Background to this inspection
Updated
30 December 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.
Inspection team
The inspection team was made up of an inspector and a pharmacy inspector.
Service and service type
This service provides care and support to people living in a 'supported living' setting, 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 not a registered manager in post, however there was a manager in post who had stated they were looking to go through the process of applying to be a registered manager.
Notice of inspection
This inspection was unannounced.
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 authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This information helps support our inspections. We used all of this information to plan our inspection
During the inspection
We communicated with five people who used the service about their experience of the care provided. Where people could not communicate verbally, we used different ways of communication using objects and their body language as well as observing interactions between people and staff. We spoke with three relatives.
We spoke with seven members of staff including the manager, operations' manager, support workers and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We spoke with one professional who had regular involvement with people using the service. We reviewed a range of records. This included four people's care records and three medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
30 December 2022
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.
About the service
Precious Homes Hertfordshire is a service providing supported living for people living with a learning disability, autism, mental health needs and sensory impairments. The service can support up to 15 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 the inspection 10 people were being supported with personal care.
People’s experience of using this service and what we found
Right Support
The provider had failed to ensure people’s care plans reflect up to date information and detailing long-term aspirations.
People were supported by staff who had not had adequate inductions, training and skills to support them.
The management team did not ensure people’s medicines were managed in a safe way.
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
People were not always supported by a service that had effective systems in place to report and respond to accidents and incidents. Staff did not always understand how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse, however staff actions did not always show they understood this.
Some people said they did not feel safe with the support they received.
Right Culture
People did not always have assessments in place, to identify risks people faced and how staff should manage these. When risks to people were identified actions to mitigate these were not resolved in a timely manner which put people at risk of harm. Staff were not always knowledgeable about the content of these risk assessments.
People were not supported by staff who understood best practice in relation to supporting people.
The service had a number of changes in management. Relatives and people stated they did not feel the service was well managed. Staff acknowledged there had been changes in management and gave mixed views about how they felt supported.
People's quality of support was not enhanced by the quality assurance system the provider had in place. Actions were not documented, and it was unclear if actions were completed. This had an impact on people's care.
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 inadequate (published June 2022). At this inspection we found the provider remained in breach of regulations. This service has been in Special Measures since June 2022. During this inspection the provider did not demonstrate that improvements had been made. Therefore, this service remains in Special Measures.
Why we inspected
We received concerns in relation to safeguarding people, medicines management and meeting people’s health and support needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.
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 not changed and remains inadequate.
We found was evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Precious Homes Hertfordshire on our website at www.cqc.org.uk.
Enforcement and Recommendations
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 and will take further action if needed.
We have identified breaches in relation to keeping people safe, medicines management and a lack of good leadership and governance systems 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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 remains 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 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.