Creative Support - Bedford Services

Updated 24 June 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 Care Act 2014.

Inspection team

Two inspectors, a member of the CQC medicines team and an Expert by Experience carried out the inspection. 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 seven ‘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.

The service had a manager registered with the Care Quality Commission. 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.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the settings are small, and people may have been out, and we wanted to be sure there would be people at home to speak with us.

Inspection activity started on 08 February 2022 and ended on 18 February 2022. We visited the office location on 15 February 2022.

What we did before 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 spoke/ communicated with 18 people who used the service and 12 relatives about their experience of the care provided. People who used the service who were unable to talk with us used different ways of communicating including using Makaton, pictures, photos, symbols and their body language.

We spoke with 22 members of staff including support workers, team leaders, the deputy manager, the registered manager and the service director.

We reviewed a range of records. This included four people’s care records and numerous medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 24 June 2022

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

Creative Support- Bedford Services is a ‘supported living’ service providing personal care to people living in seven ‘supported living’ settings. The service was supporting 26 people with personal care at the time of our 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

Right Support

¿ Staff were not always supporting people to pursue their interests or achieve their aspirations and goals. Services were not always fully staffed meaning that people were unable to leave their homes when they chose to.

¿ Reasonable adjustments were not always made so that people could be fully involved in discussions about their support, including support to travel where they needed to go. Staff did not always communicate with people in their identified and preferred methods.

¿ In one setting, people were not being supported to upkeep their homes to ensure they were clean and well maintained.

¿ People were not always supported to access specialist health and social care support. Appointments had been cancelled by staff with no recorded reason as to why this was.

¿ Staff worked with people to plan for when they experienced periods of distress so that their freedoms were restricted only if there was no alternative.

¿ Staff supported people to take their medicines in their preferred way. People were supported to live healthy lifestyles and staff members promoted healthy choices in areas such as eating and drinking.

¿ People had been supported to personalise their rooms.

Right Care

¿ The services did not have enough appropriately skilled staff to meet people’s needs. People were safe, however were at risk of social isolation and not being able to follow their interests as a result of this. People were unable to follow tailored social past times whenever they chose to do so and were not being supported to try new things which they may enjoy.

¿ People who had individual ways of communicating such as using body language, sounds, or pictures and symbols could not always interact with staff because not all staff had the necessary skills to understand them. Staff had requested more training in this area.

¿ People’s care, treatment and support plans and risk assessments reflected their range of needs for the most part although this did vary from setting to setting.

¿ For the most part, people received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff had supported people living at the service for a long time in some cases.

¿ Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right culture

¿ People were not always supported to lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. Staff did not feel well supported by the provider and found it difficult to raise concerns with them.

¿ The management and staff team did not understand some of the key principles of guidance such as Right Support, Right Care, Right Culture. Audits completed at the service by management had not picked up on areas that could have been improved to help support a more positive culture.

¿ Information of concern we shared with the nominated individual of the service, shared with us by the staff team about the support from management, was given to the senior management team to review. This meant that there were missed opportunities for an independent person to look in to concerns that were being raised by the staff team.

¿ People and those important to them, were not always involved in planning their care. It was unclear how staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

¿ Staff knew people well and were responsive to their support needs.

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 when it was registered under the previous provider was good (report published 16 August 2017).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of Right support right care right culture. This was a planned inspection based on when the service first registered with us. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring responsive 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.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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 have identified breaches in relation to safe care and treatment, staffing and good governance at this inspection. Please see the action we have told the provider to take at the end of this report. 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.