21 February 2023
During an inspection looking at part of the service
Opportunities for Adults and Children provides care and support for people who may have a learning disability, mental health needs or autistic people. At the time of the inspection, 54 people were receiving support.
The provider had a several 24 hour supported living houses, each with their own allocated house manager and staff team. Other people living in the community received care and support under the same registration.
People’s experience of using this service and what we found
The provider failed to ensure sufficient numbers of suitably skilled, qualified, and experienced staff were deployed to meet people’s needs at all times.
People were not always provided with appropriate support to manage their medicines, and monitoring medication administration was not carried out effectively.
The provider did not always conduct robust assessments to determine risk. Risk was not always managed effectively.
The providers governance systems were not embedded and on occasions failed to drive improvement in a reasonable timescale.
Safe recruitment processes had not always been thoroughly followed. We have made a recommendation about this.
Decisions made in people’s best interest were not always assessed in line with the requirements of the Mental Capacity Act 2005. Records failed to demonstrate referrals had been made to the Court of Protection when this was required.
We received mixed feedback from people, relatives, and staff about the quality of care provided and the organisations leadership and governance procedures.
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 assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.
Right Support: Model of care and the setting failed to consistently maximise people’s choice, control, and independence
People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible.
Right Care: Care was not always person-centred and, at times failed to promote people’s dignity, privacy and human rights
Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff sometimes failed to ensure people using services lead 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
The last rating for this service was good (published 2 November 2019).
Why we inspected
We received information of concern relating to the quality of care provided, the leadership within the organisation and the arrangements in place for governance. As a result, we undertook a focused inspection to review the key questions of safe 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 good to requires improvement based on the findings of this inspection.
Enforcement and Recommendations
We identified breaches in relation to regulation medicines, staffing and quality assurance processes. Please see the action we have told the provider to take at the end of this report. We have also made a recommendation in relation to recruitment shortfalls found at this inspection.
During our inspection, the provider sent us various action plans, records and correspondence demonstrating they had responded promptly and appropriately regarding the concerns we identified. The provider also contacted the local authority safeguarding team to share information of concern.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Opportunities for Adults and Children on our website at www.cqc.org.uk.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.