Accedo Herts South

Updated 4 December 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

Two inspectors carried out the inspection.

Service and service type

The service provides care and support to people living in four '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.

The service had a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was announced. We gave the service 48 hours’ notice of the inspection. This is because we needed to be sure that the provider or the registered manager would be in the office to support the inspection. Inspection activity commenced on 23 September 2020 and ended on 15 October 2020. We visited the office location on 07 October 2020.

What we did before the inspection

We reviewed information available to us about this service. This included details about incidents the provider must notify us about, such as safeguarding incidents. We sought feedback from the local authority. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We spoke with the registered manager, service manager and five support workers. We looked at three people's care records and people's medication records. A variety of records relating to the management of the service, including rotas and incident records were reviewed. We looked at training data, polices and quality assurance records. We spoke with four relatives about their experience of care provided. Four professionals who have regular involvement within the service also provided feedback.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 4 December 2020

About the service

Accedo Care Head Office is a supported living service providing personal care and support to adults with learning disabilities and/or mental health needs. The service was supporting 30 people, across four supported living settings, at the time of inspection.

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

This inspection primarily focused on one of the four supported living settings, where we had received concerns about the quality of care provided. Here we identified a lack of management and provider oversight, especially during the Covid-19 period. Professionals, relatives and staff all referred to a “chaotic” period of time at this location. During this period, incidents increased, and people were placed at risk of poor care and harm.

At this location, there was a negative culture, where staff did not treat people with dignity and respect. Staff used inappropriate language to refer to people and when completing incident reports. People were not supported in a consistent and positive manner, in line with their care plans and risk assessments.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. Care was not consistently person-centred and did not always promote people’s dignity, privacy and human rights. This was being addressed by the provider at the time of inspection, however, changes were yet to be embedded.

Risk assessments were not consistently developed to provide staff with the information they needed to ensure people’s care was provided safely. This meant people were not supported in a consistent way to achieve positive outcomes. Feedback received from staff, relatives and professionals was mixed. Staff reported a high volume of training, however some felt it had not given them adequate skills to support people in a safe, consistent way. Relatives and professionals also felt that the quality of support provided was inconsistent.

People were not sufficiently safeguarded against the risk of abuse. Incidents were not managed appropriately or in a timely manner. This meant people were exposed to risk of harm. The management team reviewed accidents and incidents but this was not always effective in identifying patterns and trends. Incidents were not always investigated appropriately, and measures put in place to prevent reoccurrence. This was particularly evident at one of the supported living sites.

The provider found it challenging to recruit appropriate staff. Staff recruited lacked the necessary skills and values. As a result, there had recently been a period of high staff turnover, as the provider sought to address this issue. The registered manager explained that they had reflected on this situation and identified lessons learnt.

Whilst governance systems were in place, these were not utilised effectively to identify issues where practice could be improved. Both the registered manager and provider were open about the challenges they had experienced. Prior to the inspection they had developed a service improvement plan, however this did not include all of the issues we identified. A new service manager had been recruited and staff, relatives and professionals told us about improvements made since they joined.

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 08 June 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about the management of risk, particularly at one of the provider’s supported living settings. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the staff culture and governance systems, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection

We have found evidence that the provider needs to make improvements. Please see the safe 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 monitor the service 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 the management of risk and good governance.

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.