28 April 2021
During an inspection looking at part of the service
Bespoke Guardians is a domiciliary care service registered to provide personal care to children and young people in their own homes. At the time of the inspection the service was supporting two children and one young person.
Prior to the inspection we received concerns about how the service supported children and young people. Due to this we made the decision to inspect to check if the provider was carrying out a regulated activity and to assess if the provider were to provide a regulated activity, that this would be done safely.
People’s experience of using this service and what we found
Children and young people were supported by staff who had not always been recruited safely.
Children and young people were supported by staff who had minimal training and understanding of safeguarding processes.
Children and young people did not have their individual identified risks of harm assessed, reviewed or monitored.
Children and young people were being supported by a provider who did not have an adequate infrastructure, governance or understanding of accountability and lacked oversight of the service.
Children and young people were not supported to have maximum choice and control of their lives and staff did not 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 read compliments from relatives and professionals and heard examples of how the support provided by Bespoke Guardians had resulted in children and young people making positive progress.
Although the systems and processes in place were not adequate, the provider had a drive and passion to provide a supportive service to improve outcomes for the most vulnerable children and young people.
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 the underpinning principles of Right support, right care, right culture.
Right support:
• Incidents of the use of de-escalation and physical intervention methods in children and young people’s records varied in quality and detail and all lacked analysis.
Right care:
• The support in place was not documented or recorded accurately enough to demonstrate person-centred care which promotes children and young people’s dignity, privacy and human rights.
Right culture:
• There was a lack of sufficient detailed recording of physical interventions used. This meant we were not assured staff were adhering to the ethos, values, attitudes and behaviours of the provider. We were not assured that people using the service led confident, inclusive and empowered lives.
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 21 August 2020 and this is the first inspection.
Why we inspected
We reviewed the information we held about the service. We undertook this targeted inspection to check on specific concerns we had about recruitment, staffing, safeguarding and governance and review the key questions of safe and well-led only. The overall rating for the service has not changed following this targeted inspection and remains un-rated. CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about.
Despite being registered for the regulated activity of personal care; Bespoke Guardians do not provide regulated activities to any of the three children and young people they currently support. Neither have they provided regulated activities to any children they have supported since setting up the company in 2018. Due to this CQC cannot legally and lawfully consider breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
During the inspection we identified that if the provider had been or were to commence the delivery of a regulated activity that significant improvements would be required to meet the legal requirements and to ensure the safe delivery of care and support. We have identified concerns in relation to safe care and treatment and good governance.
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.
Please see the safe and well led sections of this full report. We are currently reviewing CQC’s regulatory response to the more serious concerns found during the inspection. This will be added to the report after any representations and appeals have been concluded.
Follow up
Following inspection we have met with the provider who gave us assurances they were committed to make the necessary improvements to the service. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information, we may inspect sooner.