Active Care Group - Children's Complex Care

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is support 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

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.

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. People did not have mental capacity assessments or best interest meetings to ensure decisions being made on their behalf were the least restrictive. Staff enabled people to access specialist health and social care support in the

community.

Right Care

People's individual health risks were not always well managed to ensure they received to care and support needed. People were not always supported by staff who had the skills and knowledge needed to meet their needs. People's care plans did not always reflect their range of needs. For example, risk assessments did not always detail enough guidance for staff to support people safely. People’s equality and diversity was not considered in their care and support plans. People did not have end of life care plans.

Right Culture

Staff told us they did not always feel supported by senior management at the service. Staff had not always had training in areas which would enable them to support people with all their identified needs. Staff had not completed training in learning disability and/or Autistic people, positive behaviour support or end of life care. People and staff felt communication with the office and senior management was poor.

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 08 August 2018)

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Active Care Group – South division care in the home’ on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment, supporting people with decision making under the Mental Capacity Act, person centred care and good governance.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

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

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community and supported living homes. It provides a service to children, young people, adults and older people, with physical disabilities and a wide range of diagnoses and health needs. Active Assistance provided support with personal care to 392 people across the country when we inspected. Active Assistance has a registered office in Sevenoaks and five regional managers based across the country. The regional managers have care service managers and personal care assistants who support people who use the service. All paperwork and information is sent to and stored in the Sevenoaks office.

At the time of our inspection there was a registered manager at the service. 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 2008 and associated Regulations about how the service is run.

People were being kept safe from abuse. Staff understood their responsibilities in keeping people safe from abuse and had been trained to know how to report any possible concerns. People were supported safely around risks and were encouraged to take positive risks after control measures were applied. Staffing levels met people's needs safely and people told us that they had staff to support them when they needed it. There were emergency plans in place for people living at home who required staff to meet their medical needs.

People received their medicines safely and when they needed them by staff trained to administer them. The risk from infection was reduced by effective assessment, training and the provision of personal protective equipment. When things went wrong the service had learned from these and had shared that learning with staff teams.

People had received an assessment of their needs and their needs were tracked though care plans to ensure effective outcomes were achieved. Staff had the necessary skills and competencies to support people and had been trained in key areas such as safeguarding, moving and handling, and food safety as well as in additional areas that met people’s needs, such as catheter care. Staff were supervised effectively and had annual appraisals

People received enough food and drink to maintain good health. Staff worked in partnership to provide consistent support when people moved to or from the service. People had access to healthcare professionals and were supported to maintain good health. Staff responded in a timely way when people were unwell and medical guidance was followed correctly.

People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act were being complied with and any restrictions were assessed to ensure they were lawful, and the least restrictive option.

Staff treated people with kindness and compassion. Staff knew people’s needs well and people told us they liked and valued their staff. People, and where appropriate, their relatives were consulted around their care and support and their views were acted upon. People’s dignity and privacy was respected and upheld and staff encouraged people to maintain their independence as safely possible.

There was a complaints policy and form, available to people. Complaints had been utilised to improve the service. People received a pain free and dignified death at the end of their lives. Staff supported people with compassion and worked with local hospice teams. People were supported in a personalised way that reflected their individual needs. People’s care plan documentation was written in a way they could understand and it reflected their needs.

There was an open and inclusive culture that was implemented by the management team. Audits and governance systems were effective in providing a high-quality service. People and staff spoke of a friendly and homely culture that was empowering. People, their families and staff members were engaged in the running of the service. There was a culture of learning from best practice, and working with other professionals and local health providers to ensure partnership working resulted in good outcomes for people.