Archived: The Regard Group - Domiciliary Care Cornwall

Updated 24 August 2021

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 Care Act 2014.

Following the previous inspection in November 2020 we informed the provider that we would be proposing to impose conditions on the providers registration in December 2020. The Notice of Decision to impose conditions on the providers registration was implemented in February 2021. The provider sent us monthly reports to evidence how they were addressing the concerns identified. We also met with the provider, initially fortnightly and then on a monthly basis.

This was a focused inspection to check whether the provider had met the requirements of the imposed conditions on the providers registration. This was in relation to Regulation 13 (Safe guarding), Regulation 18 (Staffing) and Regulation 17 (Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider also submitted an action plan in how they would meet the statutory requirements identified at the previous inspection. Therefore, we reviewed the requirements of Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment) and Regulation 9 (Person centred care) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Inspection team

The inspection was carried out by a lead inspector. Two inspectors visited two supportive living settings, Fox house and Buttermill Cottages. One inspector visited Govis house. One inspector phoned staff and relatives to gain their views on the service.

Service and service type

This service provides care and support to people living in five 'supported living' settings, so that they can live as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

The service did not have a manager registered with the Care Quality Commission. A registered manager is a person who has registered with the CQC 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.

Notice of inspection

This inspection was announced. We announced the inspection a day in advance to ensure that people would give us permission to visit them in their home. Before we visited the supported living settings, we discussed infection control processes for people, staff and inspectors, with reference to COVID-19.

What we did before the inspection

We reviewed information we had received about the service since the last inspection and the information we had requested when the inspection was announced. We sought feedback from the local authority and professionals who work with the service.

We had not requested the provider send us a provider information return as this inspection was completed in response to information of concern that the commission had received. We used all this information to plan our inspection.

During the inspection-

We spoke with five people who used the service and eight relatives about their experience of the care provided. We spoke with 13 members of support staff, three service managers, deputy manager, team leaders and area operations manager. We had telephone conversations with eight staff and received nine emails from staff.

We reviewed a range of records. This included seven people’s care records and multiple medication records. We looked at five staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, inc

Updated 24 August 2021

About the service

The Regard Group – Domiciliary Care Cornwall, is registered both as a domiciliary care agency and a supported living service. It provides personal care to people living in their own houses and flats, and to people living in a 'supported living' setting, so they can live as independently as possible.

People's care and housing are provided under separate contractual arrangements. The CQC does not regulate premises used for supported living; this inspection looked at people's care and support.

People using the service lived in five Supported Living settings in Cornwall. Houses in West Cornwall included Govis House, Fox House, Meadow View and Connexion Street and one supported living setting in East Cornwall called Buttermill. Not everyone using the service received a regulated activity; CQC only inspects the service being received by people who are provided with the regulated activity of 'personal care', for example which includes help with tasks such as personal hygiene and eating. Where they do, we also take into account any wider social care provided.

Since the last inspection the provider decided to close two of its Supported Living settings, Meadow View and Connexion Street.

The service was able to support a maximum of 44 people but only 16 people received personal care. This included one person at Govis House, four people at Fox House, five people at Meadow View and five people at Buttermill.

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.

This service was not 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 did not always maximise people's choice, control and independence and measures had not been taken by the provider to mitigate this. We visited three supported living settings. One setting we visited was in a rural location and there was an absence of local amenities and public transport options. The other two settings were near to the centre of towns and had access to the local community and amenities.

One supported living setting gave the appearance of being a registered care home due to the way it was structured and managed. This was not in line with the principles of Supported Living.

People were not always supported by enough staff on duty who had been trained to do their jobs properly. People did not always receive their medicines in a safe way. People were not always protected from abuse and neglect. People's support plans and risk assessments were not always clear and up to date.

Right care:

There was a lack of person-centred care, and the support people received did not promote dignity, privacy and human rights. People's needs and preferences were not always known or respected. Staff did not always have, or display, the skills and knowledge to meet people's needs. People did not have a choice in which agency provided their care.

Right culture:

The ethos, values, attitudes and behaviours of some leaders and care staff did not ensure people using the service led confident, inclusive and empowered lives. People were not empowered and lacked choice and control over their lives through their limited knowledge of opportunity and limited staffing levels in the service. People did not always receive person- centred support to live meaningful and active lives. People did not have opportunities to form community connections and make choices about who they lived with and the support they received.

The provider had not taken the opportunity, since the last inspection, to implement effective change to ensure the service met the regulations, reflected best practice expected by Right Support, Right Care, Right Culture, and offered improved outcomes to people. As a result, the culture in the service, staff ability to implement best practice and the opportunities offered to people remained poor.

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

Relatives, staff and some health and social care professionals expressed concern about how peoples care needs were being met and felt the service at some supported living settings was not safe.

People, relatives, health and social care professionals and staff were concerned about the lack of consistent leadership in the services, and high staff turnover. Some of the staff in two of the five settings commented they felt morale was low and that communication could be better.

People, relatives and staff lacked confidence that any concerns they had would be listened to or acted upon.

People were not always supported by consistently caring and suitably trained staff. Staffing levels were not sufficient to meet people's care needs in a person-centred way. This was confirmed by feedback received from people living at the service, relatives and staff. Health and social care professionals also raised concern about the lack of consistent staffing and leadership which impacted on the care provided to people the provider supported.

The delivery and planning of care were not consistently person-centred and did not always promote good outcomes for people. Support plans did not contain detailed and person-centred information and therefore they did not always accurately reflect the needs of those who used the service.

Support plans were not always updated as people's care needs changed. People’s care needs were not monitored or reviewed to learn how to improve the quality of life for the person.

Health and social care professionals raised concerns that people’s health care needs were not met in a timely manner.

The service did not always follow the legal framework for making particular decisions in the person’s best interests.

Information about how some people communicated was limited, which meant their needs were not fully understood. Information provided to people was not always provided in a format that was tailored to their needs.

People spent most of their days in the service doing repetitive activities, which although meaningful to the person in the context of the limited opportunities available to them, did not assure us each person was living a full and meaningful life.

The provider had submitted monthly reports to us to demonstrate how they were addressing the concerns raised at the previous inspection. However, the provider had failed to effectively monitor the service's performance and ensure that high quality care was provided. Regional managers had completed audits which had identified significant issues with the service's performance prior to this inspection. However, action was not effective to address and resolve these quality issues.

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 3 March 2021) and there were multiple breaches of regulation. 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 not enough improvements had been made and the provider was still in breach of regulations.

At a comprehensive inspection in July 2018 the service was rated Good (published 28 August 2018) it was rated ‘Good’ in the domains of effective, caring, responsive and well led. It was rated ‘Requires Improvement’ in safe domain due to the numbers of safeguarding incidents recorded and staffing issues.

In July 2020 we undertook a focused inspection (published 24 August 2020) We received concerns in relation to management of the service and the quality of care and support that was being provided. There had been a number of safeguarding concerns raised by other professionals. At this inspection we only looked at the safe and well-led domain. We found that there were two breaches of regulation, safeguarding service users from abuse and improper treatment and good governance. We requested an action plan from the provider to understand what they would do to improve the standards of quality and safety.

In November 2020 we undertook a further focused inspection (published 12 January 2021 and supplementary report on the 3 March 2021)) The inspection was prompted in part due to concerns received about people's safety, staffing and leadership. A person using the service sustained a serious injury. The information CQC received about the incident indicated concerns about the leadership of the service, the safety of people using the service and the quality of care and support that was being provided. At this inspection we only looked at the safe, effective and well-led domains. We found that there were six breaches of regulation: person- centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance.

We imposed conditions on the providers registration following the inspection in November 2020. We have received monthly reports addressing the areas of safeguarding service users from abuse and improper treatment, staffing and good governance.

We requested an action plan from the provider to understand what they will do to improve the standards of quality and safety in the breaches of regulation of person-centred care, need for consent and safe care and treatment. We met with the provider on a regular basis.

The service remains rated Inadequate. This service has been rated Inadequate for the last two consecutive inspections.

Why we inspected

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