Background to this inspection
Updated
1 June 2022
Inspection team
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
Inspection team
The inspection was carried out by four inspectors and two Experts by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Two inspectors visited the office to review information relating to people’s care and all four inspectors made phone calls to staff to gain their experiences of working for the service. Telephone calls were made to people and relatives by the Experts by Experience to gain their feedback of the service.
Service and service type
This service provides care and support to people living in their own homes. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
At the time of our inspection there was not a registered manager in post.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
Inspection activity started on 15 March 2022 and ended on 06 April 2022. We visited the location’s office on 15 March 2022.
We spoke with five people who used the service and seven relatives about their experience of the care provided.
We spoke with 14 members of staff including the provider, care co-ordinators and care staff.
We reviewed a range of records. This included six people's care records and multiple medication records. We looked at three staff files in relation to recruitment of staff. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
1 June 2022
About the service
Life Path Trust is a supported living service providing personal care. The service provides support to people with learning disabilities and autistic spectrum disorders. At the time of our inspection there were 117 people using the service. 45 people using the service were receiving personal care.
Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, 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.
The service was not able to demonstrate how they were meeting some of underpinning principles of “Right Support, Right Care, Right Culture.
Right support:
People were not supported to have maximum choice and control of their lives, the policies and systems in the service did not support this practice. Staff did not have a thorough understanding of the Mental Capacity Act 2005 and how to support people who did not have capacity to make decisions. People and relatives told us they thought permanent staff had good skills and knowledge. However, staff did not always feel they had the appropriate training to complete their roles effectively.
Pre-employment checks were completed to ensure staff were of suitable character. People who were prescribed medicines were administered these safely by staff who had received training.
People were supported to maintain contact with people important to them and to follow their interests.
Right Care:
People did not receive safe care. Allegations of abuse were not always referred to the appropriate organisations to be investigated and actions were not taken to protect people from further harm. Risks to people's health and wellbeing were not always assessed and information was not available to staff about how to support people safely.
The provider was undertaking work to improve care records however, we found these were not always personalised and did not always contain accurate information.
Staff had guidance about people's communication styles but did not always consider how they would support people who did not communicate verbally to be involved in reviewing their care. Staff had received training in how to protect people from harm and knew how to report any concerns for people's safety.
Right Culture:
People, relatives and staff did not know who the manager of the service was or who to contact if they had concerns. There was not a culture within the service to empower people, relatives and staff to be involved in making improvements. Audits and quality assurance checks within the service did not drive improvements. The provider had arranged for comment cards to be available in each person’s home to promote more feedback from people.
Language used to describe people and their behaviours was not always respectful and did not always reflect a positive ethos. Audits used to monitor the quality of care people received were not always effective in identifying and driving the required improvements.
People and relatives spoke positively of permanent staff who knew them well and treated them with respect. However, people and relatives stated the care provided by agency staff was not of the same standard and agency staff did not always know them well.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Last rating and update
The last rating for this service was Inadequate (published 26 October 2021).
At our last inspection we found breaches of the regulations in relation to safe care and treatment, protecting people from the risk of abuse, need for consent, treating people with dignity and respect and good governance of the service.
The provider completed an action plan after the last inspection to tell us what they would do and by when to improve.
At this inspection, we found the provider remained in breach of regulations.
Why we inspected
We carried out this inspection to follow up on action we told the provider to take at the last inspection.
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 and will take further action if needed.
We have found breaches in relation to safe care and treatment, protecting people from the risk of abuse, good governance and failure to notify of other incidents 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
The overall rating for this service is inadequate and the service remains in in special measures. This means we will keep the service under review and will re-inspect within six months of the date we published this report to check for significant improvements.
If the registered provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question, we will take action in line with our enforcement procedures. This usually means that if we have not already done so, we will start processes that will prevent the provider from continuing to operate the service.
For adult social care services, the maximum time for being in special measures will usually be 12 months. If the service has shown improvements when we inspect it, and it is no longer rated inadequate for any of the five key questions, it will no longer be in special measures.