Background to this inspection
Updated
18 September 2021
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 Care Act 2014.
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
This inspection was carried out by three inspectors.
Service and service type
This service provides care and support to people living in a number of ‘supported living’ settings, 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.
The service did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we wanted to make sure key members of staff would be available, and we needed to seek permission to visit people in their own homes and speak with them.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report
This was the first inspection of the service since it was registered in November 2019. Therefore, there was no previous inspection history. We reviewed and analysed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
We visited seven shared houses where people who used the service lived. We also visited the main office in Okehampton. We spoke with 18 people who used the service and we received e mails and telephone calls from nine relatives about their experience of the care provided. We spoke with 25 members of staff. We also spoke with the nominated individual and a consultant who had been employed by the provider to look at the management of the service. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
Immediately before, and during the inspection, we received 27 e mails from staff who raised concerns about the management of the service.
We reviewed a range of records. This included 12 people’s care records and their medication records. We looked at five staff files in relation to recruitment, training and supervision. We also looked at a variety of records relating to the management of the service.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with professionals in the local authority care management, safeguarding and commissioning teams who had recent knowledge of the service. We also continued to receive e mails from relatives about their concerns.
Overall inspection
Insufficient evidence to rate
Updated
18 September 2021
About the service
Iverna (Central) Devon is a supported living service providing personal care to people with a learning disability in shared housing. The service provides care to people living in their own homes in and around Okehampton, Crediton, Hatherleigh and Mid Devon. Iverna is a subsidiary of Esto Care Ltd. People have tenancies and the landlord, Larch, is a separate company to Iverna.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is defined as support 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 36 people were receiving personal care.
People’s experience of using this service and what we found
The lack of quality assurance systems meant we could not be assured people were receiving safe and effective care. The provider did not have adequate quality monitoring systems in place. Staff and relatives told us they were concerned about the provider’s management of the service. Staff told us they were afraid to speak out for fear of losing their jobs. The views of relatives and professionals had not been sought by the provider to check on the quality of the service and ensure improvements were made where necessary.
People could not be confident that money paid into shared house accounts for items such as food and cleaning cost had been carefully managed or used appropriately. The provider made assurances, following a whole service safeguarding process which initially began on 4 June 2020. They said the accounts would be audited, and any money overpaid would be refunded. At the time of this inspection the concerns had not been addressed.
People were not always supported by sufficient staff with the knowledge or skills to meet their needs safely. Proposals to change staff’s pay and conditions meant there was a risk some vacant shifts may not be covered. A number of experienced staff and managers had recently left the service. The provider had failed to ensure new staff completed induction training. Staff had not always completed ongoing training on essential topics, or topics relevant to people’s needs. We were not fully assured that people were supported by staff who had been safely recruited. Records of staff recruited in recent months did not provide enough evidence that adequate checks and references had been taken up before new staff began working with people.
We were not fully assured that people were protected from the risk of contracting Covid-19. We saw some staff not wearing the correct personal protective equipment (PPE), and staff not following current government advice on safe infection control procedures. Staff had not received sufficient training, support, policies or procedures to ensure safe infection control practices were followed at all times.
Following our inspection, the provider told us about actions and improvements they had made and planned to make to address the issues we found.
People were not 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.
This service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right Support
• The model of care and setting did not fully maximise people’s choice, control and independence
Support given to people to help them manage their finances and day-to-day expenses were not personalised. People were expected to pay a set amount into a ‘house account’ to pay for food and household expenses. People were not given a choice about this.
• Shared houses were managed and staffed in an institutionalised manner. Records were held at each house instead of the main office. Notices displayed on walls gave houses an institutional appearance. Staff worked in one team based in a single house. People were not supported to choose their own team of staff with the skills and interests to meet their individual needs.
Right care:
• We were not fully assured that care was person-centred or that it promoted people’s dignity, privacy and human rights. We received concerns that several staff had recently left the organisation and that other staff were considering leaving. There was a risk that people may not be supported by experienced staff who knew them well and understood their individual support needs.
Right culture:
• The ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives. There was a closed culture; the provider had failed to communicate adequately with people, staff and relatives. We received concerns from the majority of staff about low morale, and a bullying culture. Staff and relatives expressed distrust in the provider’s ability to manage the service well.
There had been a lack of consideration for meeting the Right support, right care, right culture which had resulted in people receiving care based on the model of residential care rather than promoting personalised individual support.
All of the people we spoke with told us they were very happy with the support they received. Comments included, “It’s great. The people are wonderful. The staff are great. They are so kind and understanding”, and “The staff are alright”. We observed staff supporting people in a range of activities such as games, supporting people with household tasks, and sitting and chatting to people and looking at photographs. People were relaxed and smiling.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
This service was registered with us on 21 November 2019 and this is the first inspection under the current provider. Due to being in a national pandemic we had not being able to complete a rating inspection as early as we would have normally. However, due to the number and nature of concerns being raised, we decided we needed to inspect this service.
The last rating under the previous provider, Lyndridge Care and Support, was Good published on 15 May 2018
Why we inspected
Before this inspection took place, we received a high number of concerns and complaints from staff, relatives and from other professionals. The service had been the subject of a whole service safeguarding investigation since June 2020.
Concerns included, high numbers of staff leaving or planning to leave the service, low staff morale, a lack of trust in the provider’s ability to manage the service, a culture of bullying, low reporting of accidents, incidents and abuse. Staff told us they had been instructed not to contact CQC or the local authority about concerns or abuse.
We have found evidence that the provider needs to make improvement. Please see the Safe 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 our inspection, the provider told us about a range of actions they had taken, or were planning to take, to address the issues we found. However, it is too early to be confident that their actions are sufficient to fully address all of the issues.
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 five breaches in relation to: safe care and treatment, safeguarding, good governance, notifications of other incidents, and staffing
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.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.