HF Trust - Kent DCA

Updated 27 July 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 inspectors.

Service and service type

This service provides care and support to people living in 12 ‘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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We reviewed information we held about the service, and we spoke with a healthcare professional. We used this information to plan our inspection.

During the inspection

We visited 4 settings and spoke with 10 people and 5 relatives about their experience of care their loved one received. We spoke with 17 members of staff including the registered manager, cluster managers, support staff and agency staff. We reviewed a range of records including 13 care plans, daily notes and multiple medication records. We reviewed a variety of records relating to the management of the service including staff recruitment files, training and supervision.

Updated 27 July 2023

About the service

HF Trust Kent DCA is a supported living service registered to provide personal care. The service provides support to people with a learning disability and/or autism living in supported living settings, so that they can live in their own home as independently as possible. At the time of the inspection they were providing support to 69 people who were in receipt of the regulated activity personal care. 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 lived in their own flats and had access to their own facilities such as bathrooms and kitchen. There were a number of different locations across Kent where the service was providing support to people, known as clusters. Each cluster had their own manager, overseen by the registered manager.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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. Risks to people were not always assessed or managed. For example, risks to people with epilepsy, people at risk of falling, risks relating to constipation and choking had not always been assessed and mitigated. Medicines were not always managed safely. There was not enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Care:

Staff told us they understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse however not all incidents were documented to ensure concerns could be raised. People’s care, treatment and support plans didn’t always reflect people’s range of needs or promote their wellbeing and enjoyment of life. People were supported to maintain balanced diet.

Right Culture:

There was a lack of effective oversight of the service. We found inconsistencies within the clusters, where lessons were not learned and shared throughout all the service. There was not a positive culture within all the clusters to ensure people lived empowered lives. Some communication we reviewed about people was not respectful. Staff did not always support people within all clusters to achieve their aspirations and goals. People and their relatives were not always involved in care planning.

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 01 May 2018)

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safeguarding and allegations of abuse. A decision was made for us to inspect and examine those risks.

We undertook an inspection to review the key questions of safe, effective, and well-led only.

We have found evidence that the provider needs to make improvements. 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.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to risks to people, the failure to ensure the principles of the Mental Capacity Act were consistently followed and the oversight and governance of the service at this inspection.

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

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.