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Archived: PiCAS Requires improvement


Inspection carried out on 10 February 2016

During a routine inspection

This inspection took place on 10 February and 3 March 2016. The provider was given 48 hours’ notice because the location provides a domiciliary care service in people’s own homes and we needed to be sure that someone would be available to assist with the inspection. The provider has now moved office and their new address is 221 Aldborough Road South, Ilford, Essex, IG3 8HZ.

PiCAS is registered to provide personal care to people their own homes. At the time of the inspection they were providing a supported living service to 12 people. Supported living is where people live in their own home and receive care and/or support in order to promote their independence. Some people lived in a house that they shared with another person who used the service but most people lived on their own.

The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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 and associated Regulations about how the service is run. The registered manager is also the registered provider.

We found that the quality of the service provided varied between different supported houses.

Relatives were happy with the quality of care and felt that people had benefitted from the service provided to them. One relative told us that the service was marvellous. However, feedback from some health and social care professionals was that the service needed to improve to ensure people were supported safely in ways that met their needs.

Although people were encouraged to make choices and to have as much control as possible over what they did and how they were supported, systems were not in place to ensure that their human and legal rights were protected.

People did not consistently receive a safe service. Systems were not in place to ensure that people were protected from the risk of abuse. This was because although incidents were recorded they were not reported to the placing authority, to the local authority safeguarding team or to the Care Quality Commission.

The systems for staff summoning assistance in the event of an incident or emergency were not robust enough. We have recommended that these be reviewed and changed to ensure that help can be summoned when needed.

Systems were in place to ensure that people received their prescribed medicines safely and appropriately. Medicines were administered by staff who were trained to do this.

Staffing levels were sufficient to meet people’s needs and to enable them to do be supported flexibly and in a way that they wished.

The staff team did not always receive the training they needed to ensure that they supported people safely and competently. We have recommended that the training programme be reviewed to ensure that staff receive all of the necessary training in a timely way.

People were protected by the provider’s recruitment process which ensured that staff were suitable to work with people who need support.

People were encouraged to develop their skills and to be as independent as possible. One person said, “Staff have motivated me. I do what I want to do.”

Systems were in place to support people with their nutritional needs. They were supported to shop and cook for themselves according to their ability.

The registered manager monitored the quality of the service provided and sought feedback from people about the service.

Staff told us that they received good support from the registered manager. They were confident that any concerns raised would be addressed. People who used the service and their relatives also felt able to talk to the registered manager and said that any issues were dealt with quickly.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and one of the Care Quality Commission (Registration) Regu

Inspection carried out on 14 August 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The service met the regulations we inspected at their last inspection which took place on 11 February 2014.

PiCAS provides supported living services to adults with learning disabilities, mental health conditions, physical disabilities and sensory impairments. People using the service had a range of learning disabilities ranging from people on the autism spectrum to those with physical disabilities. The head office is based in the Seven Kings area of the London Borough of Redbridge, and they provide support to people who live in a number of privately owned properties across East London. At the time of our inspection, PiCAS was providing a support service to 13 people. There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People using the service lived in their own homes and received 24 hour care from staff. Each person was assigned a team of care workers, one of whom was a senior care worker who acted as their key worker.

Some people using the service displayed behaviour that challenged. We found that staff dealt with this in a safe way while respecting people’s safety and protecting their rights.

Staff were enthusiastic about their work and proud that people using the service had enhanced their independent living skills as a result of the support they had provided. This was further supported by feedback from relatives and advocates using the service.

Care records were person centred and individual to people using the service. Some specialist care plans, such as autism care plans had been developed with input from the National Autistic Society which had assisted staff to support people using the service more effectively. Records were reviewed and audited on a regular basis.

People were able to pursue interests of their choice. The provider encouraged people to become more independent by setting achievable goals and supporting people to reach these.

Staff received good training and support. If they required extra skills to enable them to support particular individuals, such as Makaton to communicate with people, then the provider arranged it. Regular staff meetings and individual supervision meetings were held.

The service was well-led by the manager and deputy manager. Robust quality assurance tools were used to ensure the service provided was of a good standard. The provider was working towards accreditation with the National Autistic Society which demonstrated their commitment to providing a quality service for people with autism.

Inspection carried out on 11 February 2014

During a routine inspection

Staff described the importance of obtaining consent of people before any care or treatment took place. People we spoke with confirmed staff communicated well with them and asked their permission before they offered any assistance.

We found people were able to express their opinion and were involved in choices about their care. We observed staff supporting people in a friendly and professional manner. Staff had a good understanding of the needs of the people they supported and potential risks they faced. We found staff positive about the service being provided to people who used the service. This indicated the service was aware of the needs of the people they supported. They encouraged people to develop their personal and social skills and become as independent as possible.

For some people communication was limited. They expressed themselves with gestures and facial expressions. It was down to the expertise of staff caring for them that helped them express their needs. One relative who said "I'm happy with the care and support my relative receives".

There were sufficient staff on duty to ensure the safe and effective delivery of care. The provider monitored the quality of service and had arrangements in place to improve areas where required

We spent time speaking with people and their relatives as well as the registered manager and staff. We viewed a number of records throughout the inspection which were accurate, fit for purpose and up to date.

Inspection carried out on 6 June 2012

During a routine inspection

People we spoke with voiced positive opinions about the service they receive. One person described the staff as being �nice.� People told us they can make decisions for themselves, and that they have control over their daily lives. We were also able to observe staff interacting with people who use the service in a friendly and respectful manner.

Inspection carried out on 29 November 2011

During an inspection in response to concerns

We spoke with people who use the service, and they provided generally very positive feedback about their experience of the service. Comments included �Brilliant, good staff.� and �Everything is OK.�