Arrow Support Limited

Updated 6 September 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.

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

This inspection was carried out by 1 inspector and 1 Expert by Experience who made telephone calls. 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

Arrow Support Limited is a domiciliary care agency. This service provides care and support to people living in their own houses and flats, so that they can live as independently as possible.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

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

Notice of inspection

The first day of this inspection was unannounced. Inspection activity started on 30 June 2023 and ended on 13 July 2023. We visited the location’s office on 30 June 2023 and 04 July 2023.

What we did before the inspection

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 information gathered as part of monitoring activity that took place on 26 July 2022 to help plan the inspection and inform our judgements. We reviewed the information we held about the service, including notifications we had received. Notifications are changes, events, or incidents the provider is legally required to tell us about within required timescales. We sought feedback from the local authority. We used this information to plan the inspection.

During the inspection

We spoke with, 3 relatives, 7 members of staff, and the registered manager. To help us assess and understand how people's care needs were being met we reviewed 8 people's care records. We also reviewed records relating to the running of the service. These included staff recruitment and training records, medicine records and records associated with the provider's quality assurance systems.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and care records.

Updated 6 September 2023

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

Arrow Support Limited provide personal care and support to people of working age with a learning disability, autism or who have complex needs associated with their mental and /or physical health. The support is provided to people who live in their own homes in Plymouth and the surrounding area. Packages of care varied from daily visits (a few hours) to 24-hour care. At the time of this inspection Arrow Support Limited were supporting 43 people within their own homes. 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. At the time of our inspection there were 9 people using the service who were in receipt of the regulated activity of personal care.

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

Right Support:

People were not always supported to have maximum choice and control of their lives and staff were not supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people’s best interests.

People were not always protected from the risk of harm as staff did not always have all of the information needed to meet people's needs safely. People were able to choose how they spent their time and were supported by staff to take part in activities and pursue their interests in their local area.

Right Care:

People’s care and support plans were not always reflective of their range of needs. However, staff knew people well and understood how to communicate effectively with people. Staff spoke to people in a dignified and respectful way and it was clear from what we were told that people and staff had developed good relationships.

Right Culture:

The management team had created an open and transparent culture, where constructive feedback was encouraged. Relatives knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns. However, we found more work was needed to ensure the service was operating in accordance with the regulations and best practice guidance.

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 on 27 September 2017).

Why we inspected

We undertook this inspection as part of a selection of services rated Good and Outstanding. We undertook a focused inspection to review the key questions of safe, effective, and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, safeguarding, need for consent, deprivation of liberty safeguards (DoLS) and good governance. We have also made a recommendation in relation to training . 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.