Date of assessment 12 March 2024 to 17 April 2024. The assessment was carried out in response to information of concern we received. We found four breaches of the legal regulations relating to person-centred care, safe care and treatment, governance and staffing. The provider still did not always support the delivery of high-quality person-centred care. Care records lacked detail due to inadequate recording. Gaps were identified in the recording of health records. However, staff knew the person well which meant the person developed skills. The provider still did not ensure safe care and treatment. The risk assessments did not include meaningful plans to minimise risks. Accidents and incidents were not effectively monitored. The provider informed us they had plans to address this. The provider had still not operated an effective system to assess, monitor and improve the quality and safety of care provided. Leaders were not fully aware of their responsibilities under the Mental Capacity Act 2005 (MCA). Systems were not effective in identifying or addressing areas for improvement. The provider informed us they had plans to address this. The provider had still not maintained oversight of staff meetings, supervisions, training and competencies. The provider informed us they had plans to address this. Since the last inspection, improvements had been made with management of medicines and recruitment procedures. We assessed against the Right Support, Right Care, Right Culture (RS, RC,RC) statutory guidance. We expect health and social care providers to guarantee people with a learning disability and autistic people 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.
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First inspection of this domiciliary/supported living service identified multiple regulatory breaches around governance, risk management, medicines, recruitment, staff training/competence and notification of changes, leading to Requires Improvement in safe, effective and well-led. Caring and responsive were rated Good, with positive feedback from a relative, professionals and staff about kind, person-centred support and an open management culture.
Concerns (11)
criticalGovernance: “The provider did not operate effective quality assurance systems to oversee the service. These systems did not ensure compliance with the fundamental standards”
criticalMedication management: “The medicine management was not robust enough to demonstrate that medicines were managed safely at all times. This placed people at risk of harm.”
criticalStaff training: “only two out of seven staff had up-to-date training. The staff had to complete competency assessments once they had completed their training, and one staff's assessment was not completed.”
criticalStaff competency: “The registered manager did not ensure all staff were competent, skilled and had up to date training in order to carry out their role”
criticalOther: “The registered manager had not obtained all the information required by the Regulations to ensure the suitability of all staff employed.”
moderateCare planning: “the support plans did not contain all information specific to people's needs and how to manage any conditions they had. Staff did not have all detailed guidance”
moderateIncident learning: “Incident/accident forms were completed inconsistently and did not indicate further review by the management team.”
moderateRecord keeping: “The provider did not ensure that clear and consistent records were kept for people who use the service and the service management.”
moderateLeadership: “the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
minorConsent / capacity: “provider's policies did not include much information regarding the process to follow when supporting children with decisions, consent and any capacity issues.”
minorCommunication with families: “the support plans did not ensure all information presented was in a format people/children would be able to receive and understand it.”
Strengths
· Relative felt their family member was safe and staff were caring and kind
· Staff understood safeguarding responsibilities and how to report concerns
· Staff used PPE and followed infection control procedures
· Staff treated people with dignity, respect and upheld privacy
· People, children and families were involved in care planning
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot rated
safe: Staffing and recruitmentNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcareNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Meeting people's communication needsNot rated
responsive: Planning personalised care to ensure people have choice and controlNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Engaging and involving people using the service, the public and staff; continuous learning and partnership workingNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Promoting a positive, person-centred, open, inclusive and empowering cultureNot rated