Archived: Dyke Road Community Support Services

Dyke Road Community Support services is a community-based adult social care service providing personal care and social support to people in supported living settings. At the time of our inspection there were 24 people living in 6 separate supported living homes using the service.

Not everyone who lived in the different supported living settings received personal care. CQC only inspects the support being given to people who 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:

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. People’s medicine support was not being managed safely. People were not always supported to assess their needs effectively and did not always achieve good outcomes from their support. Staff had not always received effective training or supervision.

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.

Right Care:

Staff did not always communicate or support people in dignified or respectful ways. People were not always involved and included in a personalised way when being supported by staff. Relatives told us staff were not always caring and did not always encourage them to be as independent as possible.

We observed some staff in the services we visited supporting people with tasks such as meals and going out in a kind and respectful manner, offering choices and communicating with people in ways they understood.

Right Culture:

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Internal quality assurance systems and processes to audit or review service performance and the safety and quality of care were not operating effectively to identify or resolve issues.

People and their relatives said they did not always feel involved and engaged in planning their support or being supported to do things they wanted. Staff did not always feel supported to fulfil their roles and responsibilities and raised concerns about closed cultures within homes, negative and punitive leadership and how this was not helping people to achieve good outcomes.

The provider offered immediate reassurances on request about quality and safety issues at the service identified during our inspection visits. They told us about actions they would take in response and were committed to providing resources to make any necessary improvements as quickly as possible.

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 24 February 2022) and we identified multiple breaches of regulations. 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 the provider remained in breach of regulations and the rating has changed to inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and due to concerns we received about unsafe care and staffing.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections in this 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 dignity and respect, safe care and treatment, abuse, staffing, good governance and notifying CQC 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

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.

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 act 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.

Dyke Road Community Support Services is a supported living service providing personal care to 19 people with a learning disability, autism, behaviour that may challenge, and mental ill health at the time of the inspection.

Dyke Road Community Support Services is based near Brighton and is made up to three supported living houses. People had their own bedrooms and shared a communal kitchen and staffing. The Care Quality Commission inspects the care and support the service provides to adults but does not inspect the accommodation they live in. CQC only inspects where people receive personal care, this is help with tasks related to personal hygiene, medicines and eating.

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

The service is made up of three supported living houses and we found serious concerns in one house, other concerns in a second house and no concerns in the third house.

Risks were not being safely managed in relation to choking and people’s behaviours that others may find challenging. People were not consistently being protected from the risks of abuse.

Medicines management was not safe in all the supported living houses as we found important guidance for as required medicines missing or not in place. One person did not receive their medicines when they needed them.

Staffing levels in one of the houses frequently failed to provide people’s allocated hours, and staff and relatives told us that there were not enough staff to support people safely, as some people needed one to one staffing which they were not receiving at times of low staff.

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 consistently support this practice. Some people who were unable to consent to restrictions did not have these assessed under the Mental Capacity Act 2005 as required. We have made a recommendation about how decision are made for people.

One person did not have access to the medical appointments they needed as staff were unaware of the need. Staff had not received the training and support they needed with people’s behaviours that may challenge. Staff told us they needed the training and felt unsafe at times.

People were having sufficient food and drink to maintain good health.

Not all people were involved in planning their care and some people had not been responded to in a caring way when they experienced distress. Some language used in incident forms was not person centred.

We did see some caring support from staff and people in two of the houses told us they liked their staff and could talk to them if they needed.

People did not always receive person centred care and support. There was a lack of planned individualised activities for people in one of the houses, and one person had not been supported with things such as blood tests in the way they needed to be. Staff were not trained to communicate with some people.

Complaints were not being managed consistently and end of life care had not always been care planned.

We have made a recommendation about planning peoples end of life care.

Governance systems were not effective in identifying or putting right the shortfalls we found at this inspection. We found one incident that had not been notified to CQC. Risks were not being safely managed and this left people exposed to the possibility of harm. Governance systems had not ensured that any lessons learned improved the services people received.

The culture in one of the houses was not positive or person centred and staff told us they had concerns about safety especially around some behaviours that may challenge.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not always maximise people’s choice, control and independence. One of the houses had staff shortages that meant people did not always have the support they wanted.

Right care:

• Care was not consistently person-centred. Some people had not been supported to communicate effectively.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using services lead confident, inclusive and empowered lives. Some relatives feedback expressed concerns about one house and staff told us that the culture was not positive.

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)

This is the first rated inspection of this service under the new provider.

Why we inspected

This was a planned inspection due to the length of time the home had not been inspected since the change of provider. The service had been under the new provider since September 2020.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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.

Since the inspection, the provider has taken action to mitigate the risks to people around constipation, choking and management of expressions of emotional distress.

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 regarding the management of risk and the safe management of medicines, and abuse; management of health needs and staff training; personalised care; and management oversight of these issues, and in relation to failing to notify CQC of an event.

Please see the action we have told the provider to take at the end of this report.

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

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 alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.