8 January 2024
During an inspection looking at part of the service
Main Office is a domiciliary care agency providing personal care to people living in their own homes. At the time of our inspection there were 5 people using the service.
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 there were 3 people receiving a regulated activity.
People’s experience of using this service and what we found
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.
At the time of the inspection, the location did not care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.
Right Support:
Some people did not have all relevant health specific risk assessments in place, but staff had received training relevant to their roles including Learning Disabilities and Autism.
Some people did not appear to always receive medicines they were prescribed. Audit systems were not effectively used to identify gaps in recording of medicines in a timely manner.
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 but was not embedded.
Right Culture:
Oversight of the service required improvement. We identified shortfalls at inspection that had not been independently identified by systems and processes already in place. These included audits not effectively being used to identify risk. This meant opportunities to make improvements were lost. People using the service and staff felt the culture was open, and the registered manager was easily accessible. Concerns raised were listened to and people and staff had faith the registered manager would act upon any issues to make positive changes for people where needed. People were happy with the care they received from a consistent team of care workers.
Right Care:
Systems were in place to identify safeguarding concerns, although there were no recorded incidents to review to demonstrate practice was embedded. Staff were able to identify adult safeguarding concerns and the registered manager was aware of their responsibility to investigate and report concerns to relevant partner agencies.
People were supported by staff who were highly passionate about delivering good care and going above and beyond for people. Staff understood consent and processes to support the assessment of people’s capacity was in place. It was difficult to establish if practice was embedded as people’s capacity in relation to decision specific choices had not been assessed.
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 02 November 2022) and there were breaches of regulation. 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 some regulations.
Why we inspected
We carried out an announced inspection of this service on 08 January 2024. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve how risks were identified and monitored; how medicines were administered; how staff were recruited safely and how governance of the service would be improved.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
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 Inadequate to Requires Improvement. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Main Office on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to people’s care needs and associated risks not always being assessed; safe administration of medicines and how the service was governed 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.