Collaborative Care Solutions

Updated 5 January 2024

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 was carried out by 4 inspectors and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service

Service and service type

This service provides care and support to people living in 5 ‘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 no registered manager in post. The new manager had joined during the inspection period and they intended to register with the Care Quality Commission.

Notice of inspection

The first day of the inspection was unannounced. We provided a short period of notice for the second and third inspection dates. This was to gain consent to visit people in their supported living houses. Inspection activity started on 21 September and ended on 16 October 2023. We visited the location’s office on 21 September and 3 October 2023.

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. 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 used all this information to plan our inspection.

During the inspection

We spoke with 6 people who used the service and had feedback from 5 relatives about their experience of the care provided. We spoke with the nominated individual who is responsible for supervising the management of the service on behalf of the provider. We also spoke with 10 members of staff including the general manager, clinical lead consultant, team leaders and care workers. We also spoke with the newly appointed operations consultant, manager and clinical lead.

We also received feedback from 4 social care professionals who have worked with the service.

We reviewed a range of records. This included 6 people's care records and multiple medication records. We looked at 6 staff files in relation to recruitment. We looked at training data and quality assurance records. A variety of records relating to the management of the service, including policies and procedures were also reviewed.

Updated 5 January 2024

About the service

Collaborative Care Solutions is a domiciliary care agency providing supported living services. The service delivers personal care in 5 settings across the borough of Slough, to people with mental health conditions and associated needs, to people living with learning disabilities and autistic people. The service also provides treatment of disease, disorder or injury for people carried out by or under the supervision of a qualified registered nurse. At the time of the inspection there were 16 people being supported by the service. We visited 3 settings and reviewed the care and support needs of 6 people who received the regulated activities.

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 exposed to avoidable risk of harm as systems to ensure the safe and proper management of medicines were inadequate. Not all staff had their competency to administer medicines assessed in line with best practice guidance.

Since our last inspection care plans and risk assessments continued to lack robust and clear guidance, with incorrect or conflicting information. Not all records demonstrated risk was effectively assessed, monitored or mitigated.

Staff had not always been safely recruited. References had not always been appropriately obtained and we were not assured staff had access to training. Lessons were not always learnt.

The providers monitoring systems were inadequate because failures identified at the inspection were not all known or acted upon.

Right Care

People and relatives provided positive feedback about the skills and experience of staff. People were treated with kindness. Staff were person centred in their approach which promoted people's privacy and dignity.

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.

People told us they were supported effectively with food and drink and had choice and involvement.

Right Culture

Governance systems remained inadequate, and the service was not well-led. The provider failed to carry out their regulatory responsibilities and did not have adequate oversight of the service. The provider had not submitted all relevant statutory notifications when incidents had occurred, as required. The provider lacked robust assessments and controls to protect people and keep them safe.

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 the service under the previous provider was inadequate (published 27 January 2023). 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.

This service has been in Special Measures since 27 January 2023. Following this inspection and the inadequate rating of key questions Safe and Well Led, the service remains in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

You can see what action we have asked the provider to take at the end of this full report. The provider and management team were responsive to the concerns we shared and took immediate action to reduce the risk to people using the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for 61 Langley Road on our website at www.cqc.org.uk.

Enforcement and Recommendations

At this inspection, we identified continued breaches in relation to Regulation 9 (Person centred care), Regulation 12 (Safe care and treatment) Regulation 13 (Safeguarding service users from abuse and improper treatment), Regulation 17 (Good governance), Regulation 18 (Staffing) and Regulation 19 (Fit and proper persons employed) of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was also a continued breach of Regulation 18 (Notification of other incidents) of The Care Quality Commission (Registration) Regulations 2009.

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.

Special Measures

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 of their 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.