About the service St Elizabeth's Domiciliary Care Agency is a supported living service for people with learning disability and autism. The service was provided to adults in shared accommodation on their college site and in individual flats.
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 the inspection 32 people were supported with the regulated activity.
People’s experience of using this service and what we found
People were put at risk of harm due to the lack of safeguarding processes and effective systems in place to implement improvements where risks had been identified. Care plans and risk assessments did not always correlate and identify fundamental information to ensure people were supported in a safe way. People did not always receive their medicines in line with their care plans. There was a lack of staff trained to administer medicines, which had an impact on delivery of care.
People did not always get the dedicated support commissioned and this meant people were not always provided with safe support and were unable to experience new things or meet their aspirations.
People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
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.
The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People did not receive support that was person-centred and gave them autonomy on their life. Relatives felt there needed to be a stronger focus on people’s interests and ensuring their support was meaningful to them. People did not have choice of who they were supported by. Support did not focus on people’s quality of life or follow best practice.
Staff told us and records confirmed there needed to be additional training to ensure there was enough appropriately skilled staff to meet people’s needs.
The management team did not always offer the support and leadership required for the staff. Staff felt there was a lack of communication between staff and management. The provider and manager had a governance system in place, which included various audits and monitoring, however, these were not effective and did not identify the issues we found.
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 September 2019).
Why we inspected
We received concerns in relation to the management of safeguarding concerns. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe, effective 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.
Following the inspection visit the nominated individual met with CQC to discuss their evaluation of the inspection and what actions they will be starting to take following the visit. The nominated individual stated they were to develop an action plan following the inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Elizabeth's Domiciliary Care Agency on our website at www.cqc.org.uk
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe management of medicines, management of risk, developing care that is person centred and the governance oversight at this inspection.
At the previous inspection we have identified breaches of regulation in relation safe care and governance and oversight. In response to the areas of risk we took enforcement action to keep people safe. This included conditions being placed on the provider's registration to restrict them from providing care to new people unless they take specific actions to ensure this is done safely.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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.