Background to this inspection
Updated
31 August 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 1 inspector 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 homes and in holiday accommodation.
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
We gave the service 48 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us.
Inspection activity started on 3 July 2023 and ended on 6 July 2023. We visited the location’s office on 3 July 2023.
What we did before inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. 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 used all this information to plan our inspection.
During the inspection
We spoke with 1 person who used the service and 7 relatives about their experience of the care provided. We spoke with 6 members of staff including care staff, the registered manager and 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 6 people’s care records and medicine administration records and 4 staff files in relation to recruitment and staff supervision. A variety of records relating to the management and oversight of the service were reviewed including policies and procedures.
After the inspection
We continued to seek clarification from the provider to validate evidence found.
Updated
31 August 2023
About the service
The Cube Disability Ltd is a domiciliary care agency providing personal care to people whilst they are in holiday accommodation. The service provides support to people living with a learning disability and/or autism. At the time of our inspection there had been 8 holidays in the UK in 2023 for 48 people of which 6 people received 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.
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.
People’s experience of using this service and what we found
Right Support:
People’s risks had not been formally assessed and staff did not have all the information they needed to mitigate the risks relating to people’s care, travel, activities and accommodation. Staff relied on verbal handovers and feedback from families to understand people’s needs.
People’s families were involved in people’s preparation for their holidays, providing managers with information about people’s needs and how to manage people’s anxieties. Staff did not have this information available to them in written form; the information did not reflect people’s protected characteristics under the Equality Act.
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. People’s mental capacity to make decisions had not been assessed and there were no systems to hold best interest decisions.
People did not receive their medicines in a safe way.
Staff ensured they asked consent from people before supporting them. Staff understood people's rights to refuse care.
Staff understood safeguarding procedures and knew how to protect people from potential abuse and harm.
Right Care:
The provider failed to ensure staff received the training they needed to provide person centred, safe care to people.
People did not have care plans or behavioural support plans for staff to refer to. Staff did not have the information they needed to always know how to provide safe care or mitigate risks. People's records were not always reviewed when people's needs changed. Staff did not record daily notes to demonstrate people received their care as planned.
People received care from staff that were of good character that were recruited using safe recruitment practices.
Staff showed kindness and treated people with dignity and respect.
Right Culture:
The provider failed to have all the systems and processes in place to assess, monitor and mitigate risks, or make improvements to the service. There had been a recent change in management whereby they recognised the changes that were required to improve the service.
People were involved in choosing the types of holidays and activities they wanted. People were cared for by staff who knew them and shared their holidays with people they knew from the day centre.
Staff adapted activities to ensure all people could take part in the activities they wanted.
People, relatives and staff had been asked to feedback on the service, the information was used to drive 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 1 October 2020 and this is the first inspection.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive 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 breaches in relation to risk assessments, care planning, person centred care, consent and management at this inspection.
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.