28 March 2023
During a routine inspection
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
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. We considered this guidance as there were people using the service are living with a learning disability and/or autism.
Right support
The provider did not plan people’s care in a personalised and person-centred way or plan for when people experienced periods of distress. There were no specific risk assessments in place for people. This meant there was not sufficiently detailed information for staff about the risks to people and how to safely manage them. People’s medicines were not administered safely. We found no evidence anyone had been harmed. However, the lack of specific and detailed risk assessment information for staff and the provider’s failure to follow guidance for medicines management put some people at increased risk of potential harm.
The provider enabled people to access specialist health and social care support in the community. Staff supported people to play an active role in maintaining their own health and wellbeing. Staff supported people to have the maximum possible choice, control and independence.
Right Care
Not all staff understood how to protect people from poor care and abuse and the provider lacked knowledge of how to work with other agencies to do so. The provider did not deploy enough appropriately skilled staff to meet people’s needs and keep them safe. People’s care, treatment and support plans did not reflect their range of needs. The provider did not assess risks people might face. We found no evidence anyone had been harmed. However, the lack of safeguarding knowledge, detailed information about people’s needs and risk assessments put some people at risk of potential harm.
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs.
Right culture
People were not supported by a registered manager and staff with a good understanding of best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. The provider did not sufficiently evaluate the quality of support provided to people. The service did not have a person-centred culture or a culture of learning and improvement.
Staff knew and understood people well and were responsive. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well. Staff placed people’s wishes and needs at the heart of everything they did. People and those important to them, were involved in planning their care. Staff valued and acted upon people’s views.
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 4 September 2019) and there were breaches of regulation. This service was rated requires improvement for the last 3 consecutive inspections. At this inspection we found the provider remained in breach of regulations and the rating for this service has changed to inadequate.
Why we inspected
We carried out an announced comprehensive inspection of this service on 11 July 2019. 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 the effectiveness and governance of the service.
We undertook a focused inspection to check they had followed their action plan and to confirm they now met legal requirements. We inspected and found there were concerns with the safety, effectiveness, responsiveness and governance of the service, so we widened the scope of the inspection to become a comprehensive inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for LIM Independent Living and Community Care Services Limited on our website at www.cqc.org.uk
We have found evidence the provider needs to make improvements. Please see the safe, effective, responsive and well-led sections of this full report.
Enforcement
We have identified breaches in relation to safe care and treatment, person-centred care, staffing, safeguarding, recruitment, registered manager requirements and governance at this inspection.
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, which will help inform when we next inspect.
Special Measures
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 time frame 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.