Head Office

Updated 19 July 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

The inspection team was made up of 7 inspectors.

Service and service type

This service provides care and support to people living in 21'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 however they were on leave. We were supported on the inspection by the Nominated Individual and the senior management. We fed back to the registered manager once they had returned from leave.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

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 sought feedback from the local authority and professionals who work with the service. We used this information to plan our inspection.

During the inspection

We visited 11 homes and spoke with 27 people and 3 relatives. We spoke by telephone, with a further 23 relatives about their experience of care their loved one received. We received feedback from 5 health and social care professionals. We spoke with 32 members of staff including care staff, the registered manager, quality managers, and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records including 16 people's care plans, daily care notes, staff rotas, multiple medication records, safeguarding records and complaints. We reviewed a variety of records relating to the management of the service including 16 staff recruitment files, training and supervision.

Updated 19 July 2023

About the service

Head Office is a supported living service providing personal care to people with a learning disability and/or autism. Some people also have physical disabilities and a mental health diagnosis. Support was provided across 21 different supported living settings where people had their own houses or rooms. As part of our inspection, we visited 11 of the supported living homes. 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 57 people were 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.

Right Support

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. People were not being protected from abuse including financial, physical, emotional and verbal abuse. The risks associated with people’s care were not reviewed and updated to reflect the most up to date information. Staff were not always familiar with the risks around people’s care. Medicines were not always being managed in a safe way. There were not enough staff to support people safely. People were not always being treated in a kind and dignified way at all homes although we did see some caring interactions from some staff.

Right Care

Health care support was not always being sought for people and where it was, staff were not always following the guidance provided. Staff had not always received appropriate training and supervision to support people in the right way. People were not always being encouraged or given choices around healthy and nutritious meals. People and families were not always being involved in the reviews of care.

Right Culture

There was a lack of robust oversight of care by the provider. Where audits were being undertaken, they were not always picking up on shortfalls. Relatives and external professionals fed back concerns about the lack of actions and communication from the leadership team. Relatives did not always feel complaints would be responded to. Where feedback was sought actions were not always taken to make the improvements. The provider and leadership team were not encouraging an open culture within the staff team and were not always leading by example.

Rating at last inspection and update

The last rating for this service was good (published 16 January 2020).

Why we inspected

The inspection was prompted due to concerns received about people not being protected from abuse and unsafe care and unsafe staff levels. A decision was made for us to inspect and examine those risks.

We undertook an inspection to review the key questions of safe, effective, caring, responsive and well-led.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

Enforcement and Recommendations

At this inspection we have identified breaches in relation to people not being protected from the risk of abuse, people not being protected from unsafe care including risk mitigations and the management of medicines. We also identified breaches in relation to the failure to ensure the principles of the Mental Capacity Act were consistently followed, staff not being appropriately trained and supervised, and people not being supported appropriately with their health care needs. We also identified a breach relating to the lack of robust response to complaints, lack of person centred care and staff levels. We identified breaches relating to the lack of robust oversight by the provider and people not being treated in a caring and dignified way.

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 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.

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