Quality Support Solutions Limited

Quality Support Solutions Limited is a domiciliary care agency. It provides personal care to adults living in their own homes, so that they can live as independently as possible.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of this inspection 42 people were using the service, 22 of whom were receiving personal care. People had a variety of care and support needs including learning disabilities, autistic spectrum disorders and physical disabilities.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures 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 using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. For example, staff did not wear uniforms and were discouraged from wearing anything that suggested they were care staff when coming and going with people.

People’s experience of using this service:

Since the last inspection a number of improvements had been made. This included the provider’s internal systems to monitor the quality of service provision and to drive continuous improvement. However, we identified some areas requiring improvement during the inspection that had not been fully identified by the provider. This included the planning and timing of care visits, staff recruitment checks and the actions taken when someone runs out of their medicine. This showed that the provider’s systems required further strengthening to ensure all legal requirements are consistently identified and met.

Despite this, people we spoke with told us the care and support they received was generally reliable and helped to improve their quality of life. They said staff provided care and support in a kind, compassionate way and their privacy, dignity and independence was respected and promoted.

People were supported 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 outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff knew how to protect people and keep them safe. They had the right skills and knowledge to meet people’s needs. Staff maintained good standards in relation to infection control and hygiene, and supported people to stay healthy too. They helped them to access healthcare services when they needed them and ensured they had enough to eat and drink.

People were given the opportunity to make suggestions and provide feedback about the service provided to them. 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.

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

Rating at last inspection

The last rating for this service was Requires Improvement (published 17 January 2019).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Quality Support Solutions Limited on our website at www.cqc.org.uk.

The provider completed an action plan following that inspection to show what they would do and by when to improve. At this inspection we found enough improvements had been made and the provider was no longer in breach of regulations.

However, pending additional improvements, the service remains rated requires improvement. This is the second time the service has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make further improvements. Please see the safe and well-led key question sections of this full report. We found no evidence during this inspection that people were at risk of harm from these concerns.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Quality Support Solutions is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older people, younger adults, people living with a physical disability, people living with a sensory impairment and people living with learning disabilities or autistic spectrum disorder. People using the service were all being supported with the regulated activity which the service was registered to provide.

There were 19 people using the service when we completed the inspection. There was a registered manager employed at the service. 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 service was last inspected in February 2016 and the rating at the last inspection was Good. At this inspection the rating has deteriorated to Requires Improvement.

We found that the service was not always safe. Risk assessments for some people were not detailed and did not explain how to reduce risks. Known risks were not always documented in people's care plans.

The current rota system meant that there was no way of effectively monitoring whether staff were arriving for calls at the correct time or staying for the entire call duration. People told us about calls that had been missed or late however these had not been picked up by the current rota system.

Staff members had necessary checks completed before starting employment including a disclosure and barring services (DBS) check.

People were not always supported safely to take medicines. Some people were prescribed as and when required (PRN) medicines however the protocols for these were often not clear as to when or how medicines should be administered. Staff members did not receive regular competency checks to ensure that they were able to support people with medicines safely. Monitoring of medication stock and administration records were not effective.

There were systems and processes in place to protect people from harm or abuse.

The service was effective although some improvements were needed. Some staff members had not received regular training in some areas of their job roles. Staff members did not receive regular supervisions or observations of practice to ensure that they were performing their job roles.

People were supported to maintain their health and well-being. The service worked with and referred people to other health and social care professionals to support people’s wellbeing. People were supported with their dietary needs where needed.

Consent to care and treatment was obtained from people and people were supported in line with the principles of the Mental Capacity Act (2005).

People were positive about the care and support that they received from staff members. There were systems in place to ensure that people’s privacy and dignity were respected and that people had the opportunity to remain as independent as possible and make choices about their care and support.

People were supported with kindness and respect and staff members. People and those important to them had been involved in making decisions about their support as much as possible.

People received care that was responsive to their needs. However, the service was not always responsive as changes to people’s care was not always documented thoroughly. People’s care plans were task-orientated and there was little information about people’s preferences, likes and dislikes in their care plans.

Assessments completed for people before they started using the service were task orientated and did not go in to detail about people’s preferences with regards to the support they received.

People's complaints and comments about the service were not always documented or responded to appropriately. People's concerns had not been picked up in quality audits and late calls had not been monitored or noted within the current rota monitoring systems.

Quality monitoring and the recording of records were not operating effectively which meant that the provider is in breach of Regulation 17 of the Health and Social Care Act 2018 (Regulated activities) Regulations 2014. Good governance.

Rota monitoring systems were not effective at monitoring whether peoples care calls were happening on time or whether people were staying at care calls for the full duration of the time.

Quality monitoring and assurance systems were not completed regularly. Where audits were completed they did not identify issues in the service and actions were not taken to continually improve the service. Feedback collected from people who use the service was not always used to improve the quality of the service.

The provider worked with other organisations such as the local authority and we saw that action plans were produced following these visits. However we saw that these were not monitored and actions were not completed in the timeframes that the provider had set themselves.

Feedback about the registered manager from people and staff members was positive. The registered manager had a passion for supporting people in a caring manner and wanted to improve the service going forward.

Everyone we spoke with told us they were 'very satisfied' with the service they received. One person said it 'really changed my life' and another described the service as 'fantastic.'

People we spoke with told us that care staff carried out all the tasks they needed them to do, and everyone spoke of having regular carers who turned up when agreed. One person said 'I could set my clock by them' and another person told us 'it really does fit the bill.'

People confirmed that they or their relatives felt safe in the presence of the manager and care staff, who they described as 'brilliant', 'kind' and 'caring.'

Everyone told us that they were regularly asked for their feedback, to make sure the service was meeting their needs appropriately. They said they felt comfortable approaching the manager if required with any concerns.