25 July 2021
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.
The inspection was carried out by five inspectors. One inspector acted as the lead inspector and together with four other inspectors visited supported living services in five local authority areas. We also visited the regional office.
Two Experts by Experience were involved in the inspection and contacted relatives by telephone to seek their views. 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 provides care and support to people living in supported living settings, 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.
The provider’s statement of purpose showed the location required three registered managers. At the time of the inspection there was one registered manager who was absent from the service. Registered managers and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
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 reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used all of this information to plan our inspection.
During the inspection
We began the inspection with a visit to the Community Integrated Care Northern Regional Office on 20 May 2021. Between 24 May and 2June 2021 we visited the supported living services. We spoke with five people who used the service and carried out observations of people’s interactions with staff. We also spoke with 12 relatives about their experience of the care provided. We spoke with 26 members of staff including the managing director, the regional director, service leads, deputy manager, advanced support workers and care workers.
We reviewed a range of records. This included people’s risk assessments and medication records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records. We reviewed information sent to us by local authority commissioners.
25 July 2021
About the service
Community Integrated Care Northern Regional Office provides personal care to people living in supported living services. At the time of our inspection the service was supporting 178 people in different types of accommodation across the north east.
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.
The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture in some of the individual supported living services.
• Staff were using people’s homes as an office base. Documentation in relation to the service provision was evident in people’s homes.
• People’s homes were not sufficiently adapted to include them in domestic activities and promote their independence.
• People were given choices by staff and were encouraged to pursue their individual likes and interests. People were treated with dignity and respect.
• The managers of the services demonstrated they had the right values and ethos to lead a supported living service. However, audits failed to identify where services could be improved to further develop and enhance people’s experience of living in their own homes.
Staff reported safeguarding incidents on an electronic system and allocated a rating for the harm caused. Some of the reported safeguarding incidents were avoidable.
Although no one had been harmed by medicine errors, there were a number of repeated errors which had put people at risk of being harmed.
The provider had a range of audits in place to monitor the individual supported living services. Actions were put in place to make improvements. The audits did not include a robust overview of the safeguarding concerns and medicines errors.
Staff learned lessons about how to meet people’s needs when their behaviour changed, or people showed distress. They engaged family members and other professionals to assist them. People’s personal risks were well-documented.
Staff were clear about to whom they were accountable and felt supported by their service leads. One staff member said, “[service lead’s name] is a good manager.”
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.
Staff promoted people’s inclusion in their community and engaged them in events according to their wishes and interests.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was good (published 30 August 2017).
Why we inspected
The inspection was prompted in part due to the length of time since our last inspection and the number of notifications we received from the provider which either did not meet with legal requirements or contained information of concern. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. No areas of concern were identified in the other key questions. We therefore did not inspect them.
Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to requires improvement. This is based on the findings at 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. The provider has taken steps to address the risks.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Community Integrated Care Northern Regional Office on our website at www.cqc.org.uk.