Optima Care Shine London Limited

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.

At the time of the inspection, the service was supporting people with a learning disability or autism. We therefore assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Optima Care Shine London Limited is a supported living service providing personal care and support to people with a learning disability or autistic spectrum disorder and/or mental health care needs. At the time of our inspection there were 11 people receiving personal care living in the services, in 4 separate ‘supported living’ settings/houses, each with their own separate facilities.

An additional 6 people using the service did not receive any 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

The service had improved since our last inspection and was now able to demonstrate how they were meeting the underpinning principles of Right Support, Right Care, Right Culture.

Right Support

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. How medicines systems were managed had been improved, and people received their prescribed medicines as and when they should. Staff followed current best practice guidelines regarding the prevention and control of infection. Staff received the right levels of training and support which enabled them to deliver safe and effective personal care and support to people. Staff knew how to recognise and report abuse, and how to apply this knowledge. Enough staff were deployed throughout the services 4 supported living settings and their offices to meet people assessed personal care needs. Staff’s suitability and fitness to work in an adult social care setting had been thoroughly assessed.

Right Care

People had access to a wide variety of food and drink that met their dietary needs and wishes. People were helped to stay healthy and well. The provider worked collaboratively with external health and social care agencies and professionals to plan and deliver people’s packages of care. People were confident any concerns they raised would be listened to. The provider kept people safe by appropriately assessing, monitoring and managing risks they faced. Staff knew and understood the risks people might face and responded well to people’s individual needs. The care and support people received was person-centred.

Right culture

The provider’s culture was positive, open, and honest, with leadership and management that was clearly identifiable and transparent. The provider sought the views of people using the service, their relatives, external health and social care professionals, and their staff. Staff were aware of and followed the provider’s vision and values which were clearly defined. Staff knew their responsibilities, accountability and were happy to take responsibility and report any concerns they may have. Complaints, concerns, accidents, incidents, and safeguarding issues were appropriately reported, investigated, and recorded. Service quality was reviewed regularly, and appropriate changes made to improve people’s care and support if required.

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 14 March 2022) when 4 breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve how they managed, medicines, infection control, staff training and support, consent to care, and governance systems. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

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 requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Optima Care Shine London Limited 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. If we receive any concerning information, we may inspect sooner.

About the service

Optima Care Shine London Limited is a supported living service for autistic people and/ or people with learning disabilities and mental health needs. This service provides care and support to people living in four supported living homes but only three of these were providing a regulated activity to people. At the time of the inspection, out of a total number of 17 people, 12 people were receiving personal care.

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 

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

Right Support: Staff knew people well and supported them in accordance with their choices and wishes. They worked towards improving the care delivery related to nutrition, independence and choice of activities so that people could achieve the best outcomes in meetings their goals and aspirations.

Right Care: Staff attended to people's care with compassion. People's care records were in the process to be updated so that individual information about people and their behavioural support was included to ensure person- centred care delivery.

Right Culture: The management team worked towards implementing the improvement-driven culture. Actions were identified to improve low staff morale and to empower people to choose the way they wanted to live their lives.

We found evidence during our inspection of multiple breaches of regulation and the need for this provider to make improvements.

Staff did not always followed people's medicine management procedures and there was a lack of management oversite to ensure good practice. Infection control and prevention guidance was not followed effectively, including those associated with COVID-19, to prevent people and visitors from catching and spreading infections.

Staff did not receive on-going support on the job to ensure they carried out their role responsibilities as necessary. This included lack of continues supervision, observation and training for the staff team.

People were not always effectively supported in the decision-making process because the provider did not applied the principles of the Mental Capacity Act (2005) as necessary.

Governance systems in place to assess and monitor the quality and safety of the care people received were not always operated effectively. This is because there was a lack of continuity in monitoring the care provisions which resulted the provider failing to pick up a number of issues we identified during our inspection. Risk management issues in relation to people's finances and fire safety placed people at risk of harm.

There was a high turnover of managers in recent years which have had an impact on the care delivery. The management structure in place was not meeting the service expectations which resulted the managers leaving their posts frequently. We made a recommendation about this.

The healthcare professionals told us they worked closely with the provider to improve the care delivery but that the feedback provided was not sustained due to high turnover of managers at the service. This resulted an increased safeguarding activity at the service.

We received mixed responses from people's family members related to effectiveness of their communication with the service and staff's proactiveness when supporting their relatives which the management team looked to address as necessary.

People told us they were happy living at the supported living service we visited. For example, one person said, “I like it here…Staff are nice and let me live my own life.” Staff were aware of what was important to people, including their background and cultural needs which they assisted people to meet where they wished to do so.

Staff were aware of people's communication needs and had encouraged their involvement in conversations. We observed staff interacting with people in a friendly manner and people looked at ease in presence of staff.

The provider's recruitment procedures to check the suitability and fitness of new staff were safely applied. There was enough staff to support people with their choices and where necessary, the provider used agency staff to mitigate the risks related to current staff pressure.

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 good, where we undertook a focused inspection to review the key questions of Safe and Well-led only (published 19/04/2021).

Why we inspected

We received information of concern in relation to safeguarding investigations taking place. As a result, we undertook a comprehensive inspection to review all key questions.

The overall rating for the service has changed from good to requires improvement because we found evidence that the provider needs to make improvement.

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 identified four breaches in relation to safe care, staffing, need for consent and governance systems. This was because the provider failed to ensure they always consistently managed the risks associated with people's finances, medicines, consent to care, infection control practices and staff's support. The provider did not always operate their established governance systems effectively.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and the relevant local authorities to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Optima Care Shine London Limited is a supported living service for adults with an autistic spectrum disorder and learning disabilities. This service provides care and support to people living in three supported living homes. At the time of the inspection, eight people were receiving support with personal care.

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/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. There was an open culture which helped people to achieve the outcomes they wanted to. Staff empowered people to make decisions about their care and support needs. People had access to the community so that they could build and maintain important relationships to them.

Staff were provided with guidance on how to support people with their individual care needs but not all staff had specialist training to ensure they had the required knowledge to support people safely. We have made a recommendation about the training requirements for staff.

Systems required reviewing on how the manager recorded the safeguarding concern raised so that information was up-to-date and not missed. People’s care plans were robust and provided guidance for staff on how people wanted to be supported in their homes and out in the community. However, likelihood of the risks was not recorded, and the manager told us they would include this information as necessary.

Staff were aware of the safeguarding procedure and the actions they had to take should they notice any concerns related to people’s safety. Recruitment procedures were robust, and people had support to take their medicines safely. Agency staff were used to cover shifts where required and the provider was in the process of recruiting permanent staff. The premises were cleaned regularly by staff who followed relevant best practice guidelines regarding infection control and prevention.

Healthcare professionals were positive about the change that was happening at the service and told us how staff worked towards good practice to support people’s positive behaviour. Staff said that restraint was not used or appropriate for this service.

There was a recent change in management and feedback from relatives, staff and healthcare professionals was that things started to improve for better in all aspect of people’s care. Relatives told us how the new manager was visible and approachable to talk to should they have any concerns. Healthcare professionals had noticed improved communication and engagement from the service to support people with their complex needs. Staff felt supported and confident to raise issues where necessary. Positive culture at the service was promoted so people could have a good quality life. Audits were in place to monitor the quality of service delivery and action was taken to make improvements where necessary.

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 11 June 2018).

Why we inspected

We received provider concerns in relation to management and people's care. As a result, we undertook a focused inspection to review the key questions of Safe 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 remains good.

This is based on the findings at this inspection.

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

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.

This service provides care and support to people living in three ‘supported living’ settings, so that they can live in their own home as independently as possible. At the time of inspection 12 people were receiving support. 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was no registered manager at the time of our inspection, however the role had been recruited to. In the interim the director of development had full oversight over how each service was run. 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 supported by staff that knew them well and treated them with dignity and respect. Relative told us that staff were kind and caring and treated their loved ones well.

Processes were in place to protect and safeguard people from the risk of abuse, and staff were aware of the actions to take if they suspected people were at risk. Any risks to people were thoroughly assessed and robust management plans were in place to mitigate the risk of any potential incidents reoccurring. Lessons were learnt from any incidents and accidents and comprehensive debriefs were held to support all involved. There were suitable numbers of staff to meet the needs of the people using the service.

People were supported to receive their medicines appropriately, and encouraged to self-medicate where it was safe for them to do so. Cleanliness and infection control processes were maintained and regularly checked to maintain good hygiene levels.

People’s needs and choices were assessed prior to accessing the service to ensure the provider could meet their needs. People’s consent to treatment was sought in line with the Mental Capacity Act 2005 (MCA).

People were supported by staff that were sufficiently trained to meet their needs, and followed the standards of the Care Certificate. Staff received regular supervision to support them and appraisal plans were in place.

Where necessary, people were regularly referred and supported to access a range of healthcare professionals. People were well supported to maintain a balanced diet and receive enough food and fluids to keep them well.

The provider was pro active in supporting people to express their views in ways that suited them. People were supported with the ways in which they liked to articulate needs in relation to their diversity or culture. People were supported to be as independent as they were able to be.

People’s support plans were personalised and reflected people’s choices in how they preferred to be cared for. People were supported to participate in activities of their choosing at the times that it suited them. There was a robust complaints policy in place, that was accessible to people, their relatives and stakeholders.

The service was well-led and staff received good levels of support in helping them to deliver their duties. Steps had been taken to build links with partnership agencies and other community groups in order to strengthen the development of the services delivered. There were effective quality monitoring systems in place to drive improvements across the service.