Precious Homes Bedfordshire

Precious Homes Bedfordshire (AKA Treow House) is a domiciliary care agency and supported living service, providing personal care for adults with a learning disability, autistic people, and people with mental health needs, in their own homes.

Treow House comprises of 22 one-bedroom flats, with a shared communal living room and garden. Staff also support individuals in their own homes through an 'outreach support in the community' 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 this inspection the service was supporting 21 people. Of these, 9 people were receiving personal care.

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

Although improvements had been made, the service was not yet able to demonstrate they were consistently meeting the underpinning principles of Right support, right care, right culture:

Right Support:

Daily records demonstrated improvements in the way some staff recorded the care and support provided. However, there were still entries that lacked personalised information and read as a list of tasks carried out by staff. Senior staff were checking these regularly to address this.

Staff enabled people to access routine and specialist health and social care support in the community. However, more work was needed to ensure people received good oral healthcare.

People’s care and support plans reflected their range of needs, and this promoted their wellbeing.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Improvements had been made to learn lessons from incidents; to see how they might be avoided or reduced in future.

Staff helped people to live in a clean and well-maintained environment that met their sensory needs.

Staff supported people to make decisions following best practice in decision-making.

Senior staff carried out regular spot checks and audits to support with making sure people received their medicines in a safe way and as prescribed.

Right care:

Further work was needed to ensure all staff had the skills to communicate with and understand people who had individual ways of communicating such as using body language, sounds, Makaton (a form of sign language), pictures and symbols.

People did not consistently receive care which focused on their aspirations, quality of life, and followed best practice.

Some people did not yet routinely take part in activities. New activity planners had been introduced to support people to try new activities which enhanced and enriched their lives.

Staff had identified potential goals for people, however, there was little evidence of people’s involvement, progress, or measurable steps to achieve their goals. More work was needed to ensure people were supported to increase their independent living skills too.

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood and responded to people’s individual needs.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse, and they knew how to apply it.

There were enough staff to meet people’s needs, and to keep them safe.

Right culture:

Work was in progress to ensure people were consistently supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

The service was not always proactive in enabling people and those important to them to provide feedback and develop the service.

Throughout the inspection the registered manager and senior team spoke openly and honestly about what had been achieved since the last inspection and what still needed to be done. They were open to feedback and acted on this in a timely way.

An improved recruitment process had been introduced to ensure staff were suitable to work with people.

The provider had recently introduced a new auditing system to check the quality of the service provided to people. The new system included all the areas CQC assess when inspecting services.

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

We carried out a comprehensive inspection in July 2022 (published 4 November 2022). We found multiple breaches of regulation and the service was rated requires improvement. The provider completed an action plan after the inspection to show what they would do and by when to improve.

We undertook a further targeted inspection* in November 2022 (published 17 December 2022); to check the most urgent breaches, which related to using medicines safely, preventing and controlling infection, learning lessons when things go wrong and supporting people to access healthcare services and support, had been met. We found improvements had been made in all these areas and the provider was no longer in breach of those regulations.

*Targeted inspections are used to check urgent concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

During this inspection we checked all the remaining breaches from the July 2022 inspection and rechecked the breaches we looked at during our November targeted inspection.

We found improvements had been made in all areas and the provider was no longer in breach of any regulations.

Why we inspected

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

The last rating for this service was requires improvement. The service remains rated requires improvement and has been rated requires improvement for the last 2 consecutive inspections.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Precious Homes Bedfordshire (AKA Treow House) is a domiciliary care agency and supported living service, providing personal care for adults with a learning disability, autistic people and people with mental health needs, in their own homes.

Treow House comprises of 22 one-bedroom flats, with a shared communal living room and garden. Staff from the service also support individuals in their own homes through an 'outreach support in the community' 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 this inspection the service was supporting 24 people. Of these, 11 people were receiving personal care.

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

This was a targeted inspection that only considered the safe management of medicines, preventing and controlling infection, learning lessons when things go wrong and supporting people to live healthier lives; by accessing healthcare services and support. Based on our inspection we found improvements in all of these areas:

¿ Action had been taken to ensure people received their medicines in a safe way and as prescribed.

¿ Staff followed current government guidance by wearing face masks correctly; to prevent and control infection risks.

¿ New cleaning rotas and spot checks had been introduced to make sure people’s homes were clean and hygienic.

¿ Incidents were being monitored more closely; to identify opportunities to learn lessons and improve safety across the service.

¿ Systems were in place to ensure people had regular access to routine and specialist health care support and services.

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 4 November 2022).

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 improvements had been made.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Precious Homes Bedfordshire (AKA Treow House) is a domiciliary care agency and supported living service, providing personal care for adults with a learning disability, autistic people and people with mental health needs, in their own homes.

Treow House comprises of 22 one-bedroom flats, with a shared communal living room and garden. Staff from the service also support individuals in their own homes through an ‘outreach support in the community’ 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 this inspection the service was supporting 24 people. Of these, 11 people were receiving personal care.

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.

The service was not able to demonstrate how they were consistently meeting the underpinning principles of Right support, right care, right culture:

Right Support:

¿ Staff did not always support people to have the maximum possible choice, control and independence over their own lives.

¿ Opportunities to learn lessons from incidents, including those when people experienced periods of distress, were not always followed up; to see how they might be avoided or reduced in future.

¿ People did not always live in a clean and well-maintained environment that met their sensory needs.

¿ Staff did not consistently follow guidance on how to prevent and control infection.

¿ Although some people felt they were always involved in decisions about their care and support, staff did not consistently seek everyone’s consent or follow best practice in decision-making.

¿ Staff did not always safely support people with their medicines, to achieve the best possible health outcome.

¿ Staff enabled people to access specialist health and social care support in the community the majority of the time.

Right care:

¿ People’s needs were not robustly assessed before they started using the service, to ensure their needs could be fully met.

¿ Some people told us staff were kind, caring and treated them with respect. However, other people’s experiences varied.

¿ Staff did not always demonstrate respect or promote and protect people’s privacy and dignity.

¿ Staff had training on how to recognise and report abuse and they knew how to apply it. However, there had been delays in some potential safeguarding concerns being reported.

¿ The service had enough staff, but they were not always appropriately skilled to meet people’s needs and keep them safe.

¿ Staff could not effectively communicate with everyone using the service, because they did not have the right guidance and skills to understand some people’s individual communication needs.

¿ People did not consistently receive care that supported their needs, aspirations, focused on their quality of life, and followed best practice.

¿ People did not routinely take part in activities and pursue interests that were tailored to them.

¿ The service provided limited opportunities for people to try new activities that enhanced and enriched their lives.

¿ Some staff had varying knowledge and skills on managing risk, particularly with people who expressed their needs through actions, distress or agitation.

Right culture:

¿ Staff did not meaningfully evaluate the quality of support provided to people, involving the person, their families and other professionals as appropriate.

¿ The service was not proactive in enabling people and those important to them to provide feedback and develop the service.

¿ The provider’s systems for checking the culture, quality and safety across the service were not sufficiently robust.

¿ People told us a new manager had been recruited, who was approachable and had started to make improvements at the service.

¿ The provider also had a plan to improve the service, but they did not confirm when this plan would begin.

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

Rating at last inspection

The last rating for this service was good (published 27 November 2018).

Why we inspected

We undertook this inspection to assess that the service was applying the principles of Right support right care right culture.

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 requires improvement based on the findings of this inspection.

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

Enforcement

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: person centred care (including assessing people’s needs, personalised care, meeting people’s communication needs and social needs and interests), dignity, consent, safe care (including lessons learnt, medicines, infection prevention and control and access to healthcare services), governance and staffing.

You can see what action we have asked the provider to take at the end of this full report.

In addition, and in response to areas of more immediate risk found at the inspection, we have issued two warning notices; to help keep people safe.

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.

At the last inspection we found an insufficient level of leadership at the home, there were concerns with the culture of the staff team. Accidents and incidents were not always processed or in a safe way. Peoples medicines were not stored safely. People were not always protected from harming themselves. Staff did not always understand what harm could look like. Staff security checks were not complete and training was not up to date. People’s confidential information was not protected and there was no complaints process in place. The provider was not completing meaningful and effective audits and responding to the issues found.

We inspected the service again in October 2018 and we found improvements had been made. The overall rating for this service is now ‘Good’.

When we inspected the service on 30, 31 October and 1 November 2018. This inspection was announced.

Precious Homes Treow house is a domiciliary care agency and a supported living service. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger adults who have a learning disability. The service was supporting eight people with the regulated activity of personal care. The service was supporting others but they were not receiving assistance with the regulated activity.

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. At the time of this inspection eight people were in receipt of the regulated activity of personal care.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were kept safe as staff understood what harm looked like and they knew what to do about it if they had any concerns. Staff also understood what constituted discrimination, but staff did not know what they could do about it, if a person experienced discrimination.

There were safe processes in place to respond to accidents and incidents to promote people’s safety. People had detailed risk assessments and care plans in place. However, there was no evidence to confirm if staff routinely looked at these documents.

There were sufficient numbers of staff who said they responded to people’s needs in a timely way and they did not feel under pressure to rush people. People received their medicines safely and medicines were also stored safely. Staff told us that they followed good hygiene practices when they supported people with personal care and food preparation.

A person’s health need was not responded to or identified appropriately andstaff did not receive competency checks when they were supporting people alone. The management checks on new staff were not kept available in the service and were not reviewed to check these had been robust checks.

There were plans in place which staff followed when people were at risk of choking or of being an unhealthy weight.

Consent to care was sought according to the principles of the Mental Capacity Act 2005. However, there were some short falls with how people were supported to spend their money, when they did not have capacity to do so. Also, the service did not evidence who exactly they would share people’s sensitive information with if they needed to do this.

The provider? and staff valued and cared for the people they supported. People’s confidential information held at the service was protected. Staff understood what dignity and privacy looked like.

People had detailed and updated assessments, care plans and reviews of the care and support they received. People were also involved in the planning of their care and in the development of the service.

There was consistent management presence at the service. Staff felt supported by their senior staff who supervised them. Staff felt confident that any issues they had would be listened to. The provider had completed well evidenced quality checks on the service.

The inspection took place on 4 and 5 October 2017. Precious Homes Bedfordshire provides assistance for people who require support with daily tasks and personal care in their own homes in supported living accommodation. This is when people have their own tenancy and are supported by staff on site to live as independent lives as possible. The service also supported two people who lived outside of Treow House the supported living scheme. The service was supporting about 19 people when we visited the service, but not all of these people were in receipt of the regulated activity of personal care. During the inspection we focused on the care of three people who were in receipt of personal care.

There was a registered manager in place. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

There was a lack of systems for the management of the service to ensure they consistently and robustly responded to accidents and incidents involving people who used the service in a safe way. Concerns by the local authority had been raised about this and the management of the service had not responded in a timely way to resolve this issue.

The service was not always storing people’s medicines in a safe way. Staff recruitment checks were not fully completed and in a robust way before staff started working at the service.

Staff knew how to identify abuse, and report it to the registered manager. However, not all staff knew of the outside agencies they could also report their concerns to.

The risks which people faced were identified in their risk assessments. However, the plans in place to mitigate these risks were not always detailed enough to advise staff about what action they must take, in certain situations.

Staff did not receive a full induction to their work before they started working independently in people’s homes. The competency of staff was not being monitored effectively enough to check if staff were competent in their work. Not all staff had training in key areas before they started working independently.

People were supported by staff to make choices with their daily care needs. The service assessed if people had capacity to make certain decisions. However, there were no records that showed that people had fully given their consent to share their care information with other agencies.

People told us that staff were kind to them and they were happy to be around the staff who supported them. People’s confidential information was not always treated in a respectful and safe way.

People’s care assessments were centred on them as individuals but they were not always up to date. Staff were not accessing this information in a meaningful way in order to understand the needs of the people they were supporting. People had regular reviews and were involved in this process.

With the exception of medicine audits, the provider and the registered manager were not completing audits to assess the quality of the care provided, and putting plans in place to make timely improvements. Some quality audits were not effective and were not being checked by the manager. There was a lack of systems in place to ensure the service was monitored in a meaningful way. Despite concerns raised by the local authority about the culture of the service, timely action had not been taken to ensure these were addressed, resolved, and did not occur again.