17 November 2022
During an inspection looking at part of the service
61 Langley Road is a domiciliary care agency providing supported living services. The service delivers personal care in 7 settings across the borough of Slough, to people with mental health conditions and associated needs, to people living with learning disabilities and autistic people. The service also provides treatment of disease, disorder or injury for people carried out by or under the supervision of a qualified registered nurse. At the time of the inspection there were 27 people being supported by the service. We visited 2 settings and reviewed the care and support needs of 8 people who received the regulated activities.
People’s experience of using this service and what we found
People told us they were safe from harm but systems to protect people from abuse were not effective. Restrictive work practices were not proportionate to the level of risk of harm, where people were not legally subject to control or restraint. Some of these practices were unlawful and failed to protect peoples' rights. Risks to peoples’ health were not always identified, managed, and mitigated. Staff were either not trained, or their training had not been refreshed, to enable them to recognise and report abuse.
Staff recruitment checks were not satisfactorily carried out to ensure people received care and support from staff who were suitable for their job role. There were unsafe medicine practices and people were placed at increased risk of being infected with COVID-19 because staff did not use personal protection equipment safely (PPE).
The service failed to work collaboratively with people and their representatives to ensure care and support delivered was centred around their individual needs. Care plans did not provide enough information for staff to understand how to meet peoples’ needs. People’s nutritional and hydration needs were not always met. The provider did not always work with other health and social care professionals to ensure people received good health outcomes.
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.
Quality assurance systems used to assess and monitor the service were not effective in ensuring people’s safety was not compromised. We were unable to assess the effectiveness of the provider’s auditing systems because the service did not give us full access as requested during, and after our inspection. Records relating to care and the management of the service were not always accurate, contemporaneous or fit for purpose. The provider failed to notify us when notifiable incidents happened, this is a legal requirement.
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:
People were not supported to have maximum choice and control of their lives. Staff did not receive appropriate training to support people who were autistic, living with learning disabilities and with mental health conditions. Care plans did not always contain enough information to enable staff to support people and meet their individual needs.
Right Care:
People were not always supported with care that was person centred, promoted people's dignity, privacy, and human rights. The provider failed to ensure there were enough appropriately skilled and competent staff to meet people's needs and keep them safe.
Right Culture: The ethos, values, attitudes, and behaviours of the provider were not open, transparent or empowering but very restrictive. People’s independence was not always promoted, and staff were not empowered to make decisions in order to support people in their day to day lives. The service failed to always work collaboratively with people and those who represented them. The provider failed to have effective quality assurance systems. Therefore we could not be assured that risks to peoples' welfare and safety were identified and managed appropriately. There was evidence of a closed culture.
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 5 January 2019).
Why we inspected
The inspection was prompted in part due to concerns received from local authorities regarding risks to peoples’ welfare and safety. A decision was made for us to inspect and examine those risks. This report covers our findings in relation to the Key Questions Safe, Effective and Well-led only.
We looked at infection prevention and control measures under the Safe key question. We look at this in all inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.
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 Inadequate. This is based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective 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.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 61 Langley Road on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to person-centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, need for consent, meeting nutritional and hydration needs, good governance, staffing, fit and proper persons employed and notifying the Commission of change and incidents.
Please see the action we have told the provider to take at the end of this report.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
Follow up
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying their conditions of registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.