Charnat Support Services

Charnat Support Services provides personal care and support to people with learning and physical disabilities who live independently in the community. At the time of the inspection three people were using the service and receiving 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.

People's experience of using this service and what we found

The provider's audits and quality monitoring processes were not consistently effective in identifying improvement required within the service.

We found inconsistencies in care records and changes to some people’s health conditions had not been reflected in care plans.

Audits conducted had not identified the inconsistences we found in MARS charts and training records.

The provider carried out recruitment checks to ensure staff were suitable for the role. Improvements were required to DBS risk assessments to ensure they were specific to the individual concern and how that could potentially have an impact on people.

Systems were in place to protect people from the risk of abuse and harm.

People received their medicines as prescribed. Infection control policies and procedures were in place to keep people safe.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way and in their best interests: the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. There was a strong focus on supporting people to be independent, develop their skills and access their local community. This enabled people who used the service to live as full as life as possible and achieve the best possible outcomes. Improvements were required in relation to care records and quality assurance processes to support good outcomes for people.

Right support:

• Model of care and setting maximises people's choice, control and independence

Right care:

• Care is person-centred and promotes people's dignity, privacy and human

rights

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.

People's individual communication needs were considered to support them to be involved in their care.

The management and care team ensured they supported people in a person-centred way to reflect people's equality and diverse needs.

The service worked well with health and other professionals to ensure people's needs were met.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Inadequate (02 December 2020 Inadequate).

Why we inspected

This was a planned inspection based on previous rating.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified continued breaches in relation to the governance of the service being provided. However, the provider was no longer in breach of safeguarding service users from abuse and improper treatment. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Charnat Support Services provides personal care and support to people with learning and physical disabilities who live independently in the community. At the time of the inspection three people were using the service and receiving 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.

People’s experience of using this service and what we found

There continued to be a lack of provider oversight which meant risks to people’s safety had not been responded to appropriately.

Systems to monitor the quality and safety of the service were ineffective and placed people at the risk of harm.

Risk assessments were not robust enough and did not contain enough information of actions to take to minimise risks to people.

Audits of accidents and incidents did not provide a full and clear picture of frequency of accidents or incidents and did not include actions taken to reduce further occurrences. Systems and process which were in place were not robust to protect people from potential harm.

We were not provided with evidence of any lessons learnt following incidents or accidents.

Staff we spoke with told us they understood their roles and responsibilities, had received some training but did not always feel supported by the management.

Staff we spoke with told us they had received some training to meet people’s needs. However, we saw from records that staff had not completed training on all of the health conditions of people, to meet their needs. Support for staff to carry out their role was not consistent.

Relatives we spoke with said they felt people were safe and received support to meet their needs. One relative told us they their relative needed increased support from an additional staff member. Staff we spoke to also said they felt an additional staff member was needed to support this person. We were told by the registered manager, staffing levels were being reviewed for one person however, no evidence of the actions taken by the registered manager were provided, although this evidence was requested.

Spot checks of staff visits in people’s homes were not completed to monitor that people received the support they needed. This meant that the provider could not be sure carers were supporting people as they wished and detailed in their care plans.

We experienced some difficulty in completing the inspection due to records not being available when requested and delays in sending information to us.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 21 October 2017).

Why we inspected

The inspection was prompted in part due to concerns received about notifiable police events, issues relating to fire and personal safety, delays in repairs putting people at risk and risks associated with behaviours that challenge. A decision was made for us to inspect and examine those risks.

As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Charnat Support Services on our website at www.cqc.org.uk.

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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

At this inspection we have identified breaches in relation to Regulation 12, Safe care and treatment of people using the service putting people at risk of harm or injury and Regulation 17 Good governance, due to the lack of systems and process’ in place to assess, monitor and improve the quality and safety of the services provided.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Charnat Support services provides personal care and support to people with learning and physical disabilities who live independently in the community. Seven people used the service at the time of our inspection.

The previous registered manager left the service in March 2015. The service is currently being managed by a manager with the support of an assistant manager. The manager had submitted an application to register as the registered manager. We were advised during our inspection that the manager has resigned from his role and therefore this application will not be completed. The provider appointed a new manager following our inspection and they have commenced the process to register with the Care Quality Commission.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At our last inspection of this service in June 2016 we found the provider was meeting the regulations of the Health and Social Care Act 2008. However we did identify some areas that required improvement in relation to the service not working in accordance with the principles of the Mental Capacity Act (2005). Staff had not received training in relation to this legislation and other refresher training relevant for their role and they did not receive regular supervision. We also found that audits were not being consistently completed to assess and monitor the quality of the service provided.

On this inspection we found the provider had made all of the required improvements since our last inspection.

People were supported by sufficient numbers of staff who had undergone recruitment checks to ensure they were safe to work. Staff understood how to report concerns on abuse and manage risks to keep people safe. People were supported with their medication by staff who had received training in how to do this.

Staff had access to training and supervision to support them in their role. Staff understood the importance of seeking consent in line with the Mental Capacity Act 2005 and knew how to support people to make their own decisions. Staff monitored the health and wellbeing of people and knew the action to take if someone became unwell.

People and relatives described staff as kind and caring, and confirmed staff treated people with dignity and respect. People were encouraged to be involved in the planning and review of their care. People felt supported by staff who knew them well. People and relatives knew how to raise any concerns they had about the service.

People, relatives and staff spoke positively about the manager and they told us the service was managed well and in people’s best interests. People and relatives made positive comments about the service people received.

Charnat Support services provides personal care and support to people with learning and physical disabilities who live independently in the community. Six people used the service at the time of our inspection.

The previous registered manager left the service in March 2015. The service is currently being managed by two acting managers with the support of an assistant manager. There has been a delay in the provider submitting an application to register a manager for this service. Following our inspection we have received written confirmation that one of the acting managers will submit an application to register as the registered manager.

A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People received a safe service, and procedures were in place to reduce the risk of harm to people. Staff knew how to report and deal with issues regarding people’s safety. People received their medicines as prescribed. Staff were recruited in a safe way which ensured they were of a good character to work with people who used this service.

Although the acting managers understood their responsibilities under the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). We found that applications had not been submitted until after our inspection for people whose liberty was potentially being restricted.

Not all of the staff had received training in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However staff knew about people’s individual capacity to make decisions and they told us how they gained people’s consent before providing support.

We found that staff had not completed refresher training to ensure their knowledge and skills were up to date. Some staff had not received essential training since their employment. Not all of the staff received regular supervision to support them in their roles.

Staff were described as caring and respectful and staff told us how they maintained people’s privacy and dignity and promoted their independence.

People were supported to go shopping and to eat a healthy diet. Staff told us how people were involved in their support plan and made decisions about their care.

People were supported to maintain good health; we saw that staff alerted health care professionals if they had any concerns about their health. Relatives knew how to raise any issues they had about the service.

Due to the management arrangements in place we found inconsistencies with the way the service was managed and monitored. We found support systems were not in place for all of the staff. We found improvements were required with the records and audits were not always in place to demonstrate how the overall quality of the service was assessed and monitored.

We found that systems were in place to ensure people's consent was always obtained before any support was provided. One person told us, "Staff always get my permission for everything."

We saw that people's needs were assessed, and support plans were in place. Staff we spoke with were able to tell us about people's needs. This ensured people received support in a way they preferred. A representative we spoke with told us, "I think the service meets people needs well."

Systems were in place to ensure people received their medication as required.

We found that procedures were in place to ensure only suitable staff were recruited.

There was a complaints procedure in place to enable people to share their concerns.

A representative spoken with told us they were happy with the support provided by the agency. They said, 'The staff are respectful, approachable and provide good support. I am involved in the development of the person's support plan and the staff keep me informed. Overall I am satisfied'. Another representative told us, 'I am impressed and happy with the service provided, they meet the person's needs and maximise their independence'.

We saw that people's needs were assessed, and support plans were developed in consultation with people's representatives. Staff spoken with were able to tell us about people's needs. This ensures they receive support in a way they prefer.

We found that staff were clear about the action to take should they become aware of an allegation of abuse. This ensures people are safeguarded from harm.

Staff spoken with told us they felt supported by the management team. They confirmed they have regular training opportunities. This ensures staff are able to deliver care to an appropriate standard.

We found that systems were in place for assessing and monitoring the quality of service provided.