Social Care Solutions Ltd (Bedford & Northampton) retained an overall rating of Requires Improvement at this November 2022 inspection, with Safe, Responsive and Well-led domains requiring improvement while Effective and Caring were rated Good. Key concerns included outdated risk assessments, inaccurate medicines administration records, inconsistent care plan updates, ongoing agency staffing reliance, and a newly implemented governance framework still requiring time to embed.
Concerns (11)
moderateRecord keeping: “not all risk assessments had been reviewed regularly. For example, for one person a risk assessment for a health condition contained the date of January 2019 of review.”
moderateMedication management: “Handwritten entries were not dated and signed by two members of staff to confirm they were accurate and up to date. This created a risk that medicines records were not accurate.”
moderateCare planning: “some of these required updating to ensure the information was accurate and reflective of people's current needs.”
moderateCare planning: “Health action plans had not been consistently reviewed and updated.”
moderateStaffing levels: “Some relatives told us they felt concerned about the high use of agency staff...there were several new staff who had been successfully recruited...and a total of six staff vacancies.”
moderateGovernance: “The quality assurance system had been reviewed and new processes implemented. This required time to embed to ensure it was robust in identifying and addressing shortfalls of the service.”
moderateLeadership: “Many did not know who the registered manager was but felt the general scheme managers did a good job. One relative said, 'The management change so often, there is no continuity in the job role.'”
minorMedication management: “Some protocols for medicines prescribed to be given on a when required basis lacked personalised information.”
minorCare planning: “there was some evidence of goal setting in care plans, however, this required further work to ensure each step of the goal was documented and updated with progress and achievements.”
minorComplaints handling: “felt that responses from the registered manager at times were slow. One relative said, 'Just sometimes I know that if I spoke to staff, they'd pass things on or do things quicker.'”
minorIncident learning: “Staff told us the new registered manager had introduced a 'lessons learnt' folder...This was a new process and required further time to become embedded across all supported living schemes.”
Strengths
· Staff were knowledgeable, passionate and provided dignified, person-centred care tailored to individual needs.
· People's needs were fully assessed prior to starting with the service, involving relatives in the assessment process.
· Staff completed thorough induction including shadowing experienced staff and meeting people they would support.
· Timely referrals to external professionals including GPs, community teams, SaLT and learning disability teams.
· Court of Protection applications were made where required and MCA principles were followed.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
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 support: induction, training, skills and experienceGood
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: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships; follow interests and activitiesGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportGood
well-led: Continuous learning and improving care; governance and quality performanceRequires improvement
well-led: Promoting a positive culture; engaging and involving people, public and staffRequires improvement
Social Care Solutions Ltd (Bedford & Northampton) was rated Requires Improvement overall for the third consecutive inspection, with a statutory breach of Regulation 17 (Good Governance) found due to governance systems failing to consistently assess, monitor and improve quality and safety. Recurring failings from previous inspections remained unresolved, including gaps in staff recruitment checks, inadequate incident learning, inconsistent financial safeguarding under MCA, and delays in notifying CQC of safeguarding incidents.
Concerns (9)
criticalGovernance: “governance systems are still not adequately robust, and further improvements are needed to meet all legal requirements and to drive continuous improvement.”
criticalSafeguarding: “delays in notifying CQC where abuse is suspected or alleged”
moderateIncident learning: “Most of the records we looked at however did not always provide clear information about the lessons that could be learnt from incidents, in order to minimise the risk of a reoccurrence in future.”
moderateConsent / capacity: “one person had paid £115 in taxi fares on four separate occasions...there was no evidence to show they had consented to, or understood the financial impact of, paying for transport costs twice.”
moderateRecord keeping: “legibility and accuracy of some records...Some records did not adequately demonstrate people's involvement or explain how the expenditure was in their best interests.”
moderateStaff competency: “At the 2018 inspection we found that required recruitment checks for new staff were not always in place...by this inspection we found some gaps again.”
minorCare planning: “Goals did not yet fully reflect people's personal aspirations and wishes however, and some of the information was out of date.”
minorEnd-of-life care: “one person had some very clear instructions in place, whilst another contained gaps relating to more personalised information and preferences, indicating there was more work still to do.”
minorComplaints handling: “Some of the information lacked detail, so we could not always be clear what the issues were...There was also limited information about possible actions to mitigate the risk of a future reoccurrence.”
Strengths
· Staff trained to recognise and protect people from abuse; understood reporting routes to managers, local authority, police and CQC.
· Medicines systems in place with staff competency checks by team leaders or service managers; PRN protocols developed.
· Good infection control practices maintained throughout COVID-19 pandemic; PPE always available and sufficient.
· People supported with communication needs using visual options, sign language, photographs and speech and language therapy guidance.
· Two new registered managers appointed and registered with CQC; received positive feedback from staff and relatives for visibility and approachability.
Quality-Statement breakdown (20)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Social Care Solutions Ltd (Bedford & Northampton) was rated Requires Improvement overall for the second consecutive inspection, with regulatory breaches identified for having no registered manager and failing to notify CQC of Court of Protection deprivation of liberty authorisations. While caring interactions were Good and improvements had been made since the previous inspection, significant instability in the management team had slowed progress, leaving issues with safeguarding reporting, consent, staffing vacancies, and governance still requiring embedding.
Concerns (9)
criticalGovernance: “Soon after the last inspection in August 2018, the registered manager left. Since that time there has not been a registered manager at the service. This is a breach of the provider's conditions of registration.”
criticalSafeguarding: “we found a small number of concerns that had not been reported to appropriate external organisations, such as the local authority, the Police and CQC, without delay.”
criticalIncident learning: “The provider had failed to notify CQC, as required, of all incidents affecting the health, safety and welfare of people using the service. This included Court of Protection authorisations.”
moderateStaffing levels: “there were approximately 46 support worker vacancies. One person told us, 'We are constantly using agency. I don't really like it. I like my own staff.'”
moderateConsent / capacity: “one person paying for bus fares on several occasions...there was nothing in their file to say that this had been assessed as being in their best interests. The person did not have capacity to understand or manage their finances.”
moderateCare planning: “individual goals and aspirations were not always updated in people's support plans...a communication passport in place but this had not been reviewed since 2013 and contained information that was no longer relevant.”
moderatePerson-centred care: “staff supporting another person - who used limited verbal communication, were not aware of such an aid to support this person. Records showed that an external professional had suggested a communication board.”
moderateLeadership: “due to the instability within the management team since the last inspection we found progress had been made at a slower rate than expected and had also resulted in inconsistencies across the service.”
minorEnd-of-life care: “Information about people's end of life preferences varied across the service. The new area manager told us that by August everyone's end of life wishes would be recorded in their support plans.”
Strengths
· Staff provided care and support in a kind and compassionate way, with relaxed and friendly interactions observed.
· Medicines systems were in place ensuring people received medicines as prescribed, with safe protocols followed.
· Significant improvements in staff recruitment checks since last inspection, with all required checks in place.
· People's privacy, dignity and independence were respected and promoted throughout the service.
· The service worked in partnership with local authorities and external healthcare professionals in an open and positive way.
Social Care Solutions Ltd (Bedford & Northampton) was rated Requires Improvement overall at its first CQC inspection in August 2018, with four regulatory breaches identified covering risk management, medication safety, staff recruitment checks, consent/capacity practices, and governance. Caring was rated Good, reflecting genuine compassion and person-centred values among staff, but significant work remained to embed robust systems across the service.
Concerns (9)
criticalCare planning: “conflicting information in their file about the use of thickeners in drinks, making it unclear whether the person needed thickeners or not to keep them safe when drinking”
criticalRecord keeping: “epilepsy support plan which did not fully incorporate the most recent consultant neurologist's advice; in terms of the actions to be taken by staff, including the dosage and frequency of recovery medicine”
criticalStaffing levels: “Systems in place to check whether staff were safe to work at the service, were not adequate. (Regulation 19 breach)”
criticalConsent / capacity: “a relative had been asked to consent on behalf of someone who did not have capacity… This relative did not have these powers so should not have been asked to do this.”
criticalGovernance: “quality monitoring arrangements needed to be strengthened… anomalies between the care records being held in the provider's office and those being maintained in people's own homes”
moderateMedication management: “there had been a number of medicine errors across the service… variations between the different supported living settings in terms of the accuracy and quality of Medication Administration Records”
moderateStaff training: “some training was now out of date and staff required refresher training… supervision was not always happening on a regular basis”
moderateEnd-of-life care: “Information about people's preferences and choices for their end of life care was not evident in the files we looked at. In one file this was completely missing.”
minorSupervision / appraisal: “a service manager confirmed that the service had fallen behind with staff supervision but there was a plan to address this”
Strengths
· People were protected from abuse; staff trained to recognise signs and knew how to keep people safe
· Sufficient staffing levels maintained including during summer holiday period using permanent and bank staff
· Staff treated people with kindness, compassion and respect; multiple testimonials from people and relatives
· People's privacy, dignity and independence were respected and promoted
· Effective partnership working with external health and social care professionals