We carried out a review of the data available to us about Expeditions Living on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Expeditions Living, you can give feedback on this service.
Expeditions Living is a domiciliary care and supported living service providing personal care for younger adults with physical disability, learning disability and/or mental health needs. The service supported five people at the time of the inspection.
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.
People’s experience of using this service and what we found
People and their relatives were positive about the support they received from staff. They told us they felt safe when staff visited and were confident that any concerns would be dealt with promptly. Appropriate numbers of staff were employed to deliver the care and support people required. Where people were supported with medicines, they received support from staff who had received training around this and medicines were managed safely.
Infection prevention measures had been established within the service. Staff had a good understanding of these procedures and people confirmed staff were wearing protective equipment when visiting people in their homes.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
The registered manager acted on concerns to ensure people received care which was safe and responsive to their needs. Staff were trained in safeguarding people and protecting them from harm. Any concerns or accidents were reported and acted on.
The registered manager had developed quality assurance systems to monitor the overall quality of the service provided to people. These systems had led to improvements in the quality of the service being provided to people.
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 requires improvement (published 10 June 2019) and there were multiple breaches of regulation.
Why we inspected
We carried out an announced comprehensive inspection of this service on 27 March 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Safe Care and Treatment and, Good Governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Expeditions Living on our website at www.cqc.org.uk.
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.
In domiciliary care and supported living settings, people’s care and housing are provided under separate contractual agreements. CQC does not regulate these premises; this inspection looked at people’s personal care and support.
People’s experience of using this service:
¿ Risks to people had not always been fully assessed or managed by the service. People's support plans lacked sufficient detail to keep them safe from some known risks.
¿ Health and safety audits, spot checks and service reviews supported the registered manager to identify concerns to improve the service. However, these quality monitoring systems were not always effective in identifying shortfalls in the service provided. Prompt action was therefore not taken to address the risks these shortfalls might pose to people.
¿ We received positive feedback about the service and the support people received. People felt safe and told us staff understood their needs and how to support them.
¿ Staff were knowledgeable about safeguarding and understood provider policies for reporting and
recording concerns. Staff knew when and how to involve external agencies.
¿ People were protected from unsuitable staff through safe recruitment and induction practices.
¿ Staffing levels were maintained according to people's funded hours. The service was flexible in responding to people’s requests for changes to their planned hours.
¿ People received appropriate support to take and/or order their medicines safely.
¿ Health and safety and infection control risks were monitored. The registered manager supported people to address tenancy related issues with their landlord if needed.
¿ People's health related needs were managed with support from health care professionals. People were supported to attend their health care appointments.
¿ People were encouraged to live healthy lives. Where staff were responsible for preparing people's meals, people were encouraged to eat a suitable diet.
¿ People were partners in planning their care and their relatives were consulted when appropriate. People felt respected and listened to.
¿ The service had a visible person-centred culture. People were valued as individuals and their independence was respected. People received a service that was tailored to their needs.
¿ People’s psychological, social and cultural needs were considered and people benefitted from a service where inclusion was the norm.
¿ People were supported by caring staff who felt supported and enjoyed their role. Staff competency and performance was checked regularly.
¿ People knew the registered manager well and were confident any concerns would be addressed.
¿ The service worked openly and in partnership with other community services and agencies.
Rating at last inspection: At the last inspection the service was rated 'Good'. (This report was published on 18 August 2016). At this inspection we found concerns in relation to the assessment of people’s risks and the effectiveness of the provider’s quality assurance systems. We have therefore rated the service Requires Improvement.
Why we inspected: We inspected this service as part of our ongoing Adult Social Care inspection programme. This was a planned inspection based on the previous 'Good' rating. Previous CQC ratings and the time since the last inspection were also taken into consideration.
Follow up: We have asked the provider to send us an action plan telling us what steps they are to take to make the improvements needed. We will continue to monitor intelligence we receive about the service until we return to visit, as per our inspection programme. If any concerning information is received we may inspect sooner.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
There was a registered manager in post, who was also a director of the company. 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 and associated Regulations about how the service is run.
People spoke with enthusiasm and passion about the service they received. They said their care and support was directed by them and could be flexible to meet any changes in their daily routines. Their care records had been planned with them to convey what they could do for themselves and what they needed help with. Staff encouraged them to maintain and develop their independence. People talked through any hazards they might face in their homes or local communities with staff and they agreed how to reduce risks to stay as safe as possible. People knew how to stay safe and staff were on hand to provide guidance if needed. People were encouraged to stay healthy and well; staff support was available if needed to attend health care appointments. People enjoyed their independence although if needed staff support was always available for holidays or activities.
People were supported by staff who had been thoroughly checked as part of the recruitment process. People took part in the interviewing of staff and talked with the registered manager about their preferences for the staff supporting them. Staff had access to training and individual support to develop their skills and knowledge and for professional development. Robust communication was in place between people, staff and the registered manager ensuring any changes in people’s needs were shared when needed. People were supported by enough staff to meet their needs. They commented, “It’s one of the major things which attracted me to Expeditions, it’s size and the small staff group” and “As close as perfect as it gets.”
People benefitted from a robust quality assurance process which included quarterly stakeholder meetings with the provider, relatives and other professionals involved in their care. They were confident about raising issues as they arose and knew the registered manager would listen to them, respond and take the necessary action to improve their experience of care. The registered manager was open, accessible and worked alongside staff assessing the quality of service provided. A person told us, “I trust in [name of registered manager], happy with the way he deals with things.” A relative commented, “The company philosophy on independent living is great.”
People told us they wrote their support plans with staff. These were person centred and reflected the way in which they wished to be supported. They said,"we are taking control of paper work and have more self control".
People confirmed they felt safe. Staff had access to safeguarding training. Systems were in place to safeguard people from possible financial abuse.
Effective recruitment and selection processes were not in place. The safety and welfare of people could be compromised. People told us they were involved in the recruitment and selection of staff. One person said, "we interview and choose our own staff based on our needs".
People said they were involved in reviewing the quality of service provided. General meetings with staff were held to discuss the way in which their service was developing. A person told us, "I have nothing but good experiences".