Archived: Dyke Road Community Support Services

Updated 24 February 2023

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.

Inspection team

This inspection was carried out by two inspectors and an assistant inspector.

Service and service type

This service provides care and support to people living in 6 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 provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us. Inspection activity started on 14 December 2022 and ended on 9 January 2023. We visited 5 of the location’s services between 15 and 16 December 2022.

What we did before the inspection

Before the inspection, we reviewed information we held about the service. We considered the information which had been shared with us since the last inspection by the provider, the local authority and other agencies and health and social care professionals. This information helps support our inspections. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with and observed the support of people who used the service and their experience of the care provided. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We spoke with support staff, deputy managers and managers at five different homes, the area manager, the registered manager, the provider’s head of operations and the provider’s ‘Positive Behaviour Support’ (PBS) lead. We reviewed a range of records. This included people’s care and medication records and a variety of records relating to the management of the service, including policies and procedures. We spoke with and received feedback from 4 relatives of people using the service.

Updated 24 February 2023

About the service

Dyke Road Community Support services is a community-based adult social care service providing personal care and social support to people in supported living settings. At the time of our inspection there were 24 people living in 6 separate supported living homes using the service.

Not everyone who lived in the different supported living settings received personal care. CQC only inspects the support being given to people who 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.

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.

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

Right Support:

Risks to people were not always assessed, monitored and managed safely. Systems in place did not always protect people from abuse and improper treatment. People’s medicine support was not being managed safely. People were not always supported to assess their needs effectively and did not always achieve good outcomes from their support. Staff had not always received effective training or supervision.

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.

Right Care:

Staff did not always communicate or support people in dignified or respectful ways. People were not always involved and included in a personalised way when being supported by staff. Relatives told us staff were not always caring and did not always encourage them to be as independent as possible.

We observed some staff in the services we visited supporting people with tasks such as meals and going out in a kind and respectful manner, offering choices and communicating with people in ways they understood.

Right Culture:

Leaders and the culture they created did not always support the delivery of high-quality, person-centred care. Internal quality assurance systems and processes to audit or review service performance and the safety and quality of care were not operating effectively to identify or resolve issues.

People and their relatives said they did not always feel involved and engaged in planning their support or being supported to do things they wanted. Staff did not always feel supported to fulfil their roles and responsibilities and raised concerns about closed cultures within homes, negative and punitive leadership and how this was not helping people to achieve good outcomes.

The provider offered immediate reassurances on request about quality and safety issues at the service identified during our inspection visits. They told us about actions they would take in response and were committed to providing resources to make any necessary improvements as quickly as possible.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 24 February 2022) and we identified multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations and the rating has changed to inadequate.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection and due to concerns we received about unsafe care and staffing.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home 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. The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections in this report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to dignity and respect, safe care and treatment, abuse, staffing, good governance and notifying CQC at this inspection.

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

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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 act 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 the conditions the 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.