Re-Enabled Support improved from Inadequate to Good across all four inspected key questions, resolving multiple previous regulatory breaches in safeguarding, risk management, medicines, consent, person-centred care, and governance. Two minor residual issues were identified: one notifiable event unreported to CQC and one expired deprivation of liberty authorisation, resulting in a recommendation to strengthen notification processes.
Concerns (2)
minorGovernance: “we identified one event relating to one person which had not been notified to the CQC as required.”
minorConsent / capacity: “One deprivation of liberty order had expired. The provider produced extensive evidence of correspondence they had made in order to have this order reviewed.”
Strengths
· Staff recruitment was robust with appropriate checks; previous gaps fully addressed ensuring people's safety
· Risk assessments were in place, regularly reviewed and updated in response to new and changing risks
· Medicines management improved with administration records, competency assessments and regular audits
· All staff completed infection prevention and control training; appropriate PPE used consistently
· Care plans were person-centred, detailing individual preferences, routines and communication needs
Re-Enabled Support received an overall Inadequate rating on its first inspection, with breaches across six regulations including safeguarding, person-centred care, consent, medicines management, staffing and governance. The service was placed in special measures due to widespread failures in risk assessment, staff training, care planning and quality assurance, with warning notices issued for safe care and good governance.
Concerns (13)
criticalSafeguarding: “Systems to protect people from the risk of abuse or neglect were not in place. Staff had not all received safeguarding training to ensure they knew how to identify and report abuse concerns.”
criticalMedication management: “Medicines support plans were not in place. No guidance was available for actions to be taken by staff within a timeframe when a person refused their medicines.”
criticalStaff training: “Some staff were recorded as not having completed any training relevant to their roles. Significant gaps in staff training records included safeguarding, practical moving and handling and basic first aid.”
criticalStaff competency: “The provider had not identified that people were supported by staff who did not have the correct training and competency in place. For example, manual handling.”
criticalCare planning: “Care and support plans did not reflect people's needs, likes, dislikes, goals or aspirations. Most people's care plans did not provide staff with clear guidance on how to meet their individual needs.”
criticalGovernance: “Governance processes were ineffective and failed to keep people safe, protect people's rights and provide good quality care and support.”
criticalRecord keeping: “Records including mental capacity assessments, medicines records and staff records were not always accurate, complete and up to date.”
criticalConsent / capacity: “The provider was not working in line with the principles of the MCA. Assessment and care planning processes did not always consider people's capacity to consent to care and treatment.”
moderateIncident learning: “The provider did not have a process in place to analyse, identify trends or learn lessons to improve on the service provided.”
moderateSupervision / appraisal: “Staff did not have regular supervision to receive feedback on their performance and constructive feedback on how this might be improved.”
moderatePerson-centred care: “We found the language used in some people's care plans to be disrespectful and undignified. For example, '[Name] is very childlike in their manner'.”
moderateCommunication with families: “We saw limited evidence that staff meetings or meetings with people and their relatives were taking place.”
minorInfection control: “Staff had not all completed infection, prevention and control training.”
Strengths
· Relatives spoke positively about staff: 'I trust staff with [Name] 100%', 'The staff have natural empathy' and 'You could not get a better set of carers.'
· People and their relatives told us their dignity was respected and staff used appropriate personal protective equipment.
· Staff rotas showed people received support from mostly regular staff.
· One person's care plan had been developed to include more detailed information about communication needs including words, gestures, sounds and facial expressions.
· The provider was working with an adult social care consultant to address areas identified for development and improvement.
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInadequate
effective: Staff support: induction, training, skills and experienceInadequate
effective: Ensuring consent to care and treatment in line with law and guidance
Inadequate
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesInadequate
responsive: Meeting people's communication needsInadequate
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Continuous learning and improving careInadequate
well-led: Working in partnership with othersInadequate