Care at Home (Swindon)

Updated 29 October 2022

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.

Inspection team

The inspection on site was carried out by three inspectors and a member of the CQC medicines team. An Expert by Experience made telephone calls to relatives. 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

This service provides care and support to people living in eight ‘supported living’ settings, so that they can live 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.

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.

The provider's statement of purpose showed the location required three registered managers. At the time of the inspection there was only one registered manager for one of the supported living settings. The other seven supported living settings had no registered manager. We heard after the inspection that the manager currently at one of the settings would be applying to the CQC to register as manager. We were informed that recruitment had commenced for a registered manager for the remainder of the settings. In the interim, the operations manager and a deputy manager were overseeing these settings.

Notice of inspection

We gave a short period notice of the inspection because we needed to visit some of the settings and needed consent from people to do so. We also needed to be sure that the provider or manager was available to support the inspection.

Inspection activity started on 6th September 2022 and ended on 21st September 2022. We visited the location’s office/service on 12 September 2022.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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 all this information to plan our inspection.

During the inspection

We visited three supported living properties on 6th, 7th and 12th September. We spoke with five people and nine relatives about their experience of the care provided. We spoke with 15 members of staff, including four support workers, three senior support workers, the registered manager for one of the premises, a manager for another of the premises and deputy managers for two other premises. We also spoke with the operations manager, regional operations manager and external improvement professional.

We reviewed a range of records. These included 10 people's care records and eight people's medication records. We looked at staff records in relation to recruitment, training and other records relating to the management of the service, including audits, policies and procedures and quality assurance records.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance and records relating to the management of the service.

Updated 29 October 2022

About the service

Care at Home (Swindon) is a supported living service providing the regulated activity of ‘personal care’ to people with a learning disability, autistic people and other people with complex needs in their own houses. Not everyone who uses the service received personal care. This is help with tasks related to personal hygiene and eating. Where they do, we consider any wider social care provided.

At the time of the inspection, 39 people were receiving personal care in eight different supported living settings. We visited some people who lived in adapted houses where people had their own bedrooms and sometimes individual or shared bathrooms, as well as shared communal areas. People received a variable number of care hours per week, depending on their assessed needs.

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.

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

The service was not able to fully demonstrate, across all supported living settings, how they were meeting some of the underpinning principles of Right support, right care, right culture. People did not always receive consistent good standards of care.

Right Support

Two out of three premises had deregistered from residential to supported living and did not always maximise people’s choice and independence. There needed to be more focus on continuously developing meaningful activities, independence and quality of life. The provider had identified this and employed an external consultant to help drive improvement with staff in the way of ‘on the job’ training, guidance and role modelling to ensure improvements were made.

Some features in these premises were similar to a 'care home' and did not meet guidance in respect of having good access to the local community and its amenities. They were geographically isolated and the lack of public transport and staff who were drivers meant people were not always supported to be as independent as they could be. The provider was undertaking improvements in two of the settings to improve accessibility such as new kitchens.

There were not always enough staff to meet people's preferences with how they wanted to spend their day and do things they wanted outside of their homes. At one of the settings, the provider was delivering the support hours currently commissioned, but had requested, and were awaiting outstanding needs assessments for people from all relevant funding authorities. This was to ensure staff numbers accurately reflected people’s needs including social preferences, so they had support to do things they wanted outside of their homes.

At two of the three previous care homes that had now become part of the supported living scheme, we found people were sometimes placed at risk of avoidable harm. Risk assessments were inconsistent and did not always detail the relevant information staff would need to meet people's assessed care and health needs. The provider had put processes in place to address these areas of concern, but not all had been identified prior to the inspection. A new manager was in post and an action plan was being worked through to address the concerns. The provider was updating all relevant bodies of actions taken.

Right Care

We found no evidence that people had been harmed, however, there were failures to record, monitor and improve the quality and safety of the service, and failure to maintain accurate records. We also identified concerns around the safe management of medicines and risks in two of the supported living premises. The provider was addressing these concerns and an action plan in place to track improvements.

We observed positive interactions between people and staff. People were comfortable approaching staff when they needed support and we observed staff respected people's choices.

People or their relatives felt comfortable in raising issues or concerns. There were systems and processes in place to safeguard people from abuse.

People were not always supported to have maximum choice and control of their lives. The practices in some supported living settings did not always support people in their best interests.

Right culture

The provider had not always evidenced that leadership had ensured people were supported in a culture that supported leading inclusive and empowered lives. However, the provider had identified the need to improve the culture in one of the supported living settings and was in the process of embedding improvements with the aim of embedding these to ensure consistent high-quality care. The provider was working with external stakeholders to improve people's lives consistently across the service. The provider had also appointed a Regional Operations Director and Operations Support Manager to ensure that a significant amount more oversight was available in the settings to ensure that the settings delivered in line with the providers minimum expectations of good.

All staff we spoke with displayed caring and person-centred values and a commitment to make the necessary improvements.

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 outstanding (published 26 June 2019).

Why we inspected

The inspection was prompted, in part, due to concerns about one of the settings received from a local authority. This was in relation to people’s care and safety including risk assessments and care records not being updated, staff training and levels of staff. The overall rating for the service has changed from outstanding to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Responsive and Well Led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Care at Home (Swindon) on our website at www.cqc.org.uk.

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 monitor the service and will take further action if needed.

We have identified breaches in relation to safe care, person centred care, and good governance at this inspection. 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, which will help inform when we next inspect.