Social Care Solutions Ltd (Bedfordshire)

About the service

Social Care Solutions Ltd (Bedford & Northampton) is a supported living service providing personal care for adults with learning disabilities, autistic spectrum disorders, dementia, physical disabilities and sensory impairments.

Not everyone using the service received a 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. At the time of this inspection the service was supporting 47 people, of these, 28 people were receiving personal care.

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

Right Support:

People were supported in goal planning. However, this required further development to ensure records consistently captured the steps required to achieve an agreed goal and the progress made by people.

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. Staff understood the importance of providing respectful care which was person centred and tailored to individual’s needs.

Staff had received training and applied their skills and understanding to provide safe care. Additional specialist training was provided to staff to enhance their knowledge and raise awareness of people’s medical conditions.

Right Care:

People had risk assessments and care plans in place. However, some of these required updating to ensure the information was accurate and reflective of people’s current needs.

Staffing levels were improving, and recruitment continued to take place. Where required agency staff complimented the staff team to maintain safe staffing levels. The provider block booked agency staff to support continuity of care.

Right Culture:

The quality assurance system had been reviewed and new processes implemented. This required time to embed to ensure it was robust in identifying and addressing shortfalls of the service.

We received mixed feedback from relatives about the registered managers. Many of the relatives we spoke with were not aware of the registered managers names but recognised the scheme managers whom they communicated with where required.

Staff told us a newly recruited registered manager was approachable. Comments we received from staff included, “[Registered manager] is amazing. They make time for people and staff always.” And, “The new registered manager is definitely approachable. I now feel confident and able to raise concerns and know I will be listened to.”

Staff were passionate and enthusiastic in their role. Comments we received from staff included, “Knowing I have made a difference to a person makes me feel accomplished.” And, “It is rewarding to support somebody achieve things in their everyday life. Seeing a person smile makes my day.”

The provider recognised when people’s needs changed and made timely referrals to external professionals to ensure appropriate care and support was in place.

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 12 August 2021) and there were breaches in regulations. 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted in part due to concerns received about the management and leadership of the service. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe, effective, caring, responsive and well led sections of this full report.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Social Care Solutions Ltd (Bedford & Northampton) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Social Care Solutions Ltd (Bedford & Northampton) provides care and support to people living in a variety of '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.

Not everyone using Social Care Solutions Ltd (Bedford & Northampton) receives a 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.

At the time of this inspection 82 adults were using the service who had a range of care needs including learning disabilities, autistic spectrum disorder, dementia, mental health, physical disabilities and sensory impairments. Of these, 34 were receiving personal care.

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

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

People were generally 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. However, further improvements were needed to ensure people’s money was always managed in a fair way and in line with current rules and guidance.

People’s feedback was requested, listened to and acted on, to improve the service. Further work was needed to consider if there were any lessons that could be learnt when things went wrong, to try to stop them from happening again.

Right care:

Staff understood how to safeguard people from abuse and avoidable harm. Checks were carried out to make sure staff were safe to work at the service, but improvements were needed to make sure all required checks were in place. Staff had been trained to support people with their medicines in a safe way and they understood the importance of good hygiene and the prevention and control of infection.

Staff understood how to provide personalised care and support, and they encouraged people to increase their independent living skills through goal planning. People’s individual wishes needed to be included with goal planning to make sure they also followed their interests and aspirations.

Right culture:

Staff had the right training and skills to carry out their roles and meet people’s needs. They made sure people had enough to eat and drink, and if anyone became unwell, staff knew how to access health care services to support people’s health and wellbeing. Relatives told us staff kept in touch to update them if people’s needs changed.

There had been further changes in the management team since our last inspection. Two new managers were in place who had registered with us, the CQC (Care Quality Commission). There was positive feedback about the two new managers, and improvements had taken place across the service. However, we found several areas requiring improvement during this inspection. Some of these had been included in previous inspections of this service too. The provider’s systems for checking the quality of the service had not identified all of these. This meant that further work was needed to make sure everyone using the service always received a high quality and safe service.

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 8 June 2019).

At this inspection enough improvement had not been made / sustained, and the provider was still in breach of regulations.

The service remains rated requires improvement. This is based on the findings at this inspection. It has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We carried out an announced comprehensive inspection of this service in May 2019. A breach of legal requirements was found. The provider completed an action plan after the inspection to show what they would do, and by when, to improve how they notified CQC when authorisations to deprive people of their liberty had been approved by the appropriate legal authority.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Social Care Solutions Ltd (Bedford & Northampton) on our website at www.cqc.org.uk.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met this legal requirement.

This report only covers our findings in relation to the Key Questions: Safe, Effective, Responsive and Well-led. The ratings from the previous comprehensive inspection for the key question not looked at on this occasion: Caring, was used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements, although we found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Effective, Responsive and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

The registered managers did take action to put some of these things right before the end of the inspection. Other areas will need more time.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authorities to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Social Care Solutions Ltd (Bedford & Northampton) provides care and support to people living in a variety of '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.

Not everyone using Social Care Solutions Ltd (Bedford & Northampton) receives a 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.

At the time of this inspection 90 adults were using the service who had a range of care needs including learning disabilities, autistic spectrum disorder, dementia, mental health, physical disabilities and sensory impairments. Of these, 49 were receiving personal care.

People’s experience of using this service:

There had been lots of changes in the management team since our last inspection. A new manager had started around two months before this inspection. They understood their responsibilities and had some good ideas about how to improve the service.

Staff provided care and support in a kind and compassionate way, but there were many staff vacancies. These were being covered by agency staff and people told us they wanted regular staff who would get to know them well and provide consistency of care and support. New training was being arranged to make sure staff had the right skills and knowledge to meet people’s needs.

The service generally acted in line with legislation and guidance regarding seeking people’s consent but improvements were needed to make sure people always agreed about what they spent their money on.

Systems to protect people from abuse and avoidable harm and risks were in place and the new manager was making changes to improve these.

The service acted in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

People were enabled to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The new area manager had plans to improve communication methods for people, where needed and to increase opportunities for people to achieve their goals and aspirations.

People’s privacy, dignity, and independence was respected and promoted.

Systems were in place for people to raise any concerns or complaints they might have about the service. Feedback was responded to in a positive way, to improve the quality of service provided.

Arrangements were in place to involve people in developing the service and seek their feedback.

Improvements were taking place to enhance the systems to monitor the quality of service provision and to drive continuous improvement. Opportunities for the service to learn and improve were welcomed and acted upon, and the service worked in partnership with other agencies for the benefit of the people living there.

Rating at last inspection:

The service was rated Requires Improvement (report published on 14 September 2018).

After the last inspection on 7 and 8 August 2018, we asked the provider to act to make improvements to manage identified risks to people, staff recruitment checks, supporting people to make their own decisions in line with relevant legislation and guidance and quality monitoring processes.

During this inspection we found that improvements had been made in all these areas but due to changes in the management team since the last inspection, we found that progress had been made at a slower rate than expected. There was still work to be done therefore to embed the changes and make all the required improvements across the service.

Why we inspected:

This inspection was to check progress with the provider’s action plan and assess whether required improvements had been made.

Enforcement:

We found the provider had breached two further regulations on this occasion, for not having a registered manager in post and for failing to notify the Care Quality Commission when people’s liberty had been deprived.

You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up:

This is the second time the service has been rated Requires Improvement. The new area manager has already provided us with an action plan setting out how they plan to address the findings from this inspection and ensure required improvements are made in a timely way.

We will continue to monitor information about the service and will carry out another inspection in accordance with our published inspection programme. If any concerning information is received in the interim, we may inspect sooner.

For more details of this inspection, please see the full report which is on the CQC website at www.cqc.org.uk.

Not everyone using the service receives a 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. At the time of this inspection 108 adults were using the service who had a range of care needs including learning disabilities, autistic spectrum disorder, dementia, mental health, physical disabilities and sensory impairments. Half were receiving personal care.

This was the first inspection of Social Care Solutions Ltd (Bedford & Northampton) since it registered with CQC in August 2017. This means the service has not previously been rated. During this inspection, which took place on 7 and 8 August 2018, we found that the service had breached a number of legal requirements. We rated the service as Requires Improvement. This is the first time the service has been rated Requires Improvement.

Risks to people were being identified, but the arrangements to mitigate these risks were not always robust enough in order to keep people safe.

Action had been taken to address a number of medicine errors that had happened across the service. However, more work was needed to ensure people consistently received their medicines in a safe way and as prescribed.

The provider checked to make sure staff were safe to work at the service, but the checks being made did not fully meet the legal requirements.

The service generally acted in line with legislation and guidance regarding seeking people’s consent. More work was needed however, to ensure ‘best interest decisions’ were recorded for financial expenditure where people did not have capacity to understand or manage their own money.

Improvements were needed to ensure all staff had the right training to carry out their roles in order to meet people’s assessed needs.

New support plans were being introduced across the service, to help people to receive personalised care that was responsive to their needs. However, this essential work had not been completed when we inspected the service.

More work was needed to determine people’s end of life care preferences and choices, should the need arise.

The service was working to ensure people’s care and support was consistently delivered in line with current standards and evidence based guidance. However, the systems in place to monitor the quality of service provision and drive continuous improvement, needed to be strengthened.

You can see what action we told the provider to take at the back of the full version of the report.

People were protected from abuse and avoidable harm. Staff had been trained to recognise signs of potential abuse and knew how to keep people safe.

There were enough staff to meet people’s needs and help them to stay safe. They understood how to protect people through the prevention and control of infection too.

The service responded in an open and transparent way when things went wrong, so that lessons could be learnt and improvements made.

People were supported to eat and drink enough. People were actively involved in choosing what they ate and preparing their own meals. Risks to people with complex eating needs were understood by staff.

Staff worked with other external teams and services to ensure people received effective care, support and treatment. People had access to healthcare services, and received appropriate support with their on-going healthcare needs.

Staff provided care and support in a kind and compassionate way.

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 were enabled to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s privacy, dignity, and independence was respected and promoted. They were supported to participate in meaningful activities and work.

Systems were in place for people to raise any concerns or complaints they might have about the service. Feedback was responded to in a positive way, to improve the quality of service provided.

The leadership at the service promoted a positive culture that was person centred and open. Arrangements were in place to involve people in developing the service and seek their feedback.

Opportunities for the service to learn and improve were welcomed and acted upon, and the service worked in partnership with other agencies for the benefit of the people living there.

Further information is in the detailed findings below.