Distinct Care and Support

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.