Ebenezer (Stone of Help) Ltd

Ebenezer (Stone of Help) Ltd is a domiciliary care and supported living service. It provides care for people living in their own houses and flats. People are supported in their own homes so that they can live as independently as possible. The service provided care for people with learning disabilities and / or autism and people with physical disabilities. CQC regulates the personal care and support. There were 3 people who received personal care at the time of the inspection. 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

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:

Care was planned, and risks were assessed and managed to help people live safely. Risks from medicines and infection were reduced. Accidents and incidents were reported and reviewed to help improve the safety of the service. Staff recruitment practices helped check that staff were suitable to care for people. Staff had the skills and knowledge to meet people’s needs safely and understood how to protect people from risk of harm. Staff received supervision and support to help them work effectively.

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

People had choice and control over their meals and were supported to have a balanced healthy diet. People were supported to have active daily lives and accessed the healthcare they needed.

Right Care:

People’s care was provided in line with person-centred principles. People’s choices, dignity and privacy was upheld. People’s independence was promoted. Equality and diversity principles were supported by the provider.

People were provided with information in a way they could understand that helped them understand their choices. People received support to help reduce any social isolation. People could make suggestions and be listened to and knew how to make a complaint if this was needed.

Right Culture:

The service had embedded person-centred care principles into its care planning, risk assessment and staff development practices. Both registered managers were actively involved with the service. People, relatives and staff knew them well. The provider had systems in place for governance and oversight.

Staff received support and development and felt confident in their roles. The service worked well with other professionals involved in people’s care. People were supported to lead confident lives supported by staff that understood them.

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 requires improvement (published 8 June 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ebenezer (Stone of Help) Ltd on our website at www.cqc.org.uk.

Follow up

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

Ebenezer (Stone of Help) Ltd is a domiciliary care service. It provides care for people living in their own houses and flats. People are supported in their own homes so that they can live as independently as possible. CQC regulates the personal care and support. There were three people who received personal care at the time of the inspection. 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

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 autistic people and providers must have regard to it.

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

We could not see evidence of how people were supported to have maximum choice and support as people’s consent had not always been sought and people experienced restrictions on their choices. Care staff had not been equipped with the skills and competence to safely manage risks from people whose behaviour could at times place themselves and others at risk.

Right support

People’s decisions for their own choices had not always been supported.

People were supported to access other health care professionals and participate in other health promoting activities in the community.

People’s interests and hobbies were supported.

People were supported with different communication methods when they needed this.

Right care

Consent had not always been sought for decisions about people’s care.

Care staff had been trained in how to identify signs of potential abuse and how to report concerns. However, some care staff had not recognised restrictions were being placed on people’s care without their consent.

For some people, strategies to reduce risk were not always effective.

There were enough care staff employed to meet people’s needs.

Care staffs’ suitability for working at the service was assessed at the recruitment stage.

Right culture

The principles of the Mental Capacity Act had not always been followed. People experienced restrictions on their choices.

Best practice in supporting people with learning disabilities and / or autistic people was not always demonstrated.

People had been involved in reviewing their care, however people had not always been empowered and included in planning their care.

The service supported people to maintain relationships with those important to them.

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 requires improvement (published 24 August 2021). At this inspection we found some improvements had been made, however some were still required and there were continued breaches of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Previously, we carried out an announced focussed inspection of this service on 12 May 2021. Breaches of legal requirements were found.

We undertook this inspection to confirm they now met legal requirements.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the full report. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.

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

Risk to people were not always assessed and actions taken to mitigate the impact. Medication was not always managed safely and where mistakes had been made, management did not have oversight to make improvements.

Staff recruitment was safe, however, staff training was not always delivered in a timely manner. Staff had not received essential training which was specific to the care needs of the person they were supporting.

Staff supervision was not carried out regularly and varied in the quality of the content. Staff competency was not checked adequately.

The service lacked management oversight, managers did not carry out audits and checks on all aspects of the service. This meant that they were not monitoring the service effectively.

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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. We could not see evidence of where people were supported to have maximum choice and control as staff were not trained effectively to deliver effective, person centred support to meet the needs of people using the service.

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

The last rating for this service was good (published 19 February 2019).

Why we inspected

We received concerns in relation to staff training and the management of complex needs and behaviours which challenge. As a result, we undertook a focused inspection to review the key questions of safe, effective 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 requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Effective 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ebenezer (Stone of Help) Ltd on our website at www.cqc.org.uk.

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 monitor the service and 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 two breaches in relation to safe care and treatment and governance at this inspection.

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

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.

People’s experience of using this service:

• People felt safe and staff understood their responsibilities to safeguard people from the risk of abuse.

• Risks associated with people’s care and support needs were managed safely and reviewed regularly.

• People were supported to have enough to eat and drink to maintain their health and wellbeing.

• People were supported to access relevant health and social care professionals. People were supported with their medicines in a safe way.

• Safe staff recruitment practices were followed. There were enough staff to ensure people received care and support as planned. Staff were trained and supported to carry out their roles.

• Staff demonstrated their understanding of the Mental Capacity Act, 2005. Staff gained people’s consent before providing personal care and support.

• People were encouraged to make decisions about how all aspects of their care and support was provided. People were involved in the planning and review of their care. Support plans were person centred and updated regularly.

• People’s privacy and dignity was protected and promoted.

• People were encouraged to remain independent, where possible. Staff supported people to develop new skills, access the wider community and meaningful activities of interest to them.

• People knew how to raise a concern or make a complaint. There was a system in place to respond to complaints and advocacy support was available.

• There was an open and a positive culture where the registered manager and staff communicated well and people’s needs were met.

• People, their relatives and staff were given opportunity to give feedback and influence how the service develops.

• There was a system in place to monitor the quality of service and action was taken where areas for improvement had been found. Any lessons learnt from incidents were shared with the staff to try to avoid future incidents.

• The registered manager and staff team worked well with professionals and organisations that promoted people’s quality of life.

• The service met the characteristics for a rating of “good” in all key questions.

• More information about our inspection finding is in the full report.

Rating at last inspection: We inspected the service but it was not rated (5 June 2018).

Why we inspected: This was a planned inspection based on the rating of the last inspection.

The inspection took place on 17 April 2018. The inspection was announced because we wanted to make sure that the registered manager was available to conduct the inspection.

A registered manager was in post. This is a condition of the registration of 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 and associated Regulations about how the service is run.

Staff recruitment checks were not comprehensively in place to protect people from receiving personal care from unsuitable staff. Risk assessments were not comprehensively in place to protect people from risks to their health and welfare.

The person and their relative told us they thought the service ensured safe personal care was provided by staff. Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area. Policies set out that when a safeguarding incident occurred management needed to take appropriate action by referring to the relevant safeguarding agency. The registered manager was aware these incidents, if they occurred, needed to be reported to us, as legally required.

They also told us that medicines had been prompted so that the person could take their medicine safely and on time, to their health needs, though records had not always evidenced this had happened.

Staff had largely received training to ensure they had skills and knowledge to meet people's needs, though training on other relevant issues had not yet been provided.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) to allow, as much as possible, people to have effective choices about how they lived their lives. Staff were aware to ask people’s consent when they provided personal care. A capacity assessment was not in place though this was carried out after the inspection to agree any restrictions on choice in the person's best interests.

The person and their relative told us that staff were friendly, kind, positive and caring. They said they had been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans were individual to the people using the service, which helped to ensure that their needs were met.

The person and their relative were confident that any concerns they had would be properly followed up. They were satisfied with how the service was run.

Staff members said they had been fully supported in their work by the registered manager.

The registered manager had not yet carried out comprehensive audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service.