Transparent Care Limited

Updated 4 August 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 Health and Social Care Act 2008.

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

Four Inspectors, and two Experts by Experience carried out the inspection. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

This service provides care and support to people living in 16 ‘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

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 that we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 6 May 2022 and ended on 16 June 2022. We visited the office location on 10 and 20 May 2022.

What we did before 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 communicated with ten people who used the service and 13 relatives about their experience of the care provided. Some people who used the service who were unable to talk with us used different ways of communicating including using Makaton, pictures, photos, symbols, objects and their body language. We spent time observing people and how they were supported by staff to help us understand the experience of people who could not talk with us.

We spoke with 17 members of staff including care workers, agency staff, a team leader, service managers, area managers, assessment and transition manager, the registered manager and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We asked for written feedback from staff we did not speak with and received 15 responses.

We reviewed a range of records. This included 15 people’s care records including parts of medication records. We looked at seven staff files including agency staff 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. We requested further written feedback from professionals who were involved with the service but did not receive this.

Updated 4 August 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

Transparent Care Limited is a supported living service providing personal care in shared houses and bungalows across a wide geographical area. At the time of the inspection the service supported 71 people with a learning disability, autism or living with mental ill health.

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.

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

Right Support

The service worked with people’s funding authorities to identify people who needed a Court of Protection derivation of liberty y authorisation to keep them safe. There was no system to track the progress of applications to ensure outcomes were known and shared with staff teams. We have made a recommendation about this.

People’s care plans contained detailed information about many aspects of their physical and emotional needs, however, protected characteristics such as gender identify and sexuality were not captured. We have made a recommendation about this.

The service supported people to have the maximum possible choice and independence and they had control over their own lives.

The service worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

Right Care

The service did not consistently identify or report safeguarding concerns. The registered manager had acted to improve this through increased monitoring systems. Other concerns were reported appropriately and the service worked well with other agencies to protect people from poor care and abuse in these cases. We have made a recommendation about safeguarding.

We received feedback that some agency staff were not appropriately skilled or demonstrate the right values to meet people’s needs and keep them safe. The service was aware of these concerns and we saw evidence they were acting to improve this. We have made a recommendation about agency staff.

Other staff demonstrated commitment and compassion towards people and received mandatory and specific training to benefit people. The service had taken action to ensure refresher training was planned where this had lapsed in some cases during the COVID-19 pandemic.

The service did not consistently ensure assessments documented all identified risks to people. Some health and safety checks such as water safety were not robust. Safe medicines systems were not always implemented by staff. We have made a recommendation about this. The service took action to address these short falls. In practice, staff were knowledgeable about risks to people and took action to mitigate risk with people.

We found most people could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives. Some people’s activity opportunities were discontinued due to COVID-19 restrictions; the service was in the process of supporting people to source and access other opportunities in the community.

People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right Culture

The ethos, values, attitudes and behaviours of leaders and staff ensure that people using the service lead inclusive and empowered lives. We received mixed feedback about the leadership team. Some felt managers were supportive and valued their input, others felt managers were not doing enough to address their concerns. We raised this with the registered manager who shared their action plan to address concerns.

The service acknowledged that quality assurance monitoring systems had lapsed during the COVID-19 pandemic whilst the service focused on managing risk. There was a clear commitment from the registered manager to drive improvement and we saw evidence of recent progress. We have made a recommendation about quality monitoring to ensure improvements are sustained.

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 (29 December 2017).

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, governance and the management of risk to people. A decision was made for us to inspect and examine those risks.

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

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.