Care at Home (High Street)

Updated 10 August 2022

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 Health and Social Care Act 2008.

This was a targeted inspection to check on a concern we had about noise levels at one of the households. We needed to check that people with behaviours of distress had proactive plans in place and were being supported by trained staff who understood their needs.

As we were completing our draft report we received further information of concern relating to the management of behaviours and governance of the household. We considered these concerns against our inspection findings. We will continue to review all information as part of our ongoing monitoring of the service.

Inspection team

The inspection was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

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 service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

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 authorities and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We met with three people who lived at the household and spoke with two relatives about their experience of the care provided. We spoke with eleven members of staff including the regional operations director, quality assurance officer, lead PBS & PBM trainer, registered manager, deputy manager, four care staff, and two agency staff.

We reviewed a range of records. This included four people's care records including their behaviour plans and risk assessments. A variety of records relating to the management of the service, including governance systems, policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We sought feedback from ten professionals to gather their experiences of the care provided.

Updated 10 August 2022

About the service

Care at Home (High Street) is a supported living service providing personal care to people who may live in single or shared occupancy households with their own tenancy agreements. This registered location supports people living in seven households of different sizes (single and multiple occupancies). Some households have shared communal areas and shared care at different parts of the day.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Care at Home (High Street) was supported by a new provider and management structure. A service improvement plan had been developed as a result of the provider’s governance and quality assessments of the service. The plan helped focus and direct the provider and managers on areas which required further improvement.

Additional management support had been implemented to support managers to understand their role, share learnings, review incidents and set new improvement targets.

However, further work was needed to ensure all households were consistent in their infection control practices. We have made a recommendation that the provider reviews their monitoring systems to ensure good infection control practices are fully embedded across the service in line with national guidance.

The provider had identified that further development was needed to assist and demonstrate that people were being supported to live a life of their choice and reach their potential in independent living, with support as required.

The provider used feedback from staff, people, relatives and other stakeholders to help understand their experience and also help shape the culture of the service moving forward. They were open to learn and promote a culture which was person centred and empowering.

Clear procedures were being implemented to help ensure people were involved in their decisions about where they wanted to live, who they wanted to share their home with, and how they wish to be supported. This new process will help to ensure the service could meet their needs and ensure people who shared households were compatible.

Throughout our visits to four households, we observed staff treating people with kindness and in a dignified and respectful manner. People looked relaxed around staff and engaged with them freely. Staff were aware of people’s communication needs and spoke to them in a polite and respectful manner.

Support plans described people’s preferences and support requirements. Risk management plans and how staff should respond to changes in people’s needs had been identified and recorded. Staff had sought specialist health care advice when people’s needs had changed. An internal positive behaviour support trainer assisted staff teams to identify triggers and strategies to support people who express their distress in ways that other people find difficult.

People received their medicines as prescribed. Their medicines were regularly reviewed and there was evidence that alternative strategies were used to support people with their emotions before ‘as required’ medicines were administered.

Suitable numbers of safely recruited staff were available to support people. Regular agency staff who were familiar with people’s needs were used when there were staff shortages. Plans were in place to review their recruitment processes with the aim of reducing agency staff.

Progress was being made to ensure all staff received regular supervisions and had current and in date training. The method of delivering training and the induction programme was being reviewed to ensure staff had the skills they needed to support people.

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.

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.

The service was able to demonstrate how they were progressing to meet the underpinning principles of Right support, right care, right culture. We found that people received care which was focused on their support needs and in their best interests. There was a shift in culture away from residential care to supporting people to reach their potential in a supported living setting. Staff were observed supporting people in a kind and friendly manner and ensured people’s human rights and dignity was always protected. The provider was implementing a service improvement plan which helped to implement the provider’s values and to promote a culture which was open and inclusive.

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 3 April 2020 and this is the first inspection.

Why we inspected

This service had not been inspected since their registration in April 2020, therefore, this inspection was carried out to gain assurances about the quality of care and systems used to monitor and manage the service.

Follow up

We will continue to meet with the provider and to monitor their progress in implementing their service improvement plan and ensuring that the principles of supported living is fully embedded. We will also monitor the 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.