Archived: Plymouth Support Service

Updated 27 July 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This was a comprehensive inspection. The inspection site visit activity started on 23 April 2018 and ended on 31 May 2018. It included office visits and visiting people in their own home. We visited the office location on 23 and 25 April to see the management team and office staff; and to review care records and policies and procedures. We followed this up by meeting a registered manager for the company on the 1 June 2018 to provide feedback. This registered manager was standing in for the registered manager of the Plymouth service who was away at that time.

We gave the service 48 hours’ notice of the inspection visit because the location provides a domiciliary care service and we needed to be sure that office would be staffed and enable time for home visits to be arranged. The inspection was completed by one inspector.

Before our inspection we reviewed the information we held about the service. We reviewed notifications of incidents that the provider had sent us since their registration. A notification is information about important events, which the service is required to send us by law.

We reviewed the information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

During our inspection we met with 15 people who received support with personal care. We spoke with six relatives for their views on the service. We spoke with ten staff members and received feedback from four professionals involved with people who use the service. We were supported by the two service managers who oversaw the day to day running of the services and spoke with the registered manager of this service and provided feedback to another registered manager who was overseeing the Plymouth service because the Plymouth service registered manager was unavailable.

We looked at six records which related to people’s individual care needs. We viewed three staff recruitment files, training evidence and records associated with the management of the service. This included policies and procedures, people and staff feedback, and the complaints process.

Updated 27 July 2018

Plymouth Support Service is a domiciliary care service registered to provide personal care. The service provides personal care and support to adults of all ages living in their own homes within the Plymouth area. It provides a service to people with a learning disability who may also have a physical disability and people living with sensory impairment.

Plymouth Support Services also provides care and support to people living in a 'supported living' setting. Where people live in their own home and receive care and/or support in order to promote their independence. If there is genuine separation between the care and the accommodation, the care they receive is regulated by CQC, but the accommodation is not. The support that people receive is often continuous and tailored to their individual needs. It aims to enable the person to be as autonomous and independent as possible, and usually involves social support rather than medical care.

The service supports some people on a 24 hour basis and others who may require support with personal care needs at specific times of the day and/or night. At the time of this inspection, seventeen people received support with their personal care needs from the agency including people in the shared houses.

The service had 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.

At the last inspection in April 2016 the service was rated Good. At this inspection we found the service Required Improvement.

Why the service is rated Requires Improvement.

We visited and spoke to 15 people in their own homes and observed the interaction between them and the staff supporting them. People were not all able to fully verbalise their views, so staff used other methods of communication, for example visual choices and sign language.

The service was not consistently safe. When asked, people from one shared house said they did not feel safe. They raised concerns about a person who lived nearby. This person and the people living in the shared house had to gain access to their front door via the shared car park/garden area. People did not feel safe leaving their own home, some people missed appointments if the person concerned was outside of their home as they felt too frightened to leave. Staff also felt intimidated either going off duty or if they were leaving with people they were supporting to access the community if this person was outside in the shared car park/garden area. The service manager was currently in talks with the local safeguarding team over this issue.

People and relatives also raised concerns over a second provider currently providing overnight care for people in one of the shared houses. They were not happy with the level of care and one person commented; “Not sure if they are going to turn up.” The provider was due to stop providing care shortly.

Staff highlighted an issue with one person and their current funding level to help keep them safe and well cared for. This person’s care records all clearly showed they required two to one staffing to assist them to the toilet. At times this person was in the shared house with only one member of staff. Staff told us of an occasion that this person had to wait 45 minutes to be taken to the toilet. This could have caused this person a lot of discomfort and the Commission reported this to the local safeguarding team. The service manager overseeing this service said they were in the process of trying to obtain additional money to fund extra hours to support this person whose health had deteriorated over time due to increasing age. However records showed this person had been receiving over 700 minutes of additional care hours currently provided. These additional hours could indicate that this person may need a more suitable placement. Also if they were deemed to lack capacity to make that decision then a best interest meeting may need to be considered. After one of our site visit days a re-assessment of this persons hours had been carried out by the local authority and an additional two hours a day had been allocated. The service manager said they would discuss this with the registered manager as this still fell short of additional hours currently being provided.

Staff raised concerns over the number of staff employed to cover the current work load. For example some staff worked over 60 hours a week and another had completed six waking night duties to help support people have consistent staff working with them. Though some staff felt this was staffs own choice, other staff felt pressured into working extra hours.

People’s risks were assessed, monitored and managed by staff to help ensure they remained safe. Risk assessments had been completed to help support positive risk taking, and help reduce risks from occurring. Risks associated with people's care and living environment were effectively managed to ensure their freedom was promoted. People were supported by consistent staff to help meet their needs. People's independence was encouraged and staff helped people feel valued by supporting people to engage in everyday tasks, for example helping prepare meals. However some people’s independence was at times restricted due to not feeling comfortable leaving their home due to issues with a person living near a shared house.

People however felt safe with the staff that supported them. Family members provided positive feedback about the management and staff, the safety of people and how staff related to their loved ones. Comments from relatives included; “Safety comes high on their list of priorities.”

People’s medicines were managed safely. People were protected from abuse because staff knew what action to take if they suspected someone was being abused, mistreated or neglected. People had their needs met by suitable numbers of employed staff. Staff were recruited safely and checks carried out with the disclosure and barring service (DBS) ensured they were suitable to work with vulnerable adults.

The service was not consistently well led.

We were assisted during our inspection by two service managers. These two service manager were in day to day control of the service. This included each one overseeing a shared house individually, and jointly overseeing people who received care in their own home. We also had contact with the registered manager of the Plymouth service during the inspection. We then met with another registered manager for the company to provide additional feedback after the inspection in the temporary absence of the registered manager of the service.

The feedback we received from support staff was variable. Some staff told us one of the service managers was very approachable with some saying; “X [the service manager] is working hard to resolve some issues we have with “X [a person who lived close by]” and “Very approachable” and “Very good manager and involved in the home.”

The feedback on the other service manager was less positive; “Unapproachable”, “X [service managers name] doesn’t speak to us (staff) when they are in the home”, “The worst manager I’ve worked with.” We passed this information onto another registered manager for the company in the absence of the registered manager for this Plymouth service.

The provider had systems in place to monitor, assess and improve the service. However, the current checks and audits carried out were not effective in giving the provider and registered manager a clear oversight of the service or alert them to issues raised during our inspection. For example, that some staff were very unhappy with the running of one of the shared houses, that there was a short fall on providing safe care for one person, namely they only had one staff available to them when they may at times require two staff to assist with personal care. Also the number of additional hours which were being provided to one person over and above their allocated funded hours, possibly indicating an increase in their care needs or a more suitable care package.

People and relatives said they found access to the management team easy and approachable. Though some staff were positive and happy in their jobs, other staff said they were looking for work elsewhere and unhappy in their jobs due to lack of support. There was a clear organisational structure in place.

The service was responsive to people's needs and people were given a wide range of choices about their day to day lives.

The service manager had been responsive in contacting the local authorities before our inspection over issues including the problem with a neighbour who the service was finding challenging and the concerns raised by the people, relatives and staff over the second care provider involved in one shared house. During the inspection one person needing additional staffing, for extra support for all transfers and to meet toileting needs, had been referred to healthcare professionals for a re-assessment of extra funding.

However these were still ongoing issues that had not yet been resolved for the people concerned.

People had access to a very wide range of organised and informal activities which provided them with mental and social stimulation. People were supported to access the local community.

People were enabled and supported to lead fulfilling and active lives. 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.

People could make a complaint and relatives were very confident action would be taken to address their concerns. One relative said how the service manage