Date of Assessment: 05 February 2025 to 6 March 2025. This assessment was carried out in response to concerns CQC had received about restrictive practices. Inshore is a supported living service providing personal care to people with a learning disability and autistic people who live in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive a regulated activity of personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. Systems were in place to learn lessons from incidents, complaints and safeguarding events and staff confirmed these were shared with them. People were supported by the number of staff they needed. Staff had been trained and understood how to protect people from abuse. Staff felt supported in their roles. Staff managed medicines well and involved people or their advocates in planning any changes. Staff worked with all agencies involved in people’s care for the best outcomes and smooth transitions when moving between services. People and their advocates knew how to raise concerns. The provider had systems in place to maintain oversight and drive improvements in the service. Care records varied in detail and quality. Some records required further information to ensure details of incidents were fully recorded and information reflected people’s needs. Action plans were in place to address this. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.
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Inshore Support Ltd improved from Requires Improvement to Good across all inspected key questions (Safe, Effective, Well-led), with the previous breach of Regulation 17 (Good Governance) remedied. The service demonstrated strong safeguarding practice, person-centred care, stable staffing, and effective governance including a notable 95% reduction in physical restraint through specialist equipment.
Strengths
· Staff demonstrated strong safeguarding knowledge and confidence in reporting concerns
· Stable staffing team with minimal agency use, providing continuity of care for people
· Robust and flexible training programme including specialist face-to-face competency assessments
· Comprehensive person-centred care plans accounting for sensory and environmental needs of autistic people
· Effective use of specialist equipment (POD) reduced floor-based physical restraint by 95%
Quality-Statement breakdown (17)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Continuous learning and improving careGood
well-led: Engaging and involving people using the service, the public and staffGood
Inshore Support Limited was rated Good across all five key questions at its April 2016 inspection, with staff demonstrating kind, person-centred care and robust training systems. Minor recording gaps were identified around safeguarding investigations, DoLS documentation, PRN medication guidance, and complaints records, but none constituted regulatory breaches.
Concerns (4)
moderateRecord keeping: “where safeguarding concerns had been raised, the appropriate authorities had been notified but there was no information available on file to evidence that concerns were investigated”
minorMedication management: “the guidance on this lacked detail in order to ensure this medication was administered consistently”
minorRecord keeping: “DoLS applications in place and the reasons for these, but there was no evidence of this on people's care files”
minorComplaints handling: “recordings were inconsistent and the information available regarding individual investigations varied, depending on each location”
Strengths
· People felt safe and spoke positively about staff, describing them as friends and caring individuals
· Staff received regular training including specialist areas such as PAMOVA and the Care Certificate
· Care plans and communications were produced in easy read pictorial formats to support people's participation
· Effective transition arrangements were in place to introduce new people to the service at their own pace
· Monthly quality audits monitored training, supervisions, MAR records, care plans and accident recordings
Inshore Support LTD - Supported Living was rated Requires Improvement across all five key questions at its April 2019 inspection, representing a decline from its previous Good rating in 2016. Critical failures were found in governance, medication management, and Mental Capacity Act compliance, resulting in a warning notice for breach of Regulation 17.
Concerns (11)
criticalConsent / capacity: “Relatives were signing records to consent on people's behalf without the legal right to do so.”
criticalMedication management: “We saw 32 gaps on the same person's medicine count sheet for one month. This practice puts people at risk of potential harm.”
criticalGovernance: “Audits undertaken had failed to identify the issues we found at inspection. These included concerns with care plan, risk management, consent and medicines.”
moderateStaffing levels: “There was a high use of agency staff and staff turnover meaning consistent care and support was not always delivered.”
moderateStaff competency: “Staff did not always have the skills or ability to support people effectively.”
moderateCare planning: “Care plans contained duplicate information and different versions of documents therefore, staff did not always have the most up to date information to follow.”
moderateIncident learning: “Incidents were recorded at the end of the month but not analysed for patterns and trends.”
moderateRecord keeping: “One person had three separate behaviour plans dating back to 2011, this meant staff did not have clear guidance to follow.”
moderatePerson-centred care: “Staff could not always demonstrate they gave people choice and control and responded to their needs.”
minorInfection control: “The check had been completed by staff to say refrigerated food was in date, however we found out of date food in the person's fridge.”
minorEnd-of-life care: “There was no information provided about end of life care.”
Strengths
· Staff had a good understanding of safeguarding procedures and knew the correct process to protect people from abuse.
· People were supported to access healthcare services including their GP, dentist, and local community teams.
· Staff supported people to maintain family relationships and encouraged people's independence in daily tasks.
· A complaints procedure was in place and complaints had been logged and actioned.
· Staff received regular supervision, team meetings, and training including NVQ qualifications.
Quality-Statement breakdown (19)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet
Requires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support; continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement