Navigation Support & Care Services Ltd, a domiciliary care provider for adults with learning disabilities and autism in Lincoln, retained its overall Good rating across all five key questions at this December 2018 inspection. The service demonstrated strong person-centred care, low staff turnover and inclusive practices, with minor shortfalls identified in record-keeping detail, incident reporting timeliness and communication with external professionals.
Concerns (7)
moderateRecord keeping: “'Incident reports will often state "showed behaviours" rather than describing the behaviour and its impact. Daily records are sparse, and lack detail to evidence how individual support to manage behaviours is being delivered'”
moderateSafeguarding: “There had been occasions when there was a delay in reporting incidents to the local authority.”
moderateCare planning: “After our inspection we received information from professionals about the service not always following their guidance. An example included a care plan not having detailed enough information in when a person became anxious.”
minorCommunication with families: “health and social care professionals told us that there had been occasions when meetings had been arranged in people's home and on arrival to the home, no one was home.”
minorGovernance: “These were not always easy to follow as some records were paper based and others on the IT system, but issues had been highlighted and actioned appropriately.”
minorStaff training: “Staff told us that received regular supervision and records confirmed this for most staff. The registered persons agreed to schedule in supervisions for those staff that were overdue.”
minorMissed or late visits: “One relative told us that recently a call had been missed and she or her relative were not informed.”
Strengths
· People spoke highly of staff and registered managers, describing care as compassionate, unhurried and person-centred.
· Low staff turnover enabled consistent, familiar support for people with learning disabilities and autism.
· Thorough 14-week induction including the Care Certificate and apprenticeships supported staff competency.
· Robust medicines administration recording and regular monthly medication audits were in place.
· People were genuinely involved in recruitment, care planning, and service design decisions.
Quality-Statement breakdown (23)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff skills, knowledge and experienceGood
effective: Supporting people to eat and drink enough with choice in a balanced dietGood
Allerton C&S NE Limited is rated Good overall following a focused inspection of Safe and Well-Led, with Well-Led deteriorating to Requires Improvement due to gaps in DBS renewal monitoring, inconsistent COVID-19 testing oversight, and poor communication with relatives. Key strengths include safe medicines management, consistent staffing, effective safeguarding processes, and a person-centred culture promoted by the leadership team.
Concerns (5)
moderateInfection control: “the providers system for collecting testing information was not robust enough to capture weekly evidence of staff testing, meaning the provider did not have a complete understanding of the COVID-19 status”
moderateInfection control: “some members of staff had declined to be vaccinated against COVID-19 but were still providing personal care to service users, many of whom were clinically vulnerable”
moderateStaff competency: “the provider did not have an on-going system in place to follow up on the check of criminal records. The provider could not demonstrate they were assured staff continued to be suitable”
moderateGovernance: “we identified shortfalls in areas relating to risk management and DBS checks. However, the provider's quality monitoring system had not identified them.”
minorCommunication with families: “We kept ringing and texting, asking what was happening, we didn't hear a thing. Communication with relatives needed to be strengthened.”
Strengths
· People and relatives felt safe with staff; safeguarding training was in place and responsibilities were understood.
· Sufficient staffing levels with consistent, small teams deployed during COVID-19 to prevent cross-contamination.
· Medicines were administered safely with trained staff and ongoing competency assessments.
· Risk assessments were regularly reviewed and person-centred approaches were taken to risk management.
· Effective complaints monitoring system with demonstrated learning and action taken.
Quality-Statement breakdown (9)
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Using medicines safelyGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Duty of candour; Continuous learning and improving care
Navigation Support & Care Services Ltd, a homecare provider supporting 32 people with learning disabilities or autistic spectrum disorder in Lincoln, was rated Good overall with an Outstanding rating for Responsive. The service demonstrated exceptional personalisation, accessible communication approaches, and strong continuity of care, with no regulatory breaches identified.
Strengths
· Staff provided weekly rotas with photographs of care staff to help people recognise who would be supporting them, improving comfort and confidence.
· Personalised communication arrangements in place including Makaton, signs, symbols, and pictures to support people who could not communicate verbally.
· Staff supported people to pursue interests and hobbies including go-karting, bowling, swimming, yoga, tandem cycling, and charity shop work.
· Complaints procedure provided in words and pictures, accessible to people with learning disabilities.
· Provider matched staff to people they supported and limited care teams to five people to ensure continuity of care.
Quality-Statement breakdown (15)
safe: Safeguarding and risk managementGood
safe: Medication managementGood
safe: Staffing levels and recruitmentGood
effective: Staff training, supervision and appraisalGood
effective: Consent and Mental Capacity ActGood
effective: Nutrition and healthcare accessGood
caring: Kindness, dignity and respectGood
caring: Person-centred choice and confidentialityGood
Good
well-led: Working in partnership with othersGood
responsive: Personalised care planning and reviewOutstanding
responsive: Communication and equality/diversityOutstanding
responsive: Activities and community accessOutstanding