Background to this inspection
Updated
15 September 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 Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats, and specialist housing.
Registered Manager
This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.
At the time of our inspection there was a registered manager in post, and the registered manager was the provider for this service.
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 would be in the office to support the inspection. Inspection activity started on 25 July 2022 and ended on 05 August 2022. We visited the location’s office on 27 July 2022.
What we did before the inspection
We reviewed information we had received about the service since the last inspection, this included information the provider, local authority and members of the public had sent us. We used the information the provider sent us in the provider information return. This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.
During the inspection
We spoke with nine people who used the service and four relatives about their experience of the care provided. The Expert by Experience made calls to people and relatives remotely by phone.
We reviewed a range of records. This included eight people's care and medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service were reviewed, this included quality assurance and monitoring information, policies and procedures and staff training records.
After the inspection
We continued to seek feedback about the service and review evidence collated during the inspection. We sought clarity from the provider about their recruitment, safeguarding and risk management processes.
Updated
15 September 2022
About the service
Support Solutions (West Sussex) is a domiciliary care agency. At the time of our inspection the service was supporting 22 people. The service provides personal care to adults living in their own homes, some of whom were living with long term health conditions, as well as conditions associated with old age and frailty. CQC only inspects the service being received by people provided with 'personal care', which includes 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
Since our last inspection it was evident the provider and staff had made improvements which had raised the standard of care people received and improved the management of risks to people's health and safety. Improvements were still required to ensure quality assurance systems were effective in providing managerial oversight of all risks to people’s safety, people’s care, staff recruitment and medicines.
People at risk of falls were not always protected from avoidable harm because contributory risk factors had not been identified. Some staff had not undergone pre-employment checks in line with the providers policy to ensure they were safe and of suitable character to work with people.
People told us they felt safe and were cared for by staff who knew them well. People were administered medicines by staff who were assessed as competent in the task. There were enough staff to meet people’s needs and people told us staff arrived on time for their care calls. One person told us, “They [staff] are very strict on that. They are never late; I can’t fault them.” Another said, “They are really good at time keeping. Carers don’t leave until [person] is comfortable.”
People’s needs were assessed and regularly reviewed. People told us they felt involved in their care and were invited to provide feedback. Staff completed an induction and underwent training the provider considered essential to their role. People were cared for by staff who received regular supervision and felt supported by the provider.
People were supported to eat and drink enough and access healthcare services when required. People received personalised care that met their needs and preferences. Staff worked with external agencies to provide effective care. 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.
People spoke warmly and positively about staff and said staff treated them with respect and dignity. One person said, “Carers listen, look at me and treat me with respect. They are very polite and caring." Another told us, “Carers call me by my Christian name and always give me a hug.”
People and staff were complimentary about the provider, their colleagues and the culture of the service. One person told us, “I would always ring the manager. They are very easy to talk to.” A staff member said, “This is a good company to work for.” Another told us, “The manager is very approachable.”
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 Requires Improvement (published 21 January 2022) and there were five breaches of regulation. The provider was served a Warning Notice and completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of four regulations. However, improvements were still required in relation to the overall governance of the service and there was a continued breach of regulation 17.
Why we inspected
The inspection was prompted in part due to concerns received about the culture of the service, medicines and the providers response to concerns and safeguarding. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from these concerns.
We also needed to follow up on action we told the provider to take at the last inspection and check whether the Warning Notice we previously served in relation to regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. 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.
The overall rating for the service has not changed following this comprehensive inspection and remains Requires Improvement.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Support Solutions (West Sussex) 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 a continued breach in relation to the governance of the service. 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.