Three Counties Care Services Ltd

Updated 23 April 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.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed by one inspector.

Service and service type

This service provides care and support to people living in a ‘supported living’ setting, 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 did not have a manager registered with the Care Quality Commission. This means that the provider is legally responsible for how the service is run and for the quality and safety of the care provided. The service did have a manager who had not yet commenced registration with CQC.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about this service. We sought feedback from the local authority and professionals who work with the service. Due to technical problems, the provider was not able to complete a Provider Information Return. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.

During the inspection

We spoke with eight staff, including the director, manager, and care staff. We reviewed a range of records including the support plan, care plan, risk assessment and other documents concerning care provision. We looked at two staff files in relation to recruitment and staff supervision. We reviewed multiple medication administration records. A variety of records relating to the management of the service, including policies and procedures were reviewed. We looked at training data and spoke with two professionals who had been working with the service.

Updated 23 April 2022

About the service

Three Counties Care Services is a supported living service providing personal care to young people and adults with learning disabilities and mental health issues. One person was receiving personal care at the time of the inspection.

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

Risk assessments were inadequate. Key risk concerns for the person were not explored or reduced in their individual risk assessment. This left the person at risk of their needs not being met appropriately. Staff testing for COVID-19 and use of PPE were not in line with government guidance. This meant staff and the person were not adequately protected from the risk of COVID-19 transmission.

The provider was not able to demonstrate all staff had received the training they needed to fully and safely support the person. This meant we were not assured staff had received all of the training they needed to support the person as safely and effectively as possible.

The person’s care plan did not include all the information staff needed to ensure their needs were fully met. The care plan was updated when this feedback was shared with the provider.

Staff described some differences in the way they supported the person with personal care, which meant the person was at risk of inconsistent care. The provider agreed to ensure all care support documents would be checked and updated so they all reflected the same needs and risks. Staff were able to tell us about the person’s likes and dislikes and daily notes also showed the person was supported to choose how to spend their time.

Systems were not in place to assess and monitor safety, risk and quality. Checks were not being made of care plans, risk assessments and other care documents to ensure they were accurate and effective. Checks were not in place to ensure infection prevention control measures were being followed correctly and medications were being administered safely. The provider told us they planned to introduce checks to improve oversight of safety and quality.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

The model of care provided the person with choices about their day to day life, but there was insufficient evidence the person was actively involved in their care planning and risk management. This meant the person may not feel fully involved in their care planning and they may have opinions and preferences which had not been identified. The provider agreed they would actively ensure the person was included in care plans and risk assessments in the future.

Language used by staff was not always respectful, for example, staff referred to the person’s home as ‘a unit.’ Staff were able to describe the person’s likes and dislikes and told us the person was at the centre of their care. There was no evidence to suggest the person was being unnecessarily restricted, but systems were not in place to ensure staff fully understood what the restrictions were and what they meant for the person. This meant there was a possible risk of the person being unnecessarily restricted in the event of them becoming distressed or unwell, or when being supported by a staff member who did not know them so well. The provider agreed they would look into new training for staff to enable them to better understand the mental capacity act and its implications for the person.

The provider had not established effective systems to ensure the person was fully included in their care plan and risk assessment, but staff told us, and daily notes indicated the person was supported to choose how they spent their time.

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

Rating at last inspection

This service was registered with us on 15/03/2016, and after coming out of a period of dormancy in June 2020 (dormancy was when no personal care was being provided to people) this was the first inspection.

Why we inspected

This was a planned inspection five key question first inspection.

We have found evidence the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. The provider took action to reduce some risks related to reducing transmission of COVID-19 shortly after the inspection.

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 breaches in relation to how risks were assessed and managed and in relation to oversight and quality assurance of the service at this inspection.

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 for 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.