This targeted inspection of Care at Home (High Street) checked concerns about noise levels and behaviour management at one supported living household, finding proactive PBS/PBM practices and strong infection control. The overall rating remains Good from the previous comprehensive inspection (July 2021); the Safe key question was not re-rated as only specific areas were assessed.
Concerns (2)
moderateStaffing levels: “they acknowledged work was still needed to recruit and embed a permanent and consistent staff team. An influx of new starters was imminent”
moderateGovernance: “As we were completing our draft report we received further information of concern relating to the management of behaviours and governance of the household.”
Strengths
· Proactive behaviour support plans in place; restrictive practices minimised with clear focus on de-escalation and prevention.
· Staff trained in PBS and PBM; competency assessed by internal trainers certified to Restraint Reduction Network Standards.
· Incidents recorded and functionally analysed; support plans updated regularly to reflect current needs.
· Agency staff block-booked for consistency and received the same training as permanent staff.
· Robust infection prevention and control measures in place; PPE used effectively and testing conducted in line with national guidance.
Quality-Statement breakdown (2)
safe: Assessing risk, safety monitoring and managementInsufficient evidence to rate
safe: Preventing and controlling infectionInsufficient evidence to rate
Care at Home (High Street) achieved an overall Good rating on its first inspection, with strong person-centred, caring and well-led practice evident across most areas. The Safe domain was rated Requires Improvement due to inconsistent COVID-19 infection control practices across households and gaps in actioning staff disciplinary recommendations, though medicines management, safeguarding and risk management were all found to be effective.
Concerns (6)
moderateInfection control: “the provider's COVID-19 infection control practices including their visitors screening requirements and national guidance had not been fully adopted and implemented by staff members at one household.”
moderateInfection control: “Risk assessments for staff and people had not been updated when people or staff had declined the COVID-19 vaccine to identify potential risk of transmission of the virus.”
moderateGovernance: “the household infection control audit had not been expanded to reflect the provider's COVID-19 practices and protocols. This meant the audits had not identified some of the inconsistencies relating to the wearing of PPE”
moderateStaff competency: “People may not be supported by staff who were skilled to support them as effective systems were not always used to ensure recommendations from staff disciplinaries were actioned and implemented in a timely manner.”
minorStaff training: “it was not always clear that new staff had completed the required care certificate where relevant and the required number of probation meetings in line with the provider's induction policy.”
minorCommunication with families: “Two relatives felt the principles of a key worker scheme to improve communication and the involvement of people in decisions about their life was not always reliable.”
Strengths
· Staff treated people with kindness, dignity and respect; people looked relaxed and engaged freely with staff across all visited households.
· Safe medicines management systems were in place with regular reviews, competency assessments, and a focus on reducing psychotropic medicines.
· Comprehensive safeguarding systems and processes were in place; staff demonstrated good understanding of abuse types and reporting routes.
· Positive behaviour support (PBS) trainer embedded in service, helping staff identify triggers and use least restrictive, de-escalation strategies.
· Provider carried out comprehensive self-assessment using external consultant and internal mock inspections, resulting in a regularly reviewed service improvement plan.
Quality-Statement breakdown (23)
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
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; supporting people to live healthier lives and access healthcareGood
effective: Adapting service, design, decoration to meet people's needsGood
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; respecting privacy, dignity and independenceGood
responsive: Planning personalised care; supporting people to maintain relationships, follow interests and take part in activitiesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive, person-centred, open, inclusive and empowering cultureGood
well-led: Managers and staff clear about roles; understanding quality, performance, risks and regulatory requirements; duty of candourGood
well-led: Engaging and involving people, the public and staff; considering equality characteristicsGood
well-led: Continuous learning and improving careGood