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
Churchview Care Services (Taunton) is a domiciliary care and supported living service providing personal care to people living in their own homes.
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 inspection the service supported 15 people with the regulated activity personal care.
People’s experience of using this service and what we found:
Right Support
People were not always supported to have maximum choice and control of their lives; the policies and systems in the service to support this were not effective. The provider did not always demonstrate best practice when assessing people’s mental capacity or supporting decision-making. This meant people's legal rights were not fully protected.
Staff were observed communicating with people in ways that met their needs and supported people to make choices.
Staff enabled people to access specialist health support in the community.
Right Care
People were supported by staff who knew them well and understood their needs. However, care plans and risk assessments were not always comprehensive and up to date. Some risks to people had not been sufficiently assessed and documented in their care records.
People received their medicines from trained staff. However, individual protocols for medicines which were prescribed to be given 'as required' were not always in place, and the provider’s medication policy was not always being followed. This placed people at risk.
Risks in relation to managing people’s finances were not always managed safely. The provider had raised a safeguarding concern and were investigating concerns at the time of the inspection. During the inspection we identified further concerns, and raised a further safeguarding concern with the local authority safeguarding team regarding this. However, it was found not to meet the local authority threshold.
Staff received training in safeguarding vulnerable adults and knew how to recognise and report any indicators of abuse. Staff spoken with said they would be confident to report any concerns about possible abuse or poor practice.
Safe recruitment practices were followed, and suitable induction and ongoing training was in place for staff. Relatives raised concerns regarding staffing levels. The manager provided assurances that people did receive the right amount of support and that current assessed staffing levels were safe.
People felt safe with the staff who supported them. We observed good interactions between people using the service and staff. Some relatives raised concerns regarding the safety of the support their loved ones received.
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Throughout the inspection we observed kind, relaxed, compassionate and caring interactions between people and staff. Relatives told us, “I think the staff work really hard” and “The staff are really good and caring.”
Right Culture
Improvements were needed to make sure there were effective systems to monitor the quality of the service and plan improvements.
The ethos of the service was to provide person-centred care and promote people's independence. Throughout the inspection we observed that staff were respectful of people and took time to offer support and reassurance when needed. One relative told us and there is always a happy atmosphere within the service where their loved one lives.
People told us they were pleased with the support that staff provided to them, although relatives raised some concerns about the service their loved ones received. During the inspection we raised a safeguarding concern with the local authority safeguarding team regarding this.
The management team were open and transparent throughout our inspection. They acted on queries and our feedback throughout the inspection.
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 good (published 29 May 2019.)
Why we inspected
This inspection was prompted by a review of the information we held about this service and information we received from the provider about how people were supported to manage their personal finance. As a result, 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.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Churchview Care Services (Taunton) on our website at www.cqc.org.uk.
Enforcement
The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. We have identified breaches of regulations in relation to safeguarding, risk management, consent and quality monitoring and planning improvements.
You can see what action we have asked the provider to take at the end of this full report.
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 authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.