Community Support Services

About the service

Community Support Services is a domiciliary care agency which provides care and support to people living in 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 the inspection 9 people, who were living with a learning disability and autistic spectrum disorders, were being supported with personal care. People were living independently and had their own tenancy agreements with a housing provider.

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

Right support

Staff provided effective support to identify people's aspirations and goals and assist people to plan how these would be met. Staff focused on people's strengths and promoted what they could do. There was a consistent approach to supporting people to learn new skills. Staff enabled people to access health and social care support in the community.

People and their relatives felt people were safe and felt confident to speak with staff if they had any concerns. A relative said, “[My loved one] is absolutely safe, without a doubt. They are really well looked after.”

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 provided care to people which was person-centred and promoted people’s dignity, privacy and human rights. People’s individual choices were recognised and respected. Staff promoted equality and diversity in their support for people. People could communicate with staff as staff understood their individual communication. People were empowered to take part in activities of their choice. People were supported to keep in touch with people who were important to them.

People were protected from the risks of harm, abuse and discrimination because staff knew what action to take if they identified concerns. There were enough staff to provide the support people needed. Staff understood the risks to people's health, safety and welfare. Risk assessments provided guidance for staff about individual and environmental risks. Further work, including mentoring staff, was being implemented to ensure risks were assessed consistently and this needed to be embedded into day-to-day practice.

People received their medicines safely and when they needed them. Medicines checks were completed each day which helped make sure any recording errors could be addressed quickly.

Right culture

The service enabled people and those important to them to work with staff to develop the service. Feedback was requested from people, relatives or health care professionals. Staff ensured the quality and safety of the service had been assessed to ensure people were safe. Safe recruitment practices were followed. Staff knew and understood people well.

The provider and staff worked hard to develop strong leadership. Quality monitoring systems had been developed and embedded. Morale within the staff team was high and staff felt valued.

Since the last inspection, a new senior management team had been recruited. People, relatives, and staff spoke positively about improvements in the leadership of the service. A relative said, “The communication is now brilliant. [Staff] are so responsive.”

Checks and audits were being regularly completed. Shortfalls were identified and action taken to address these. New quality assurance processes were being embedded into staff day-to-day practice to ensure a consistent approach was followed.

Most staff empowered people and encouraged them to increase their daily living skills. However, the management had identified some staff required further coaching and upskilling to ensure people were consistently supported.

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 rating for this service was inadequate (published 14 September 2022).

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

This service has been in Special Measures since 14 September 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

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

About the service

Community Support Services is a domiciliary care agency which provides care and support to people living in 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. The new manager was unable to confirm the number of people in receipt of personal care. At the time of the inspection 34 people were being supported with approximately a third of people being supported with prompting and / or supervision relating to personal care. People being provided with support lived with a learning disability and autistic spectrum disorders. People were living independently and had tenancy agreements with a housing provider.

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

People were not always protected from abuse, discrimination and harm. Staff had not kept their skills and knowledge up to date. Risks to people’s health, safety and welfare were not robustly assessed and measures to mitigate risks were not clearly recorded. People were not supported to have their prescribed medicines safely.

There was not always enough staff to provide people with the support they should have. The provider failed to monitor the one to one hours people needed to ensure they were able to spend time doing the things they enjoyed.

People were not encouraged and empowered to live their lives as independently as they could. People were not actively supported to take care of their homes and gardens.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Checks and audits, to monitor the quality and safety of the service, were not regularly completed or recorded. The new manager had implemented audits and checks prior to the inspection; however, these were yet to be completed and embedded into day to day staff practice.

People were supported by staff who had been recruited safely. People, relatives and staff provided mixed feedback about the quality and safety of the service.

An interim chief executive officer (CEO) had been contracted by the provider to provide support whilst a permanent CEO was recruited. The interim CEO, who has a background of working with people living with learning disabilities and autistic spectrum disorders, had identified shortfalls in the service delivery before the inspection. Action was being taken and they were working with multi-disciplinary health care professionals to drive improvements.

Why we inspected

The inspection was prompted in part due to concerns received about people’s finances, people not being appropriately supported to see health care professionals and low staff levels. A decision was made for us to inspect and examine those risks.

We assessed if the service was applying the principles of Right support right care right culture.

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.

Based on our review of safe and well-led:

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

Right support

Staff did not provide effective support to identify people’s aspirations and goals and assist people to plan how these would be met. Staff did not always focus on people’s strengths and promote what they could do. There was an inconsistent approach to supporting people to learn new skills. Staff did not consistently enable people to access health and social care support in the community.

Right care

Staff did not consistently promote equality and diversity in their support for people. People could communicate with staff as staff understood their individual communication. Staff did not fully understand how to protect people from poor care and abuse. People were not empowered to take part in activities of their choice. People were supported to keep in touch with people who were important to them.

Right culture

The service had not fully enabled people and those important to them to work with staff to develop the service. Feedback had not been requested from people, relatives or health care professionals for several years. Staff had not always ensured the quality and safety of the service had been fully assessed to ensure people were safe. Safe recruitment practices were followed. Staff knew and understood people well.

We have found evidence that the provider needs to make improvements. Please see the safe 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 report.

Enforcement and Recommendations

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 will take further action if needed.

We have identified breaches in relation to people’s safety and welfare, management of medicines, staff deployment and good governance.

We took action to impose further conditions on the providers registration following the inspection.

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

Special Measures

he overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Community support services provides personal nursing to people with a learning disability in their own homes. The service supported 32 people at the time of the inspection, only one person received the regulated activity of 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

Although people received a high quality of care, the registered manager had recognised there were issues in relation to communication systems and oversight. New systems had been put in place to improve communication and a staff restructure had been agreed to increase the management team. However, these changes were new and not yet embedded or had not yet happened. This resulted in the registered manager not having full oversight of the service. We have made a recommendation about this.

People were supported by staff who knew them well and who treated them with kindness and compassion. 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. People were given information in a way which was meaningful to them.

The service applied the principles and values the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People could decide when they wanted their support and what staff supported them with.

People were supported to increase their independence and develop new skills. The provider had several opportunities for people to gain work experience. People were supported to maintain relationships with loved ones and develop new friendships through social events. People were supported to access health care when required and to maintain a healthy lifestyle.

Staff knew how to keep people safe and helped people to understand how to recognise when they were vulnerable. Risks to people were assessed and positive risk taking was encouraged. People were supported by staff who they were involved in recruiting. Staff were recruited using safe processes and had the training and support needed to carry out their roles.

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

Rating at last inspection

This service was registered with us on 29 November 2018 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

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.