Blossom HCG Ltd

About the service

Blossom HCG is a domiciliary care service providing personal care to 15 people living within 6 supported living environments at the time of the inspection.

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

Right Support:

Staff communicated with people in their individual and preferred methods. This meant people could be fully involved in decisions about their support.

Staff supported people to be as independent as they could if this was their choice.

People had support to pursue their interests and achieve their identified goals.

People received safe and effective support with their medicines.

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.

Right Care:

Staff demonstrated a good knowledge of how to support people effectively. The management team were implementing systems to manage staffing matters including how knowledge and competency was being checked.

People’s support plans varied in the level of detail and information provided for staff to follow. The registered manager was able to demonstrate care plans were in the process of being reviewed to help ensure consistency across the service.

Management and staff promoted people’s equality and diversity and knew them well as individuals. People received kind and compassionate care which fully promoted their privacy and dignity.

Staff prompted people to try new experiences which may enhance their well-being and enjoyment of life.

Right Culture:

People and those important to them were involved in planning their support.

People received consistent care and support from a team who knew them well and understood their individual needs. Management and staff strove to achieve good quality care and good outcomes for people.

People received good quality care and support and were supported to lead inclusive and empowered lives.

Feedback from people and relatives about the service was positive.

The management and team were passionate about continually improving the service and supporting people to achieve their goals and aspirations.

The provider’s new quality monitoring systems were not yet fully embedded in daily practice having been delayed due to significant staff shortages. A successful recruitment campaign had reduced the pressure on the staff and a tiered management structure was now in place. We have made a recommendation for the provider to concentrate on embedding their new quality assurance and governance systems into day to day practice across the service.

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 10 July 2021) and there were breaches of regulation. 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 prompted by a review of the information we held about this service.

We carried out an announced comprehensive inspection of this service on 04 June 2021. 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 safe care and treatment and overall governance of the service.

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 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 based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Blossom HCG 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.

Blossom HCG Ltd is a domiciliary care service providing personal care to nine people with a learning disability and/or autism at the time of the inspection. People lived across seven supported living schemes.

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 provider and registered manager had limited governance systems in place which did not formally capture improvements or actions. The provider had failed to ensure statutory notification were submitted to CQC when they were required to do so.

People were not always adequately protected from the risk of infections. Staff did not wear masks when supporting people. There were no individual risk assessments or plans for this. The registered manager had acknowledged this concern and was looking to implement measure to safeguard people.

People were supported by staff who knew them well and were happy with the support they were received. However, people’s current support needs and risks were not always captured in care plans or risk assessments. This meant when new staff came into support people, they would not be fully informed as to how people liked to be supported.

Staff had received some of the key training for their role, however some additional training was needed to ensure they met people’s individual needs. The manager told us this was on hold due to COVID-19.

People’s medicines were managed safely, and staff administering medicines underwent regular competency assessments.

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. The staff and registered manager were able to offer examples of how they offered people choice and control of their lives and where people needed encouraged to have confidence to make these decisions the staff were there to promote this. Staff were dedicated in ensuring the provide good care for people, however this was not always captured in the care plans and there were some training and development needed to develop staff.

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 05 October 2018).

Why we inspected

We received concerns in relation to infection prevention control measures. 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 has changed from good to requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report.

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 have identified breaches in relation to ineffective systems in place for safe infection control measures and a lack of governance systems.

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

This service provides care and support to people living in the community and in a 'supported living' setting, so that they can live in their own home 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 was supporting four people with personal care at the time of the inspection. Two people who lived in separate supportive living accommodation and two people who lived in their own homes. It provides a service mainly for adults with and learning disabilities and autistic spectrum disorders. At the time of our inspection there was one older person being supported by this service.

Not everyone using the service received a regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. This inspection started on 11 September 2018 and ended on 14 September 2018.

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.

The service had a registered manager in place. 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.

The provider had policies and procedures in place to keep people safe. Staff were trained and knowledgeable in relation to safeguarding procedures. Risks to people had been assessed and reviewed regularly to ensure their needs were safely met. Accidents and incidents were recorded and monitored.

Suitable arrangements were in place in relation to the safe administration and recording of medicines. Senior staff were overseeing medicine processes and the registered manager was in the process of formalising these checks.

Staff were trained in areas that providers are expected to deliver such as, safeguarding, first aid, the Mental Capacity Act and infection control. Additional training was in place or planned in areas specific to people's individual needs. All staff had undertaken an induction before they started work.

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

The registered manager carried out assessments of people's care and support needs before they started using the service. Their care and support were reviewed on a regular basis to ensure their needs continued to be met by staff. People's care files included information relating to their dietary support needs. Staff supported people to maintain a balanced diet and monitor their nutritional health.

People told us they were treated with kindness by staff who respected their privacy and upheld their dignity. People were given the opportunity to feed back on the service and their views were acted on.

People received personalised care that met their individual needs. People were given appropriate support and encouragement to access to follow their individual interests. People told us they knew how to complain and were confident they would be listened to if they wished to make a complaint.

The provider provided information in an easy read format for people. Community links were maintained with people accessing local amenities. People and relatives all told us that they were happy with the service provided and the way it was managed. We have made recommendations about the introduction of a more robust quality assurance process.