Background to this inspection
Updated
14 May 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
Two inspectors carried out the inspection.
Service and service type
This service provides care and support to people living in 11 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for ‘supported living’; this inspection looked at people’s personal care and support.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced at the office. We then made arrangements to visit people in their homes when staff would be there to support the inspection.
Inspection activity started on 1 March 2022 and ended on 30 March 2022. We visited the office location on 1 and 15 March 2022.
What we did before inspection
We reviewed information we have received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return (PIR) prior to this inspection. A PIR as information providers send us to give some key information about the service, what the service does well and improvements they plan to make.
During the inspection
We spoke with seven people who used the service and six relatives about their experience of the care provided. Some people were unable to talk to us and use different ways to communicate including signs, gestures, vocalisations and body language.
We used the Short Observational Framework for Inspection (SOFI) and spent time observing people. SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We spoke with 10 members of staff including the area manager, registered manager and support staff.
We reviewed a range of records. This included eight people’s care records and five medication records. We looked at six staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
14 May 2022
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.
About the service
This domiciliary care service is owned by Archangel Enterprises Limited and is registered to provide personal care to adults within their own homes. The agency offers support primarily to people with a learning disability mainly within the Winsford and Northwich areas of Cheshire. The service is run from an office situated on the outskirts of Winsford. The service provides care and support to both people living in 'supported living' settings and people living in their own home. Supported living settings are designed so that people can live in their own home as independently as possible. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our visit 57 people were being supported by the service.
People’s experience of using this service and what we found
Right Support
Improvements were required so everyone receiving support could develop and pursue their interests.
People were supported by staff who had the skills and knowledge to meet their individual needs.
Competent staff supported people to manage their medicines. Medicine care plans clearly described people’s individual needs.
People were supported to participate in some activities of their choice. Some people and their relatives did not feel they had enough opportunities to undertake activities of their choice.
People were supported with their communication. Staff understood and supported people with their individual communication styles. Information was not consistently made available in accessible formats, such as, easy read and pictorial.
Staff supported people to make decisions following best practice in decision making. People were offered some daily choices and staff respected people’s views.
Right Care
Risks associated to people’s care and choices were set out in their care records, but improvements were required to ensure all risks were individual to the person, held sufficient detail and were regularly reviewed.
People were not always supported by a consistent staff team. This was due to a high turnover of staff. Staff and relatives told us this impacted on people’s lives.
People received compassionate care from staff they described as kind. Staff respected people’s privacy and dignity.
Right Culture
Some staff had left recently and the remaining staff team were stretched to ensure sufficient staffing levels were maintained.
Some people and those important to them were not always involved in planning and reviewing their care. The registered manager was working to address this.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.
The inspection was prompted in part due to concerns received about staffing levels, areas of risk relating to moving and handling and opportunities for people to undertake purposeful activities. A decision was made for us to inspect and examine those risks.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified breaches in regulation relating to risk management and governance.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.