Ruby24hr Care and Revive Supported Living

Ruby24hr Care and Revive Supported Living is a domiciliary care service. They provide personal care to people living in their own homes or individual flats. The service provides support to people with a learning disability and autistic people within a supported living setting.

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. At the time of the inspection 4 people were receiving personal care.

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

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

Staff supported people to make decisions following best practice in decision-making. Staff supported people to have the maximum possible choice and control over their own lives. Policies and systems in the service supported this practice.

Risks to people were assessed and managed. People’s support plans were comprehensive and enabled staff to provide person centred care to meet their needs. People received care and support from staff who knew them well and understood their individual needs and preferences. This included staff supporting people to maintain their own health and wellbeing. Trained staff supported people with their medicines and their dietary needs to promote the best possible health outcome.

Right Care

Staff provided personalised care and support to promote people’s wellbeing, enhance their quality of life and to achieve positive outcomes. People’s support plans reflected their range of needs and this promoted their wellbeing.

Staff were trained and understood how to protect people from poor care and abuse. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. The service worked well with other agencies to do so.

Right Culture

Risks to people were managed safely and effectively and ensured the person and their relative or advocate was involved in the planning their care.

People were supported by staff who were trained and understood best practice in relation to impairments or sensitivities to people with a learning disability and autistic people.

Staff recruitment process had been strengthened to ensure only suitable staff worked at the service. Staff turnover was very low, which supported people to receive consistent care from staff who knew them well.

People’s quality of life was enhanced by the service’s culture of continuous improvement. Improved quality assurance systems were in place to monitor the quality service and care provided. The registered manager understood their responsibilities and worked in an open and transparent way.

People’s wishes, needs and rights at the heart of everything they did. People were aware of how to approach the registered manager to raise concerns or complaints and were confident swift action would be taken. The registered manager and staff worked with external agencies and professionals. The local authority who monitors people’s package of care told us the provider was responsive to feedback and was taking action to improve the quality of service provided.

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 22 December 2022) and there were breaches of regulation.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced focused inspection of this service on 22 October 2022. Breaches of regulations were found and a warning notice was issued in relation to good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve in relation to safe care and treatment and good governance arrangements at the service.

At this inspection we found improvements had been made. The provider had met the legal requirement in relation to the warning notice. The provider was no longer in breach of regulations.

We undertook this focused inspection to review the key questions of safe, effective and well-led only. 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 changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ruby24hr Care and Revive Supported Living on our website at www.cqc.org.uk.

Follow up

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

Ruby24hr Care and Revive Supported Living is registered as a domiciliary care agency who provide care and support to younger adults and older people, including people with complex mental health and learning disabilities, living in their own homes and in supported living settings.

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. At the time of inspection 2 people received personal care support from the service.

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 which 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

Right Support

Incident reports did not always record how staff supported people in the least restrictive way possible and in their best interests. People were supported by enough staff to meet their care needs.

Right Care

A person’s representatives told us their family member was matched with staff they liked to provide their care and support. Staff protected and respected people's rights and choices.

Right Culture

The provider and staff knew and understood people well and were responsive, supporting their aspirations to live a quality life of their choosing. The provider was committed to improving the culture where people were at the heart of everything they did.

Systems to assess, monitor and mitigate risks relating to the health, safety and welfare of people using the service and staff were not fully effective. Records did not demonstrate that incident reports were effectively overseen or analysed by the provider to ensure staff received support to reflect and discuss lessons learnt to mitigate the risk of repeat incidents. The provider had not always informed CQC of notifiable incidents.

People were supported to have maximum choice and control of their lives. However, the policies and systems did not always support this practice, as comprehensive records were not always maintained to demonstrate people received care in the least restrictive way possible and in their best interests.

The provider had not always maintained complete and detailed records in respect of staff recruitment, supervision and training. Following the inspection visit the provider confirmed the identified recruitment records had been updated and produced certificates to evidence all staff had received training in the areas identified during the inspection.

Disclosure and Barring Service (DBS) checks were completed for all staff prior to them working alone with people. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. There were enough staff deployed to meet people's needs. People received care and support from a consistent team of staff.

Staff followed infection control practices. Family members told us staff wore face masks and disposable aprons and gloves to help reduce the risk of cross infections.

People’s needs were assessed and kept under review. Family members were involved in the assessment process. People’s health care needs were documented, and staff liaised with health care professionals when required.

A family member spoke of the kind and caring approach of staff.

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 03 November 2021). 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.

Why we inspected

The inspection was prompted in part due to concerns received in relation to the safety of a person using the service. A decision was made for us to inspect and examine those risks.

We have identified breaches in the regulations in relation to safe care and treatment and good governance arrangements at the service.

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 monitor the service and will take further action if needed.

Follow up

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.

Ruby24hr Care and Revive Supported Living is a domiciliary care and supported living service providing personal care for people living in their own homes. 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. One person was receiving personal care at the time of the inspection.

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

The provider had not consistently maintained effective oversight of the safety and quality of the service. They had recently employed an experienced administrator to support them to improve in this area.

People were not consistently protected from the risk of infection as staff were not being tested in line with government guidance. However, staff were trained in infection control and had access to personal protective equipment which they were using appropriately.

Risks were not consistently assessed, mitigated and recorded by the provider, but, a small team of staff that knew the person well understood the risks and explained measures they used to keep the person safe. A system was in place for staff to report accidents and incidents.

Staff recruitment was not always in line with regulatory requirements, this had not impacted on people’s safety and checks were in place to ensure only suitable staff were employed. People were protected from the risk of abuse by staff who had received training and knew how to report concerns.

Staff were not consistently formally supervised in line with the provider’s policy and procedure. However, staff were well supported and were in regular contact with the provider who also worked as part of the small team. Staff had completed training and had been supported with extra learning on request.

The person’s care plan contained person-centred information but was overdue a review with some information out of date. The person felt not all their domestic support needs were being met. Care records evidenced food and hydration and personal care needs were provided as per the person’s choices. Communication needs were considered and planned into care.

Staff were not currently supporting anyone who needed access to health care services, but we have recommended that the provider implement a system to ensure a smooth transition into emergency services if required.

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. Care plans and care records evidenced choice and inclusion and staff had a good understanding of protecting people’s privacy and dignity.

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 4 September 2021 and this is the first inspection.

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety. A decision was made for us to inspect and examine those risks.

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 of regulations in relation to the managerial oversight of the safety and quality of the service 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 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.