8 February 2022
During a routine inspection
About the service
Creative Support- Bedford Services is a ‘supported living’ service providing personal care to people living in seven ‘supported living’ settings. The service was supporting 26 people with personal care at the time of our 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
Right Support
¿ Staff were not always supporting people to pursue their interests or achieve their aspirations and goals. Services were not always fully staffed meaning that people were unable to leave their homes when they chose to.
¿ Reasonable adjustments were not always made so that people could be fully involved in discussions about their support, including support to travel where they needed to go. Staff did not always communicate with people in their identified and preferred methods.
¿ In one setting, people were not being supported to upkeep their homes to ensure they were clean and well maintained.
¿ People were not always supported to access specialist health and social care support. Appointments had been cancelled by staff with no recorded reason as to why this was.
¿ Staff worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.
¿ Staff supported people to take their medicines in their preferred way. People were supported to live healthy lifestyles and staff members promoted healthy choices in areas such as eating and drinking.
¿ People had been supported to personalise their rooms.
Right Care
¿ The services did not have enough appropriately skilled staff to meet people’s needs. People were safe, however were at risk of social isolation and not being able to follow their interests as a result of this. People were unable to follow tailored social past times whenever they chose to do so and were not being supported to try new things which they may enjoy.
¿ People who had individual ways of communicating such as using body language, sounds, or pictures and symbols could not always interact with staff because not all staff had the necessary skills to understand them. Staff had requested more training in this area.
¿ People’s care, treatment and support plans and risk assessments reflected their range of needs for the most part although this did vary from setting to setting.
¿ For the most part, people received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff had supported people living at the service for a long time in some cases.
¿ Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.
Right culture
¿ People were not always supported to lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff did not feel well supported by the provider and found it difficult to raise concerns with them.
¿ The management and staff team did not understand some of the key principles of guidance such as Right Support, Right Care, Right Culture. Audits completed at the service by management had not picked up on areas that could have been improved to help support a more positive culture.
¿ Information of concern we shared with the nominated individual of the service, shared with us by the staff team about the support from management, was given to the senior management team to review. This meant that there were missed opportunities for an independent person to look in to concerns that were being raised by the staff team.
¿ People and those important to them, were not always involved in planning their care. It was unclear how staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.
¿ Staff knew people well and were responsive to their support needs.
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 when it was registered under the previous provider was good (report published 16 August 2017).
Why we inspected
We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This was a planned inspection based on when the service first registered with us. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring responsive 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.
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.
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 care and treatment, staffing and good governance at this inspection. Please see the action we have told the provider to take at the end of this report. 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.