Distinct Care and Support

Updated 19 June 2021

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

This inspection was carried out by two inspectors.

Service and service type

This service provides care and support to people living in two ‘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

This inspection was unannounced.

Inspection activity started on 18 May 2021 and ended on 26 May 2021. We visited the office location on 21 May 2021.

What we did before inspection

We reviewed information we had received about the service since it was registered. 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. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service and one relative about their experience of the care provided. We spoke with three members of staff including the registered manager and care workers.

We reviewed a range of records. This included one person’s care records and 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 19 June 2021

About the service

Distinct Care and Support is a domiciliary care agency providing personal care and support to 11 people across two supported living schemes. Each scheme provides a private bedroom, shared communal bathrooms, kitchen, lounge, outside space and an office. Six people were being supported in one scheme and five people in the other. Staff provided support 24 hours during the day and sleep-in at night.

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 service was supporting one person with personal care at the time of the inspection.

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

People were not supported to understand the need for good infection prevention and control or food hygiene standards. People were not referred to external professionals who could support them to better understand the need for cleanliness.

People were supported by a staff team who worked unsafe rota patterns. The risks to people and staff relating to this had not been assessed.

People had care plans that showed information about their likes, dislikes and needs. However, there was a lot of duplication in the documentation which could be confusing to staff. In other aspects of their care, actions and outcomes were not recorded, for example reviews of care, health professional input and goals.

The registered manager had not reported incidents or sought appropriate professional support for people to reduce the risks of future incidents. There was a lack of effective systems to assure the quality of the care delivered. This meant the registered manager was unable to identify concerns for themselves and relied on external agencies to inform them of areas that required improvement.

People were not always supported to have maximum choice and control of their lives and staff did not always 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.

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 not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. There was some evidence of finding out what people’s choices were and supporting people to achieve them, for example enabling past hobbies, supporting religious and cultural beliefs and access to community activities (COVID-19 government restrictions allowing).

However, positive behaviour support and the Mental Capacity Act principles were not yet fully understood by the registered manager and some staff and therefore not promoted to protect people’s rights and choices. Opportunities to develop work and independence skills were missed and people were not fully empowered. Changes to people’s support were only as a result of external input and suggestions as systems and practices did not support staff to be proactive and identify areas for improving people’s opportunities.

Despite the concerns found during the inspection, people told us they were happy at the service, felt safe and were supported by a staff team they liked and could talk to.

People were supported to access a variety of health professionals when needed.

People’s medicines were well managed, and people told us these were always correct and on time.

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 20/09/2019 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration. However, the inspection was prompted in part due to concerns received about the cleanliness of the environment, lack of risk assessments, poor care planning, consent and poor manager oversight. A decision was made for us to inspect and examine those risks.

We found evidence during this inspection that people were at risk of harm from these concerns. 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.

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 unsafe rota patterns, risk management, failure to report notifiable events, consent, quality assurance and registered manager skills and knowledge at this inspection.

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

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.