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The Regard Group - Domiciliary Care Cornwall Inadequate

We are carrying out a review of quality at The Regard Group - Domiciliary Care Cornwall. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 17 November 2020

During an inspection looking at part of the service

About the service

The Regard Group 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 locations around the surrounding area of West Cornwall. Locations included Govis House, Fox House, Meadow View and Connexion Street and one location in East Cornwall called Buttermill. Not everyone using The Regard Group received regulated activity; CQC only inspects the service being received by people provided with the regulated activity of 'personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

The service was able to support 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, one person at Connexion Street and five people at Buttermill.

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

Relatives and staff told us they did not feel one of the services was safe. Safeguarding concerns had not always been consistently reported by staff and management in a timely manner. Staff were not always clear of their roles and responsibilities in relation to safeguarding.

People, relatives, health and social care professionals and staff were concerned about the lack of consistent leadership in the services, and high staff turnover. Staff morale was low. All commented that communication was poor.

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 and some staff.

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.

Staff did not receive effective support from the management team and lacked understanding of their roles and the principles of providing high-quality care. The lack of robust management meant there was no consistent oversight of the service.

There were no effective processes in place for assessing and monitoring the quality of the services provided and to ensure records were accurate and complete. Systems had failed to identify that people were not always protected from avoidable harm. Safe care practices were not always recorded accurately within people's care records. Action had not been taken to make all necessary changes and sustain improvements following the concerns found in our previous inspection report.

The registered manager resigned in September 2020. A registered manager has been appointed and aims to commence this post in January 2021. The registered manager role is that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The service provides care and support to people living in five ‘supported living’ settings. However, the supportive living services are also used for office space and have communal areas, which is not in line with the principles of Supportive living.

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. Rig

Inspection carried out on 13 July 2020

During an inspection looking at part of the service

About the service

The Regard Group 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 locations around the surrounding area of West Cornwall. Locations included Govis House, Fox House, Meadow View and Connexion Street and one location in East Cornwall called Buttermill. Not everyone using The Regard Group received regulated activity; CQC only inspects the service being received by people provided with the regulated activity of 'personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There were 44 people being supported but only 12 received personal care. This included one person at Govis House, two people at Fox House, five people at Meadow View, one person at Connexion Street and three people at Buttermill.

The service had not been developed and designed fully in line with the principles and values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that includes having control, choice, and independence. People using the service should also receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There was a registered manager in post. 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.

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

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, lack of choice and control and limited inclusion.

Safeguarding concerns had not been consistently reported by staff and management. Staff were not always clear of their roles and responsibilities in relation to safeguarding.

People were not being supported by consistently caring and suitably trained staff. This was confirmed by feedback received from people living at the service and some staff.

Feedback from managers and staff were that managing people’s anxieties was reactive rather than proactive. People’s support plans did not always inform, direct or guide staff in what actions to take to recognise when people were becoming distressed and how to support them.

Systems were not always implemented to ensure the effective management of medicines. Staff who were administering medication were not always trained and did not have their competencies checked to ensure correct procedures were followed.

Staff did not receive effective support from the management team and lacked understanding of their roles and the principles of providing high-quality care. The lack of robust management meant there was no consistent oversight of the service.

There was a lack of quality assurance processes in place to monitor the quality and safety of the service. There was a clear lack of provider oversight and they had not ensured effective and competent management was in place

In March 2020 a regional manager was appointed. Due to recent safeguarding concerns the regional manager completed an audit and developed a comprehensive action plan to address the shortfalls which have placed people and staff at risk. This was reviewed at the i

Inspection carried out on 31 July 2018

During a routine inspection

This announced comprehensive inspection took place on 31 July and 1 August 2018. This was the first inspection since the service was registered with the Care Quality Commission (CQC) in June 2017.

The Regard Group 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 four locations around the surrounding area of Redruth or in their own homes. Locations included Govis House, Fox House, Meadow View and Connexions. Not everyone using The Regard Group receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. There were 30 people being supported but only 11 received personal care. This included one person at Govis House, two people at Fox House, four people at Meadow View, three people at Connexions and one person living in their own home in the community.

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 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.

The registered manager had been in post since the service commenced in June 2017. The service had recently had a change of management structure and the current registered manager was being supported by a second manager. This manager planned to become the future CQC registered manager of the service. At that point, the current registered manager would apply to CQC to be deregistered from their role at the service.

The organisational changes in the management structure had been necessary following a growth in the service and the registered manager role had increased. The registered manager was supported by service managers, team leaders and senior support workers. There had also been a high number of safeguarding concerns about one location in particular; this also required a regular use of agency staff to support ongoing gaps on the staff rota. These had generated a number of concerns which were being dealt with by the service and the local authority safeguarding team.

People were protected by staff who were safely recruited, trained and supervised in their work. They underwent a thorough recruitment process and undertook training relevant to their role. Supervisions were held regularly and staff felt these were useful.

Staff felt included, valued and that their opinions mattered. They felt able to raise any concerns or questions. Staff felt supported by management and felt the changes in management were for the better. Staff were very positive about the management team and their ability to lead the staff team.

Staff were encouraged to move up the ladder at the service and were supported to do this by management.

Staff had received training in safeguarding and knew what to do in the case of suspected abuse. They had been appropriately trained in medicines and people received their right medicines at the right time. People were encouraged to eat a healthy balanced diet and staff supported them