An assessment has been undertaken of a specialist service that is used by autistic people or people with a learning disability. We expect health and social care providers to guarantee autistic people and people with a learning disability respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. Castlewood Road is registered to provide personal care and support to people living in supported living accommodation and in their own homes. The service can provide support to people who could be living with dementia, mental health needs, physical disabilities, learning disabilities and/or autistic people. The last rating for the service was requires improvement, (published 29 November 2022) and there were breaches of regulations. The provider completed an action plan to show what they would do and by when to improve. We carried out our new assessment remotely from 17 May 2024 and ended our assessment activity on 7 June 2024. At the time of our inspection only a small number of people were being supported with personal care by the service. We looked at 5 key questions; Safe, Effective, Caring, Responsive and Well-Led. We covered a range of quality statements including; Safe systems and pathways, Safeguarding; Involving people to manage risks; Safe and effective staffing; Consent to care and treatment, Independence, choice and control, Person-centred care, Assessing needs, Capable, compassionate and inclusive leaders, Governance, management and sustainability and Learning, improvement and innovation.
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Golden Crown Care and Support Services received an overall rating of Requires Improvement at its first inspection, with regulatory breaches identified in safe care and treatment (Reg. 12), fit and proper persons employed (Reg. 19), and good governance (Reg. 17). While staff were praised for their caring approach and the service was effective in supporting the one person receiving care, significant shortfalls in risk assessment documentation, safe recruitment practices, and governance oversight posed risks to people's safety.
Concerns (6)
criticalCare planning: “a person was at risk of falls and had risks associated with skin integrity and diabetes. We found these risks had not been sufficiently assessed and there was a lack of detailed guidance in place for staff”
criticalStaff competency: “Where staff had worked in previous roles in health and social care, we found employment references had not been requested or obtained.”
criticalGovernance: “the provider was not completing any audits or checks of staff recruitment records... The service was asked to complete the PIR in May 2021, however no response was submitted to CQC.”
moderateRecord keeping: “aspects of a person's care plan were not detailed or up to date... sections of a person's care plan were not consistent with others and had not been updated”
moderateSupervision / appraisal: “support staff were not receiving formal supervision in line with the provider's procedure... this member of staff was not receiving regular supervision or an appraisal”
minorPerson-centred care: “care records did not sufficiently detail the person's preferences and choices, for example, with personal care support.”
Strengths
· Staff were kind, caring and knew the person well; relative praised their natural, patient approach
· People were supported to have maximum choice and control in the least restrictive way, in line with MCA principles
· Staff followed infection prevention and control measures and had access to PPE and COVID-19 testing
· The service worked with other health and social care professionals including GPs and social workers
· People were supported to maintain a balanced and healthy diet and their independence
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Using medicines safelyNot rated
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Staff working with other agencies; supporting people to access healthcareGood
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture; engaging people and staff; working in partnershipGood
well-led: Duty of candour; continuous learning and improving careGood