Background to this inspection
Updated
5 December 2023
The inspection
We carried out this performance review and assessment under Section 46 of the Health and Social Care Act 2008 (the Act). We checked whether the provider was meeting the legal requirements of the regulations associated with the Act and looked at the quality of the service to provide a rating.
Unlike our standard approach to assessing performance, we did not physically visit the office of the location, however we did go and visit the people supported by the provider. This is a new approach we have introduced to reviewing and assessing performance of some care at home providers. Instead of visiting the office location we use technology such as electronic file sharing and video or phone calls to engage with people using the service and staff.
Inspection team
The inspection team consisted of 1 inspector.
Service and service type
This service provides care and support to people living in ‘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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was a registered manager in post.
Notice of inspection
The inspection was announced. We gave 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before the 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 with 2 people who used the service about their experience of the care provided. We spoke with 5 members of staff including the registered manager, management, and care workers. We spoke with 1 professional. We reviewed a range of records. This included 3 people's care records and variety medication records. We reviewed 3 staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were also reviewed.
Updated
5 December 2023
About the service
Hertfordshire support living is a domiciliary care agency providing personal care. The service provides support to people with a Learning disability and autistic people. At the time of our inspection there were 3 people using the service.
People’s experience of the service and what we found:
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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Care
The provider did not operate a safe recruitment procedure. We found gaps in their recruitment systems.
People had risk assessments that detailed their immediate risk, however, in some area’s did not always identify how to mitigate the risks. We recommend risk assessment are reviewed and developed further, highlighting in detail how to mitigate risks where appropriate.
Medicines administration records were not always completed accurately with the prescribers’ instructions, where entries of medicines were written on the records, staff did not always follow best practice by two staff signing off to state the records were accurate.
People said they were encouraged to be as independent as they can with their medicines and staff supported them when required.
Right Culture
The provider had a management structure that monitored the quality of care to drive improvements in the service delivery. In some circumstances they had not identified the areas of improvement, such as staff completing learning disability training, recruitment files and medicine administration records.
The registered manager had a good understanding of people they supported. People described that they had a good life, and they were able to do as they wished, however in some circumstances the care plans could be developed further to capture peoples long term aspirations and what was important to them.
People and staff were involved in the running of the service and fully understood and considered people’s protected characteristics.
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.
Right Support
Staff said they felt there was enough staff to keep people safe. People said they felt safe.
People were safeguarded from abuse and avoidable harm. The provider and registered manager had systems in place to ensure people were supported safely. The registered manager made sure there was a consistent approach to safeguarding matters, which included completing a detailed investigation and sharing the learning with staff, following any incident.
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 Good (28 June 2016).
Why we inspected
This inspection was prompted by a review of the information we held about this service.
Enforcement
We found a breach in regulation 19. The provider was unable to produce the recruitment documents for staff to show that staff were recruited safely. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.
This was an ‘inspection using remote technology’. This means we did not visit the office location and instead used technology such as electronic file sharing to gather information. We visited people in their own homes and phone calls to engage with people using the service as part of this performance review and assessment.