Background to this inspection
Updated
22 April 2021
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
The inspection was carried out by one inspector.
Service and service type
This service provides care and support to people living in the community, either in their own flats or houses or in one of the six supported living services. 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. 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. The registered manager was on an extended period of leave at the time of our inspection and oversight of the service had been shared between two other registered managers.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider would be in the office to support the inspection. Inspection activity started on 1 March 2021 when we visited the office location and ended on 19 March 2021 when we gave the provider feedback about our inspection.
What we did before the inspection
We reviewed the notifications of significant incidents which the provider is required to send us by law. 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.
We used all of this information to plan our inspection.
During the inspection
The inspection visit to the offices was a formality as no records were kept there and the provider had closed the offices at the start of the COVID-19 pandemic. This meant that our inspection activity was carried out over the phone, through video calls and through e mail in the period following the inspection visit to the office on 1 March 2021. We spoke with three relatives of people who used the service about their experience of the care provided. We also spoke with eight members of staff including two area operations managers, three service managers and four care staff, two of whom worked as waking night staff.
We reviewed a range of records. This included ten people’s care and medication records and two staff recruitment files. We also viewed a variety of other records relating to the safety and quality of the service.
Updated
22 April 2021
About the service
Royal Mencap Society - North Suffolk and Coastal Domiciliary Care Agency is a care agency providing personal care to people living in the community. People received support in their own individual houses or in shared supported living services for small groups of people. 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. At the time of our inspection 26 people were using the service.
People’s experience of using this service and what we found
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.
This service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.
Right support:
The model of care maximised people’s choice, control and independence. People were included in decisions about their care and support and were supported to access and be part of their local community. During lockdown this access had understandably decreased but alternative daily activities had been put in place as a substitute.
Right care and right culture:
Care was person-centred and promoted people’s dignity, privacy and human rights. However, decisions about how to carry out night checks to keep people safe whilst ensuring their privacy needed review. Care plans were written in a person-centred way which was fully focussed on the person’s needs. The language in care plans was inclusive and oversight from service managers and the registered manager monitored this closely.
Risks relating to people living with epilepsy required further review to ensure people were kept safe and their privacy and dignity maintained. The provider gave us assurances that this review process was already underway.
Other risks to people’s health, safety and welfare had been assessed and actions needed to mitigate these risks were mostly well documented and managed.
There were enough staff to keep people safe. However, one of the supported living services, where people’s mobility needs had recently increased, needed further review of staffing levels to ensure people’s needs could be met over a 24 hour period.
Other aspects of the service were safe. Staff were clear about how to safeguard people from abuse and the service managed people’s medicines well. Staff were safely recruited and well trained and there were robust infection control procedures in place. Feedback from relatives was very positive about the skills and expertise of the staff.
The provider’s oversight and monitoring of the service was structured. Despite this, the concerns we have noted relating to staffing and the management of people’s epilepsy had not been identified and fully explored. The registered manager’s auditing of individual care records, although detailed, did not ensure comprehensive oversight of each person’s care and support needs. However, there was a strong emphasis throughout the service on being inclusive and person-centred.
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 3 September 2019.)
Why we inspected
The inspection was prompted in part by notification of a specific incident, following which a person using the service died. This incident is subject to ongoing investigation. As a result, this inspection did not examine the circumstances of the incident.
The information CQC received as part of the investigation into this incident gave us some concerns. We were concerned about the management of people’s epilepsy, especially at night. We also had questions about how the service keeps people’s needs under review. This inspection examined those risks.
We undertook this focused inspection to review the key questions of safe and well-led only. We reviewed additional 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 review some of their procedures for monitoring people at night, especially those living with epilepsy. We noted that although the provider had begun to review the needs of people living with epilepsy, this review was not complete. The provider kept people’s other needs under appropriate review, although the COVID-19 pandemic has resulted in some reviews being delayed.
We have made a recommendation relating to the management of people’s epilepsy needs.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Royal Mencap Society – North Suffolk and Coastal District Domiciliary Care Agency on our website at www.cqc.org.uk. This report is listed under the provider’s previous name.
Follow up
We will continue to monitor 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.