Archived: Person Centred Care and Support LLP

Person Centred Care and Support LLP provides care and support to people living in residential houses, split into flats. At present the service has two 'supported living' settings, so that people can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate the premises used for supported living; this inspection looked at people's personal care and support. People were supported with their personal care needs at one site operated by Person Centred Care and Support LLP, Compton Crescent.

Following the last inspection on 28 March 2018, we made a recommendation about the safer management of medicine. We also found a breach in Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014, Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.

At the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Responsive and Well-led to at least good. At this inspection, we found they had not met their action plan and there continued to be systematic failings in the oversight and management of the service.

The service did not have a registered manager in place. 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 2008 and associated Regulations about how the service is run. During our inspection, the manager of the service resigned.

The provider of the service continued to disregard the conditions of their registration with the Commission. The service moved offices in August 2018 but the provider did not inform us, nor make the necessary changes to their registration. We continued to have grave concerns about the ongoing financial viability of the provider organisation, due to their failure to provide the resources staff needed to be able to support people, to maintain an office and to pay their staff.

People continued to receive support from staff who were kind and compassionate, but were inexperienced and unqualified for the types of work they were carrying out. Staff received training in topics of relevance to their work, however their inexperience meant they were not able to apply their learning and ensure they provided safe, high-quality care that protected people’s rights. The service did not always follow the principles of safer recruitment to ensure that staff were suitable to work with people in need of support.

The provider did not have systems in place to ensure that people were able to consent to their care and support in line with the requirements of the Mental Capacity Act 2005. Assessments of people’s capacity to consent to their care were not carried out, and care was agreed by people’s relatives without proof of their legal authority to consent on the person’s behalf.

Medicines were not managed safely. Accidents and incidents were not appropriately recorded and reviewed to reduce the likelihood of reoccurrence. Risks relating to people’s support were not identified and mitigated, and the staff were not skilled at supporting people to manage their behaviours that others may find challenging and learn more community-appropriate behaviours.

The service did not undertake an assessment of people’s needs before they moved in, or at any time afterwards. As such, care and support was not designed and delivered to meet people’s needs. The inexperience of the staff also meant that people were not always treated with dignity and respect.

Records relating to the management of the service continued to be unavailable or inaccessible, including to the manager. Complaints were not recorded or responded to appropriately, and were not used as opportunities to identify and make improvements to the service people received.

The provider did not have an established system in place to assess, monitor and improve the service. People, their relatives and other professionals involved in people’s support were not asked for the feedback. The service did not work in partnership with other agencies.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During this inspection we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two breaches of the Care Quality Commission (Registration) Regulations 2009. We also identified a breach of s.33 of the Health and Social Care Act 2008.

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.

This announced inspection took place on 20 March 2018.

Person Centred Care and Support LLP provides care and support to people living in residential houses, split into flats. At present the service has five ‘supported living’ settings, so that people can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate the premises used for supported living; this inspection looked at people’s personal care and support. People were supported with their personal care needs at one site operated by Person Centred Care and Support LLP, Compton Crescent.

The service was last inspected on 11 November 2016 and the service was rated Good.

At this inspection on 20 March 2018, we made a recommendation about the management of medicines. We also found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report

The service did not have a registered manager. At the time of the inspection the manager had undergone an interview with the Commission to become registered. 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 2008 and associated Regulations about how the service is run.

Information identified on Companies House and the failure to pay the rent on the registered office, means the financial viability of Person Centred Care and Support LLP is uncertain. Companies House registers company information and makes it available to the public.

People’s tenancy agreements were not undertaken in line with good practice. People’s consent to care and treatment was not sought in line with the Mental Capacity Act 2005.

The provider had failed to demonstrate good governance of the service, as regular audits were not carried out. The provider had recently employed a compliance manager who had carried out one audit of all locations.

People did not receive care and support from staff that had the sufficient skills and knowledge to deliver effective care. Relatives and staff told us training was insufficient and records confirmed in-depth training was not provided.

Care plans were not as personalised as they could be. Pre-admission assessments could not be located and historical information contained in people’s care plans was minimal. Care plans were up to date, however there was no documentation to suggest people were encouraged to develop their care plans.

People did not always receive activities that were stimulating. Although activities were available to people both in-house and in the community, these did not always take place frequently.

People were protected against the risk of identifiable harm as the provider had developed risk management plans, which gave staff clear guidance on how to mitigate identified risks. Accidents and incidents were monitored and long term actions devised from lessons learned.

People were protected against the risk of harm and abuse as staff had sufficient knowledge on how to identify, report and escalate suspected abuse. Safeguarding policies were available to staff.

People received care and support from suitable numbers of staff to keep them safe. Records confirmed satisfactory background and criminal checks were undertaken prior to the commencement of employment. Staff received supervisions and appraisals from senior staff, which enabled them to reflect on their working practices. Although staff confirmed they received an induction upon commencing the role, only one record of completed induction was available to review.

People were supported to eat food and drink that met their dietary preferences and requirements. People were encouraged to embrace their culture and where possible staff provided foods that reflected their culture and ethnicity.

People received support from staff that were compassionate and demonstrated kindness to others. Staff were respectful of people’s decisions and treated them with dignity.

The manager actively encouraged partnership working, however records indicated advice and guidance given was not always actioned in a timely manner.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

The previous inspection of the service took place on 14 March 2013. The service met all the regulations we checked at that time.

Staff understood how to protect people from harm. Staff assessed risks to people and had guidance on how to keep people safe and healthy. Support plans contained guidance for staff on how to manage behaviours that may challenge the service. The service monitored incidents and accidents and put plans in place to prevent recurrence.

People received support from suitable staff who were recruited through a robust recruitment process. There were sufficient numbers of staff to meet people's needs.

People received the support they required with their medicines. Staff managed people’s medicines safely.

Staff understood people’s needs and had relevant skills and knowledge to support them. Staff received regular supervision and annual appraisal. Staff were supported and understood their roles and responsibilities to provide care to people.

People, their relatives and healthcare professionals were positive about the quality of care people received at the service. They were involved in planning people’s care and supported people to make decisions in their best interests. People consented to care and support. Staff supported people in line with the principles of the Mental Capacity Act 2005.

People were supported to maintain a balanced diet and encouraged to adopt healthy lifestyle choices. Staff sought advice from professionals to ensure people had appropriate nutrition. People accessed healthcare services they required.

Staff provided people’s care in a caring and compassionate way. Staff respected people’s dignity and privacy.

The service sought people and their relative's views about the service. The registered manager considered and acted on their feedback to improve the service. People were encouraged to develop new skills and further their level of independence.

Staff carried out assessments of people’s individual needs. People’s care plans contained detailed information about how they wanted to be supported and were updated when their needs changed. People received their care as planned.

People valued their relationships with staff. Staff had developed relationships with people and their relatives in order to help understand and to support people better.

People took part in activities they enjoyed. Staff supported people to pursue their interests according to their preferences and abilities.

People knew how to raise a concern and how to make a complaint. The registered manager responded and resolved complaints in line with the provider’s guidance.

The registered manager checked the quality of the service and took action to improve the care and support people received.

The agency worked in partnership with other professionals involved in the care and support of people who used the service.

People who use the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were effective recruitment and selection processes in place to ensure only suitable candidates were employed to work with people. We spoke with two support workers who said they were supported in their work.

Records were accurate and fit for purpose to support the work of the agency in helping to meet people's needs.