Accedo Herts South

Accedo Care Head Office is a supported living service providing personal care and support to adults with learning disabilities and/or mental health needs. The service was supporting 30 people, across four supported living settings, at the time of inspection.

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

This inspection primarily focused on one of the four supported living settings, where we had received concerns about the quality of care provided. Here we identified a lack of management and provider oversight, especially during the Covid-19 period. Professionals, relatives and staff all referred to a “chaotic” period of time at this location. During this period, incidents increased, and people were placed at risk of poor care and harm.

At this location, there was a negative culture, where staff did not treat people with dignity and respect. Staff used inappropriate language to refer to people and when completing incident reports. People were not supported in a consistent and positive manner, in line with their care plans and risk assessments.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, 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 providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. Care was not consistently person-centred and did not always promote people’s dignity, privacy and human rights. This was being addressed by the provider at the time of inspection, however, changes were yet to be embedded.

Risk assessments were not consistently developed to provide staff with the information they needed to ensure people’s care was provided safely. This meant people were not supported in a consistent way to achieve positive outcomes. Feedback received from staff, relatives and professionals was mixed. Staff reported a high volume of training, however some felt it had not given them adequate skills to support people in a safe, consistent way. Relatives and professionals also felt that the quality of support provided was inconsistent.

People were not sufficiently safeguarded against the risk of abuse. Incidents were not managed appropriately or in a timely manner. This meant people were exposed to risk of harm. The management team reviewed accidents and incidents but this was not always effective in identifying patterns and trends. Incidents were not always investigated appropriately, and measures put in place to prevent reoccurrence. This was particularly evident at one of the supported living sites.

The provider found it challenging to recruit appropriate staff. Staff recruited lacked the necessary skills and values. As a result, there had recently been a period of high staff turnover, as the provider sought to address this issue. The registered manager explained that they had reflected on this situation and identified lessons learnt.

Whilst governance systems were in place, these were not utilised effectively to identify issues where practice could be improved. Both the registered manager and provider were open about the challenges they had experienced. Prior to the inspection they had developed a service improvement plan, however this did not include all of the issues we identified. A new service manager had been recruited and staff, relatives and professionals told us about improvements made since they joined.

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 08 June 2018).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted due to concerns received about the management of risk, particularly at one of the provider’s supported living settings. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the staff culture and governance systems, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection

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

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

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 to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the management of risk and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Accedo Care Head Office provides care and support to people across three ‘supported living’ settings, so that they can live in their own home 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. At the time of the inspection across the three locations, 22 people received personal care and support.

There was a manager in post who had registered with the Care Quality Commission (CQC). 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 and associated Regulations about how the service is run.

Potential risks to people’s health and well-being were identified by staff and they knew how to manage these effectively and protect people from harm. Staff had received training in how to safeguard people from potential abuse and knew how to identify the risks associated with abuse.

People told us that they were involved with their care and staff always asked for their consent when providing care.

Relatives told us that their family members were kept safe and well cared for when they were being supported by the service. Risk assessments were completed to keep people safe.

Recruitment processes were robust and ensured staff employed to deliver care and support for people were of a good character and suitable to meet people`s needs safely.

People were supported them to take their medicines. Staff were trained in safe administration of medicine and had their competency regularly observed.

People and their relatives were very complimentary about the abilities and experience of the staff that provided care and support. Staff received training and regular updates to ensure they were up to date with their knowledge and best practice guidance.

Staff supported people to stay safe in their homes, and people were supported to maintain their health and well- being. Staff developed appropriate positive and caring relationships with the people they supported and their families, and feedback from people was consistently positive about the service they received.

People and their relatives where appropriate were involved in the planning of the care and support people received. People's personal information was stored securely and confidentiality was maintained.

People told us that staff provided care and support in a way that promoted their dignity and respected their privacy. Staff were knowledgeable about people`s preferred routines and delivered care that was individualised to the person they were supporting.

People told us they felt that staff listened to them and responded to them in a positive way. People and their relatives knew how to raise concerns and they were confident that the registered manager would take appropriate action to address any concerns in a timely way.

People were asked to provide feedback about the service they received regularly and we saw these were positive.

People and their relatives were positive about the staff and the management of the service. The registered manager regularly audited the service any improvements needed were actioned.