Background to this inspection
Updated
21 February 2024
The inspection
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 2 Inspectors and a Specialist Nurse Advisor.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the registered manager would be available to support the inspection. Inspection activity started on 11 December 2023 and ended on 19 December 2023. We visited the location’s office on 11 December 2023.
What we did before the inspection
We reviewed the information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with 5 people about their experience and views of the service. We spoke with 4 relatives about their experience of care provided. We spoke with 8 staff including the registered manager, HR manager, clinical lead, a senior carer and carers. We reviewed a range of records. These included 8 people’s care records and medication records for 5 people. We looked at 2 staff files in relation to recruitment and staff supervision. We reviewed a variety of records relating to the management of the service, including policies and procedures.
Updated
21 February 2024
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.
About the service
Solution2Care is a domiciliary care agency providing personal and nursing care to people living in their own homes. The service provides support to children and adults with complex healthcare needs, as well as people living with dementia and people with learning disabilities and or autism. At the time of our inspection there were 84 people using the service including 14 children.
People’s experience of using this service and what we found
Right Support
At our last inspection we found 1 person was having inappropriate restrictive interventions. At this inspection the service had introduced a clear policy of no physically restrictive practice. At our last inspection some incidents which needed to be shared with the local authority safeguarding team and CQC had not been recognised as safeguarding concerns. At this inspection although we saw much improvement, we found 1 incident which had not been recognised as requiring a safeguarding alert to the local authority safeguarding team. Some care files lacked detailed guidance for staff on how to support people with specific care needs. Staff we spoke with were, however, knowledgeable about people’s care needs. People were supported by enough staff. Where possible care calls were made by the same staff to enable them to develop a good knowledge of how the person wished to be supported.
Right Care:
People’s care records showed varying levels of detail about their cultural needs, some contained basic details, some contained more information about people’s needs. At our last inspection, 2 people we spoke with did not know they had care plans. At this inspection we found steps had been taken to address this. People who could not read their care plans had the option of having them read out to them. Staff received training in safeguarding adults and children and policies and procedures were in place. Systems to safeguard people from the risk of harm were improved but had not enabled the management team to identify the need to escalate 1 safeguarding concern to the local authority safeguarding team.
Right Culture:
Systems to investigate and analyse incidents were much improved but still required further improvement to ensure safeguarding concerns were fully explored and responded to appropriately. This meant people were benefitting from better protection from harm, but there was still risk not all incidents would be investigated and shared appropriately. Systems to ensure risk assessments were robust had not identified some areas where guidance for staff was insufficient. In some care files guidance for staff was improved, showing improvement of care files was a work in progress. People and relatives told us they knew how to make complaints and share concerns. We found that recording, investigating, and learning from complaints and concerns was much improved. This meant people and relatives felt they were listened to and had more confidence concerns would be addressed.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
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 15 September 2023). 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 whilst improvements had been made, the provider remained in breach of regulations.
Why we inspected
The inspection was prompted in part by notification of an incident following which a person using the service was subject to safeguarding risks. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the systems in place to manage risk of safeguarding concerns. This inspection examined those risks.
This inspection was also carried out to check whether the Warning Notice we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.
We have found evidence that the provider needs to make improvements to how safeguarding concerns are identified. Please see the well led section 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 remains ‘requires improvement’ based on the findings at this inspection.
Enforcement and Recommendations
We have identified breaches in relation to the governance systems in place to monitor and manage risks at this inspection.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.