduction in incidents in one setting.

Right Care: There were sufficient staff available to support people across all settings and staff knew people’s needs well. Relatives told us staff were willing to ask for guidance and had developed good relationships. People received support to access healthcare and positive feedback was received from professionals.

Right Culture: The management team had prioritised developing a positive culture across the settings. Increased staff training, enhanced supervision and involving people, relatives, staff and professionals in developing the service had led to improvements in people’s quality of life. The atmosphere at the three settings visited was described as relaxed and people appeared comfortable in the company of staff.

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 inadequate (published 10 August 2023) and there were multiple breaches of regulation. We imposed conditions to the provider’s registration relating to governance and oversight.

At this inspection we found the provider remained in breach of regulations in relation to consent to care and areas of good governance. However, in other areas including safeguarding, risk management, medicines, staff training and assessment processes we found the provider had made improvements and was no longer in breach of regulations relating to these areas.

This service has been in Special Measures since 5 April 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service in January and February 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, person centred care, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. 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 Pathway for Care on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to people’s legal rights not being protected in line with the Mental Capacity Act 2005 and how records and quality are monitored.

Follow up

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

Pathway for Care is a supported living service providing personal care to people with a learning disability and/or autism. Support was provided across 5 different supported living settings where people had their own flats or rooms. As part of our inspection we visited 2 of the supported living settings. 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 15 people were receiving a regulated activity.

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.

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

Right Support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were not being protected from abuse as systems were not in place to ensure staff responded to incidents appropriately. The risks associated with people’s care were not reviewed and updated to reflect the most up to date information. The management of medicines and infection control were not always being managed in a safe way. There were sufficient staff to support people with their care.

Right Care

Health care support was not always being sought for people and where it was, staff were not always following the guidance provided. The provider was taking on packages of care for people where it was not always appropriate or safe to do so. Staff had not always received appropriate training and supervision to support people effectively and safely. People were encouraged to eat and drink and staff were encouraging people to make healthy choices.

Right Culture

There was a lack of robust oversight of care by the provider. Where audits were undertaken, these were not always identifying existing shortfalls. Relatives and external professionals fed back concerns about the lack of actions and communication from the leadership team. Where feedback was sought, actions were not always taken to make the improvements. Staff fed back they did not always feel listened to or supported.

Rating at last inspection and update

The last rating for this service was requires improvement (published 30 September 2022). 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 remained in breach of regulations.

Why we inspected

The inspection was prompted in part due to concerns received about people not being protected from abuse and unsafe care. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of Safe, Effective and Well-Led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to people not being protected from the risk of abuse, people not being protected from risks and unsafe care, the management of medicines and poor infection control. We also identified breaches in relation to the failure to ensure the principles of the Mental Capacity Act were consistently followed, staff not being appropriately trained and supervised, and people not being supported appropriately with their health care needs. We also identified a breach relating to the lack of robust oversight by the provider.

We took immediate action to keep people safe.

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

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 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

Pathway for Care is a supported living service providing personal care to people with a learning disability and/or autism. Support was provided across four different supported living settings where people had their own flats or rooms. As part of our inspection we visited people in all four supported living settings. 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. At the time of our inspection there were 12 people receiving a regulated activity.

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

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:

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. The Mental Capacity Act 2005 was not consistently followed to ensure people’s capacity was assessed and that decisions were made in people’s best interests and in the least restrictive way possible. However, we found staff frequently consulted people about day to day choices regarding their care. These included areas such as how and where people spent their time at home, what they chose to wear and food choices.

Some people’s health care needs were not always monitored to ensure they received the support they required, and referrals were not made in a timely manner. Medicines management systems were not always robust in one setting which meant there was a risk of people not receiving their medicines in line with prescription guidelines. In some instances, we found people were supported well with both their healthcare and medicines. Staff worked alongside other professionals in order to provide holistic care which for some people had resulted in a reduction of their prescribed medicines.

Due to the availability of resources people were not always able to pursue their interests and preferred routines. In other instances, we found people received support to access local facilities and public transport in line with their interests.

Right Care:

Systems in place to monitor and review risks to people’s safety and well-being were not always robust. Where incidents were reported, lessons learnt and systems for reflective practice were not consistently followed.

Staff were aware of people’s support needs in relation to their sensory and emotional support. They were aware of triggers to people’s anxiety and how to support them during times of distress. Where appropriate, a multi-disciplinary approach was taken to manage risks to people’s well-being. Staff were aware of their responsibility to protect people from potential abuse and concerns were reported and investigated in line with requirements.

Staff supported people with care and kindness. Choices were provided to people in relation to their day to day support and how people wished to spend their time. People’s dignity and privacy were respected, and staff communicated with people in the way they preferred.

Right Culture:

Systems were not always implemented to ensure a positive ethos of the service was fully embedded into practice and to monitor outcomes through quality assurance processes. This had led to a lack of consistency across the different settings and meant people did not always receive support in a responsive way. This was of particular concern in one of the four supported living settings.

The culture of the service was positive and staff understood the aims of the service in providing people with a personalised service which focussed on their quality of life. Staff knew people well and understood what was important to them.

The provider and management team responded positively to address concerns identified during our inspection. Investment was taking place in electronic systems designed specifically for the service. The aim of this development was to provide more robust information and enable the staff team to respond to people’s changing needs in a timely way.

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 (published 24 October 2018). During the inspection we identified a breach of regulation in relation to the governance of the service. 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 remained in breach of regulations.

At our last inspection we recommended the provider continually review people’s risk assessments to ensure they remained current. At this inspection we found improvements were still required in this area.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to the governance of the service, the way in which risks to people’s safety are reviewed, their health monitored and person-centred care. The service was not always adhering to the Mental Capacity Act 2005 to ensure people’s legal rights were protected.

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

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.

Pathway for Care provides personal care for adults who have a learning disability, autism, physical disability or mental health conditions. At the time of this inspection, the service was providing personal care to 15 people across four ‘supported living’ settings.

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

The provider had failed to ensure CQC were fully informed of all significant events. They had not demonstrated an understanding of the regulated activity which meant CQC had not been able to comprehensively assess and monitor the service provided. Relatives and professionals told us that improvements had been made to the service although communication required ongoing development.

One person’s records had not been updated when their needs changed to ensure staff were aware of the correct guidance to follow. We have made a recommendation in relation to this. This risk was mitigated to a large degree as the person was supported by staff who knew them well. Core teams of staff had been developed to ensure people received consistent support. Staff were recruited safely and received the training they required to support people. Staff were aware of their responsibilities to keep people safe from abuse and reporting protocols were followed. Accidents and incidents were reported and reviewed to reduce the risk of them happening again.

Staff were positive about the support they received and felt the management team were approachable and responsive. People’s care was based around their individual preferences and the outcomes they wished to achieve. There was a positive approach throughout the staff team. Systems were in place to monitor the service and, where required, action plans were developed and monitored. The service worked with a range of organisations and professionals in order to support people in achieving their goals.

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. 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’s support was planned on an individual basis which promoted their independence. The service had developed links with the local community. This provided people with opportunities to access community resources and undertake person-centred activities. People received their support from staff who knew their needs and respected their individual preferences.

Rating at last inspection

The last rating for this service was Good (published 10 August 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service died. This incident is subject to an ongoing investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of specific health concerns and the emergency protocols in place in relation to these. This inspection examined those risks. We found no evidence during this inspection that people were at risk of harm from this concern.

In addition, we had concerns regarding the provider’s understanding of their regulatory responsibilities to provide information to CQC in relation to people receiving the regulated activity Personal Care. We identified a breach of regulations in this area.

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.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Pathway for Care 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 monitor the service

We have identified two breaches at this inspection in relation to communication, the management understanding of their regulatory responsibilities and the provider not always informing CQC of significant events.

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

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.

There was 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. The registered manager assisted us with our inspection.

People’s rights were protected in line with the Mental Capacity Act 2005. People’s medicines were stored securely.

People‘s care and support was planned in partnership with them and they had opportunity to take part in activities that reflected their interests. People were supported by sufficient numbers of staff to meet their needs and keep them safe. Staff understood their responsibilities in safeguarding people from abuse and knew how to report any concerns they had. Staff had been recruited through an appropriate recruitment process which helped ensure they would be suitable for the role.

Where people had incidents or accidents these were recorded and lessons were learnt from them. Individual risks to people were identified and guidance and action taken to minimise risks, whilst continuing to allow the person freedom. People were protected by the measures in place to manage infection control.

People could make choices about the food they ate and staff engaged healthcare professionals when people required it. Staff worked with external organisations and professionals to help provide the most effective care to people. People’s needs had been assessed prior to moving in to the service and transitions arrangements were in place to help ensure a safe move.

People were cared for by staff who were kind and caring towards them. Staff treated people with respect and maintained their dignity. People were supported to remain as independent as possible and make choices about their care. There was sufficient information in people’s support plans to enable staff to provide the most appropriate care to people.

People and staff benefited from good leadership provided by the registered manager. Staff said there was a strong team and staff said they received good support from their colleagues. They told us they had received appropriate training for their role. The whole staff team had a drive to continually improve the service. Should someone wish to complain there were appropriate procedures in place.