Transforming Support (Coulsdon)

Updated 6 October 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 5 inspectors.

Service and service type

This service provides care and support to people living in 4 ‘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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant the provider had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 21 August 2023 and ended on 29 August 2023. We visited the 3 settings on 22 and 23 August 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 4 people and 5 relatives about their experience and observed people’s support.

We spoke with 15 members of staff including 8 support staff, the registered manager, 3 service managers, senior managers, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider

We reviewed a range of records. This included 9 people’s care records and 8 people’s medication records. We looked at recruitment information for 2 staff members and supervision files for 4 staff members. A variety of records relating to the management of the service, including action plans, audits, policies and procedures were reviewed.

Updated 6 October 2023

About the service

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.

Pathway for Care is a supported living service providing personal care to people with a learning disability and/or autism. Support was provided across 4 different supported living settings where people had their own flats or rooms. As part of our inspection we visited 3 of the supported living settings. 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 inspection 17 people were receiving a regulated activity.

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

Right Support: People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This was due to the principles of the Mental Capacity Act 2005 not being consistently followed.

Although the care and support people received had improved, work was still required to ensure records were maintained and staff had up to date guidance regarding people’s care. Audits had not fully identified concerns regarding records of people’s care. In other areas we found quality assurance systems had led to improvements in the support people received. People’s medicines were securely stored and administered safely, and good infection prevention and control measures had been implemented.

People were protected from the risk of abuse as staff were aware of their safeguarding responsibilities. Staff had received additional training and had been supported to better understand risks to people’s safety and wellbeing. Along with a more robust approach to incident reviews, this had led to a reduction in incidents in one setting.

Right Care: There were sufficient staff available to support people across all settings and staff knew people’s needs well. Relatives told us staff were willing to ask for guidance and had developed good relationships. People received support to access healthcare and positive feedback was received from professionals.

Right Culture: The management team had prioritised developing a positive culture across the settings. Increased staff training, enhanced supervision and involving people, relatives, staff and professionals in developing the service had led to improvements in people’s quality of life. The atmosphere at the three settings visited was described as relaxed and people appeared comfortable in the company of staff.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 10 August 2023) and there were multiple breaches of regulation. We imposed conditions to the provider’s registration relating to governance and oversight.

At this inspection we found the provider remained in breach of regulations in relation to consent to care and areas of good governance. However, in other areas including safeguarding, risk management, medicines, staff training and assessment processes we found the provider had made improvements and was no longer in breach of regulations relating to these areas.

This service has been in Special Measures since 5 April 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service in January and February 2023. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, safeguarding service users from abuse and improper treatment, person centred care, staffing and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to people’s legal rights not being protected in line with the Mental Capacity Act 2005 and how records and quality are monitored.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.