National Care Holdings Limited

Updated 29 April 2022

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.

Inspection team

A single inspector completed the inspection.

Service and service type

This service provides care and support to people living within a ‘supported living’ setting, 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 had a manager registered with the Care Quality Commission. This means that they and the provider are 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 it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service since its registration, including notifications of

significant incidents. We sought feedback from commissioners and the local authority safeguarding team. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with three people and two relatives of people who used the service about their experience of the care provided. We spoke with two members of care staff, the business partner, and the registered manager who was also the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We reviewed a range of records. This included three people’s care records, five staff files in relation to recruitment and a variety of records relating to the management of the service, including policies and procedures.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at the incidents and accidents log, training records, mental capacity assessments, tenancy agreements and about the provider’s office location. Quality assurance records were also reviewed.

Updated 29 April 2022

About the service

National Care Holdings Limited provides care and support to people living in a supported living setting so that they can live as independently as possible. At the time of the inspection, three people were using the service. CQC does not regulate premises for supported living; this inspection looked at people’s care and support.

People’s experience of using this service and what we found

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 and providers must have regard to it.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right culture:

The provider did not have an effective oversight of the service. The quality assurance system and processes had failed to identify and correct issues, we found at the inspection. However, we found some positive aspects of culture as well. People and their relatives gave us positive feedback about their safety and told us staff treated them well. The service had systems and processes in place to administer and record medicines use. Staff received support through training, supervision and staff meetings to ensure they could meet people’s needs. Staff told us they felt supported and could approach the registered manager at any time for support. The registered manager and staff worked with other external professionals to ensure people were supported to maintain good health. The provider had a system to manage accidents and incidents. There was a management structure at the service and staff were aware of the roles of the management team. The registered manager and staff worked as a team and in partnership with a range of professionals and acted on their advice.

Right support:

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. The provider had moved their office to being co-located at the supported living setting. This was not appropriate as it meant the office based staff had to access people’s homes to access the office. We also found some aspects of good support. People’s care plans reflected their current needs. People were protected from the risk of infection. People were treated with dignity; their privacy was respected and they were supported to be as independent in their care as possible.

Right care:

People’s care records were not in line with Accessible Information Standard. However, we found some positive aspects of care. People and their relatives were encouraged to participate in making decisions about their care and support. An assessment of people’s needs had been completed to ensure these could be met by staff. Staff showed an understanding of equality and diversity. Staff respected people’s choices and preferences. People knew how to make a complaint. The registered manager knew what to do if someone required end-of life care.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

This service was registered with us on 24/10/2019 and this is their first inspection.

Why we inspected

This was a planned inspection.

Enforcement and recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to consent and good governance. We made one recommendation about formatting care records in line with the Accessible Information Standard.

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.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.