Integrate (Preston and Chorley) Limited was rated Requires Improvement overall at its first comprehensive CQC inspection, with breaches of Regulations 11, 12, 13, 17 and 18 identified across medication management, safeguarding, risk assessment, consent, supervision and governance. The service demonstrated genuine strengths in its caring culture, staff training, community engagement and co-production with people who use the service.
Concerns (8)
criticalMedication management: “MARs charts were handwritten without a second signatory, as per the providers policies and procedures. Variable doses were not always recorded.”
criticalSafeguarding: “At one property, we found ten incidents of unexplained bruising which had not been correctly documented or reported.”
criticalConsent / capacity: “Staff told us: 'We don't do capacity assessments, that is not our role'. And: 'Only social workers do MCA assessments, I wouldn't do one'.”
criticalGovernance: “We could not find documented evidence that care files had been audited...the registered manager was not aware of issues around unexplained bruises not being reported.”
criticalRecord keeping: “We were unable to locate care plans for two people...the files had been taken off the premises to be updated...staff at the property having no information about these people.”
moderateCare planning: “There were also care plans that were vague or where needs had not been care planned at all...daily routines stated; 'wash hair etc'.”
moderateSupervision / appraisal: “Some of the staff we spoke with said they had not received supervision for some time...One team leader told us that they had not undertaken supervisions for staff as often as they should have.”
moderateIncident learning: “'[Name removed] banged their head on the settee quite hard'…'large bump on left eye'. There was no accident report completed.”
Strengths
· Staff approached people in a caring, kind and friendly manner with positive interactions observed throughout the inspection.
· Comprehensive induction programme in place for all new staff prior to working unsupervised, covering health and safety, person-centred care and safeguarding.
· Rolling training programme ensuring staff received training appropriate to their role; service users co-delivered training including autism and relationships awareness.
· People supported to access community, take part in activities of their choice, and supported to participate in external meetings and consultations.
· People actively involved in recruitment, trained in interviewing techniques and sitting as equal members on interview panels.
Quality-Statement breakdown (20)
safe: Risk assessment and managementRequires improvement
safe: SafeguardingRequires improvement
safe: Medication managementRequires improvement
safe: Staffing levels and recruitmentGood
safe: Incident and accident reportingRequires improvement
Integrate (Preston and Chorley) Limited improved from Requires Improvement to Good across all five key questions, having resolved all five previous regulatory breaches relating to safeguarding, safe care, consent, staffing supervision and governance. The service demonstrated a strong person-centred culture, effective quality auditing and positive engagement with people, staff and external partners.
Strengths
· All previous regulatory breaches resolved: safeguarding reporting, risk assessments, medicines management, consent, supervision, and governance all improved to Good.
· Staff were highly motivated with a strong person-centred culture; people described feeling respected, listened to and well cared for.
· Holistic pre-service assessments ensured needs could be met; care plans were individualised, regularly reviewed and co-produced with people.
· Robust recruitment processes including DBS checks and written references; staffing levels considered appropriate by people using the service.
· Management maintained external partnerships (commissioning groups, hospital discharge meetings, community forums) to share best practice.