Archived: Ambito Community Services South West

Updated 23 June 2023

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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was undertaken by 2 inspectors and an expert by experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It also provides care and support to people living in a ‘supported living’ setting, 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.

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 not a registered manager in post. A manager had started working at the service 6 weeks before the start date of the inspection.

Notice of inspection

We gave a short period notice of the inspection so staff had time to support people to understand and consent to a home visit from an inspector.

Inspection activity started on 28 November 2022 and ended on 9 December 2022. We visited the location on 2 December 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We used information gathered as part of monitoring activity that took place on 21 June 2022 to help plan the inspection and inform our judgements. 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 3 people and met 2 other people. We spoke with 4 agency staff and 5 permanent staff including the manager and area manager. We reviewed 2 people’s records and a variety of records relating to the management of the service, such as audits and meeting minutes. We spoke with 4 relatives by phone. We received feedback from 2 health and social care professionals and spoke to 2 by phone.

Updated 23 June 2023

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

Ambito Community Services South West is a domiciliary care agency with a supported living setting which provides personal care for autistic people and people with learning disabilities. The service provides support to people with a learning disability and autistic people, some of whom may also have a physical disability. There was an office in Plymouth for the domiciliary care agency and an office at the supported living location near Liskeard.

The provider had taken over responsibility for the setting in September 2021.

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 our inspection there were 9 people using the service receiving support with personal care. 8 of these people lived at the supported living setting.

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

Right Support

The model of care and setting did not maximise people’s choice, control and independence. Support did not always focus on people’s strengths and promote what they could do.

The service did not have a clear record of any authorisations to deprive people of their liberty. This might have meant they were depriving people unlawfully.

Relatives and professionals told us they did not think people had fulfilling and meaningful, interactive everyday lives. People’s records did not clearly describe their aspirations and goals.

There was a lack of guidance on what support people needed to increase their skills and have control over their own lives. People were supported by staff who had not all received the right training to understand and meet people’s needs.

People who experienced periods of distress did not always have proactive plans in place which ensured staff understood the best way to support them at these times. Records did not evidence staff had all received training in supporting people at these times, or on how to restrain someone in the safest way.

The setting was designed as a holiday complex and not for permanent dwelling. Necessary alterations to meet people’s needs detracted from the feeling that the individual bungalows were people’s homes.

People had limited access to the local community. They lived in a remote location which meant they were reliant on staff who could drive, to take them to the local town.

Staff supported people with their medicines in a way that met their preferences. However, some medicines practices, such as how medicines were stored and administered, were not person centred.

Right care

The service was short staffed and was reliant on agency staff. Some of these worked long hours with little time off but the provider had not identified that this could compromise the safety and quality of people’s care.

Staff had not all received training in communication methods people used, such as Makaton.

People’s care plans did not give a comprehensive or holistic view of their support needs and preferences. Records contained limited information about any aims or aspirations people had and did not contain clear pathways to guide staff on how people wanted to achieve these or learn new skills.

Risk assessments were not in place for all risks related to people’s support needs.

Professionals raised concerns that it was difficult to contact the service and that staff were not always aware of guidance provided by external professionals.

Support for people with what they ate and drank was not always person centred or safe.

Right culture

The provider had not identified that the model and setting of the service limited people’s quality of life and did not reflect best practice. The service was not similar to dwellings other people would live in and was distinguishable from surrounding accommodation.

There had been inconsistent management at the service and relatives raised concerns that the service had not improved sufficiently since the provider took responsibility for it.

Staff had not all received training in learning disabilities or person-centred care. This meant they had a limited understanding of best practice models of care.

Relatives told us they did not always feel involved in their family member’s life. Records showed they had not always been included when decisions had been made on behalf of people who lacked the capacity to make the decisions themselves.

The provider had not ensured that people’s records and staff skills were in place and up to date. This had a negative impact on people’s quality of life.

Tools and audits to monitor the service had not been used effectively to ensure the service improved and met people’s needs.

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 good (published 30 April 2019). At that time, the setting we visited for this inspection was not part of the service.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ambito Community Services South West on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to consent, safe care and treatment, person centred care, governance of the service and staffing at this inspection.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We proposed to require the provider to report to us each month about the improvements they were making but the provider closed the service before this came into effect.