Parkhill Support Services Brighton Road

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

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.

Improvements had been made since the last inspection and the service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. However, improvements were still needed in some areas.

Right support

Medicines were not always managed in a safe way and in line with guidance. The registered manager made sure immediate improvements were made after our inspection to keep people safe. Staff did everything they could to avoid restraining people. However, the service did not always properly record when staff restrained people, and the provider did not share learning in this area. The registered manager had identified this as a problem and was working to put things right. People felt safe at the service and with the staff who supported them. Staff focused on people's strengths and supported people to enjoy fulfilling and meaningful lives. People were encouraged to be as independent as possible. Staff supported people to identify and achieve their goals and aspirations. People were involved in planning their care and had opportunities to give feedback about the service. Staff managed risks well to keep people safe while promoting their independence.

Right Care

The provider's recruitment procedures needed more checks to help make sure only suitable staff were employed. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. Staff protected and respected people's privacy and dignity. Staff understood their responsibilities in protecting people from abuse and were confident any concerns they raised would be acted upon. People had access to staff support when they needed it. This included allocated one-to-one support hours, which people could choose how they used. People had opportunities to take part in activities they enjoyed and to pursue their interests.

Right culture

The provider's governance arrangements were not always effective in keeping people safe and ensuring good quality care and support. The provider did not identify the issues we found during our inspection. Staff valued people's individuality, protected their rights and enabled them to lead confident, empowered lives. 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 and staff had established effective relationships with other professionals to ensure people received the care and treatment they needed.

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 inadequate (published 17 September 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in most areas. However, there was still improvements to be made and the provider remained in breach of some regulations and the service is now rated requires improvement.

This service has been in Special Measures since 17 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified three continuing breaches in relation to the management of medicine, the recruitment process and how the provider makes sure the service is safe and well led.

Please see the action we have told the provider to take at the end of this 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Parkhill Support Services Brighton Road provides personal care for people who live in supported living accommodation. The people who use the service have a range of needs including people with a learning disability and autistic people with some people requiring 24-hour support. At the time of our inspection eight people were using the service living in two separate supported living settings. People rented their room from a private landlord and used shared facilities such as kitchens, living rooms and bathrooms. Four rooms at the Brighton Road address had on-suite facilities.

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

Systems in place did not always protected people from abuse. When people raised concerns, they were not always acted on. People and staff did not always feel safe. Although staff told us they knew how to protect people from harm, they wanted more training to help them support people and keep them safe. When incidents happened, these were recorded but the provider failed to take action to make things better for people and minimise people's risk. Some restrictive practices were used but current legislation and national guidance had not been followed.

Some people's risk had not been identified or assessments were out of date. Medicines were not always managed safely. Medicine was not stored safely and records were poor. This meant it was hard to tell what medicines people had received. Staff worked excessive hours to try and cover shifts and not all staff had received important training to support them in keeping people safe. The staff we spoke with were knowledgeable about people's needs and told us about the risks people faced. They told us they wanted the best outcomes for people and were working hard to achieve these but needed more support and training from the provider to do this.

People were not always supported to communicate their needs or be involved in how the service was run. When people did raise concerns, we could not see how the provider made sure they were listened to.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests. 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 autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. The provider had not considered the needs of people using the service and had placed people together inappropriately without consultation or thought of the impact on others using the service. This meant people did not always feel safe living in their home. The environment was not suitable for some people and did not allow for their privacy or dignity to be maintained. The design and accessibility of the building did not promote people’s independence. Care and support did not always reflect current evidence based guidance and people’s human rights were not always upheld. The provider had not applied to the relevant authority to restrict people's liberty and had failed to notify the CQC when people’s liberty had been restricted and guidance was not being followed regarding restraint, seclusion and segregation practices.

During the inspection the provider had started to make some changes to make things better for people and staff. After the inspection the provider sent us an action plan stating how they were intending to make improvements.

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 20/03/20 and this is the first inspection.

Why we inspected

This was the first inspection. This inspection was prompted in part due to concerns received about risks to people’s safety. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the full report for details.

You can see what action we have asked the provider to take at the end of this full report.

The provider has sent us an action plan to explain how they are going to mitigate the risks identified at this inspection.

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 people’s safety, people’s dignity and respect, person-centred care, protecting people from abuse, how the service is managed, how staff are recruited, trained and supported and a failure to notify the CQC of important events and serious incidents 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.

Special Measures

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 time frame 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.