2 December 2022
During an inspection looking at part of the service
About the service
Ambito Community Services South West is a domiciliary care agency with a supported living setting which provides personal care for autistic people and people with learning disabilities. The service provides support to people with a learning disability and autistic people, some of whom may also have a physical disability. There was an office in Plymouth for the domiciliary care agency and an office at the supported living location near Liskeard.
The provider had taken over responsibility for the setting in September 2021.
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 9 people using the service receiving support with personal care. 8 of these people lived at the supported living setting.
People’s experience of using this service and what we found
Right Support
The model of care and setting did not maximise people’s choice, control and independence. Support did not always focus on people’s strengths and promote what they could do.
The service did not have a clear record of any authorisations to deprive people of their liberty. This might have meant they were depriving people unlawfully.
Relatives and professionals told us they did not think people had fulfilling and meaningful, interactive everyday lives. People’s records did not clearly describe their aspirations and goals.
There was a lack of guidance on what support people needed to increase their skills and have control over their own lives. People were supported by staff who had not all received the right training to understand and meet people’s needs.
People who experienced periods of distress did not always have proactive plans in place which ensured staff understood the best way to support them at these times. Records did not evidence staff had all received training in supporting people at these times, or on how to restrain someone in the safest way.
The setting was designed as a holiday complex and not for permanent dwelling. Necessary alterations to meet people’s needs detracted from the feeling that the individual bungalows were people’s homes.
People had limited access to the local community. They lived in a remote location which meant they were reliant on staff who could drive, to take them to the local town.
Staff supported people with their medicines in a way that met their preferences. However, some medicines practices, such as how medicines were stored and administered, were not person centred.
Right care
The service was short staffed and was reliant on agency staff. Some of these worked long hours with little time off but the provider had not identified that this could compromise the safety and quality of people’s care.
Staff had not all received training in communication methods people used, such as Makaton.
People’s care plans did not give a comprehensive or holistic view of their support needs and preferences. Records contained limited information about any aims or aspirations people had and did not contain clear pathways to guide staff on how people wanted to achieve these or learn new skills.
Risk assessments were not in place for all risks related to people’s support needs.
Professionals raised concerns that it was difficult to contact the service and that staff were not always aware of guidance provided by external professionals.
Support for people with what they ate and drank was not always person centred or safe.
Right culture
The provider had not identified that the model and setting of the service limited people’s quality of life and did not reflect best practice. The service was not similar to dwellings other people would live in and was distinguishable from surrounding accommodation.
There had been inconsistent management at the service and relatives raised concerns that the service had not improved sufficiently since the provider took responsibility for it.
Staff had not all received training in learning disabilities or person-centred care. This meant they had a limited understanding of best practice models of care.
Relatives told us they did not always feel involved in their family member’s life. Records showed they had not always been included when decisions had been made on behalf of people who lacked the capacity to make the decisions themselves.
The provider had not ensured that people’s records and staff skills were in place and up to date. This had a negative impact on people’s quality of life.
Tools and audits to monitor the service had not been used effectively to ensure the service improved and met people’s needs.
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 30 April 2019). At that time, the setting we visited for this inspection was not part of the service.
Why we inspected
This inspection was prompted by a review of the information we held about this service.
We undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 good to inadequate based on the findings of this inspection.
We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ambito Community Services South West on our website at www.cqc.org.uk
Enforcement and Recommendations
We have identified breaches in relation to consent, safe care and treatment, person centred care, governance of the service and staffing at this inspection.
Follow up
We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.
We proposed to require the provider to report to us each month about the improvements they were making but the provider closed the service before this came into effect.