Background to this inspection
Updated
29 November 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
The inspection team consisted of two inspectors.
Service and service type
Walsingham Support- Brent & Harrow Supported Living provides care and support to people living in 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.
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 CQC 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 not a registered manager in post. A service engagement manager from a sister service was managing the service. The provider told us they were in the process of recruiting for the role of a registered manager.
Notice of inspection
This inspection was announced.
We gave the service 24 hours’ notice of the inspection. This was because 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. We used the information the provider sent us in the provider information return. 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 contacted six relatives, but we managed to speak with two about their experience of the care provided. We were not able to speak with people because of their complex needs. However, we observed care. We spoke with seven members of staff, including the acting engagement manager, engagement manager, operations and engagement manager and four care workers. We reviewed a range of records. This included people’s care records and medicines records. A variety of records relating to the management of the service, including policies and procedures were reviewed.
Updated
29 November 2022
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 the Care Quality Commission (CQC) to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.
About the service
Walsingham Support- Brent & Harrow is registered to provide personal care. At the time of this inspection, the service was providing personal care to seven people living in a supported living scheme. People who used the service had autism and learning disabilities. The scheme consisted of three separate four bedded flats.
People’s experience of using this service and what we found
The service did not demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right care:
People’s human rights were not consistently upheld. They had not been meaningfully engaged so they understood their rights and responsibilities as tenants. Tenancy agreements were unlawfully signed. However, people’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had received training on how to recognise and report abuse and they knew how to apply it. However, systems around managing people’s finances could be improved.
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. There were examples of care that may have amounted to deprivation of liberties because some people were subject to continuous supervision. However, the provider had not requested relevant social workers or care managers to consider making an application to the Court of Protection for oversight. In addition, the model of care was not consistent with a supported living framework. Instead, the provider operated more like a traditional residential care service. The provider did not consistently meet a set of principles that are defined in the Reach Standards, which are based on people having their own homes and having control over who they live with, who supports them and how they are supported.
Right culture:
Staff had received training to meet people’s needs. They were aware of good practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have. However, people did not consistently lead inclusive and empowered lives because they were not always meaningfully involved in other aspects of their lives, including decisions around finances and restrictions.
We have made recommendations about unlawful restrictions and accommodation rights.
The provider’s quality checks, and audits did not consistently find areas for improvement. Furthermore, where gaps had been found, improvements had not been implemented within reasonable time. For example, we raised concerns with the appointeeship system at our inspection of October in 2021. Whilst we have seen evidence that shows the provider contacted the local authority in August 2022, to arrange the transfer of appointeeship, we were concerned about the length of time taken to address the concerns. This has meant a delay for people’s monies to be managed as they should.
Following this inspection, we received an action plan from the provider, which showed the they had started to make improvements in a range of areas. However, it was too early to be able to demonstrate that these processes were fully embedded and that these improvements could be sustained over time.
There were adequate systems to assess, monitor and manage risks to people’s safety. Comprehensive risk assessments were carried out for people.
There were enough care workers deployed to keep people safe. Pre-employment checks had been carried out.
There were systems in place to ensure proper and safe use of medicines. We observed from records people received their medicines on time.
People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination.
There was a process in place to report, monitor and learn from accidents and incidents. Accidents were documented timely in line with the service’s policy and guidance. The system could be improved to facilitate dissemination of learning across the organisation.
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 good (published on 9 March 2019).
Why we inspected
We received concerns in relation to health and safety, the Mental Capacity Act 2005 and arrangements for managing people’s finances. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
The overall rating for the service has changed from good 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Walsingham Support - Brent & Harrow Supported Living on our website at www.cqc.org.uk.
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 absence of robust systems to ensure people were protected from financial abuse and lack of an effective quality assurance system.
Please see the action we have told the provider to take at the end of this report.
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.