Sapphire Support Services Limited

Sapphire Support Services Limited is a 'supported living' service that provides care and support to people living in shared communal accommodation. The service supported people with mental health conditions, physical disabilities, dementia and older people. They are also registered to support people with a learning disability and autistic people. At the time of the inspection, the service supported 16 people.

The inspection took place at the providers registered office which is based within a purpose-built site that can accommodate a maximum of 16 people. There is a permanent office for the management and administration teams and waking support staff on site 24 hours a day. People had their own individual bedrooms with a private bathroom and shared communal spaces such as the kitchen, dining room and garden.

The service also supported people in the community living in their own property, but we did not visit them as part of this 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.

At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

Right Support

People did not always receive the support they needed to keep them safe from risk of harm or to ensure all their needs were met. Staff were not always recruited safely to ensure they were suitable to work with people. The service did not always support people to have the maximum possible choice, control, and to be independent and have control over their own lives. People were not always supported to achieve their aspirations and goals. Staff supported people with their medicines, but improvements were needed to promote people’s independence.

Right Care:

People were supported by the number of staff they needed but we were not assured all staff had the required skills and knowledge to meet their needs and promote their independence. Staff communicated with people in ways that met their needs. People told us staff respected their privacy and dignity when providing care and support. Where appropriate, staff encouraged and enabled people to take positive risks.

Right Culture:

The provider has continually failed to improve the systems in place to maintain oversight and drive improvements in the service. People’s quality of life was not enhanced by the service’s culture of improvement and inclusivity. People were provided with some opportunities to share their feedback about the service they received. Staff worked with health professionals to monitor people’s healthcare needs.

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 15 November 2022) 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 the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We carried out an announced focused inspection of this service on July 2022. 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 the safeguarding processes and governance systems in 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 remained as requires improvement. 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 Sapphire Support services on our website at www.cqc.org.uk.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to the management of risk, staff training, recruitment of staff and the lack of governance systems to monitor the quality of the service being provided.

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 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 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.

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

Sapphire Support Services Limited is a ‘supported living’ service that provides care and support to people living in shared communal accommodation. The service supported people with mental health conditions, physical disabilities, older people and people living with a learning disability and/or Autism. At the time of the inspection, the service supported 19 people.

The inspection took place at the provider’s purpose-built site that can accommodate a maximum of 19 people. There is a permanent office for the management and administration teams and waking support staff on site 24 hours a day. People had their own individual bedrooms with a private bathroom and shared communal spaces such as the kitchen, dining room and garden.

The service also supported people off site living in their own property, but this did not form part 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 found that some people had not always been sufficiently protected from the risk of abuse.

The provider’s oversight of the service had not identified some of the shortfalls we found at this inspection. Systems and processes in place to monitor the safety and effectiveness of the service required improvement.

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

Right Support:

We found the lack of provider oversight had allowed a closed culture to develop. This meant some people had been restricted from following their day to day interests in order to control their behaviours or as a punishment for being ‘naughty.’ A new staff team has since been recruited and people told us they now received support to follow their individual interests. Care plans were in the process of being transferred to an electronic care planning system. Not all care plans and risk assessments had been transferred to the new system. They required updating to ensure there was sufficient detail for staff to support people consistently and safely. People were supported with their medicines safely and in a way they preferred.

Right Care:

Staff received training but had not received specific training to support people living with a learning disability or how to support people when they became emotionally upset or distressed. People's specific dietary needs were understood and were being met. However, there was one person’s information that required updating to confirm whether they did or did not require support with their swallowing. There were sufficient numbers of staff to meet people's needs and keep them safe. People were supported in their preferred way by staff that understood their individual care needs. Staff took part in regular testing for COVID -19. People told us staff respected their privacy and dignity when providing care and support.

Right Culture:

People's needs had been assessed and personalised support plans were in place. However, the provider had not provided care plans or risk assessments in an accessible, easy read, format for people living with a learning disability. The recruitment process required some improvement to ensure gaps in employment were questioned thoroughly and employer/character references followed up. People were supported to live healthier lives and staff were available to help them access healthcare services if required. We saw the service worked closely with healthcare professionals to ensure good outcomes for people. People were given the opportunity to provide feedback on the service through regular contact with the management team and support staff. Relatives told us they were happy with the care and service their loved ones were now receiving.

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 18 October 2021). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We received concerns in relation to the safety of people with allegations of abuse, restricting people from their day to day activities, staff training and staffing levels and the misuse of medication. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only to inspect and examine those risks.

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 full report.

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

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 safeguarding people from the risk of abuse and governance processes monitoring the overall quality of the service being delivered to people at this inspection.

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

Sapphire Support Services Limited is a ‘supported living’ service that provides care and support to people living in shared accommodation including younger adults with mental health conditions. At the time of the inspection the service supported 23 people.

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 had grown since the last inspection, but systems and processes to provide good governance of the service were not fully in place and embedded. There was a lack of analysis of accidents, incidents, safeguarding and information gathered, that would provide the registered manager with further oversight of the service and could result in opportunities to learn lessons being lost.

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’s views of the service were regularly sought and people told us they felt involved in their care and their opinions were listened to and acted on.

People were happy with the service and support they received. They were complimentary of the registered manager and staff and felt safe being supported by a consistent group of staff.

People were supported by staff who had received training in infection control and wore PPE [personal protective equipment] in line with the latest government 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 at the previous premises was good (published 10 December 2019).

Why we inspected

We received concerns that people supported by the service may be at risk of abuse, and concerns in relation to staff management, medicines management and staff training. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We review the information we held about the service. No areas of concern were identified in the other key questions. Were 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 remained the same. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the well-led section of this full report.

We found no evidence during this inspection that people were at risk of harm from this concern as the provider took immediate action to mitigate the risks.

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

Sapphire Support Services limited is a ‘supported living’ service that provides care and support to people living in shared accommodation including younger adults with mental health conditions. At the time of the inspection the service supported two people.

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

People told us they felt safe and systems to assess and monitor risk were in place. Staff had received training in safeguarding and knew how to keep people safe. The provider had a robust recruitment process in place and there were enough staff on duty to meet people's needs. Staff were trained to administer medicines and regular checks and processes were in place to ensure they were given safely. Accidents and incidents were recorded and followed through with appropriate action to minimise the risk of re-occurrence. Staff followed infection control guidance and had access to personal protective equipment.

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. Staff had the appropriate skills and knowledge to meet people’s needs. Staff liaised with other health care professionals to ensure people's safety and meet their health needs. People were supported to prepare meals and drinks as required.

People received care and support that respected their dignity and privacy. People told us staff were kind and they were involved in their care plan reviews and supported to make choices about their care. People were communicated with in ways they could understand. The provider had a complaints process and people felt confident to raise any concerns.

A number of quality audits were in place to assess and monitor the quality and safety of the service. People told us that the manager was approachable and responsive and staff felt supported. The registered manager had worked well with other health care professionals and their feedback was very positive.

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 21/11/2018 and this is the first inspection.

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.