Background to this inspection
Updated
27 April 2022
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 Care Act 2014.
Inspection team
The inspection on site was carried out by four inspectors and two members of the CQC medicines team. An expert by experience made telephone calls to people and relatives. 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 five ‘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.
Each scheme had a manager registered with the Care Quality Commission at the time of our inspection. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.
What we did before inspection
We reviewed information we had received about the service. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used this information to plan our inspection.
During the inspection
We spoke with five people and nine relatives about their experience of the care provided. We spoke with seven members of staff, an internal occupational therapist, the management team of each scheme, the regional general manager and quality improvement manager. We reviewed a range of records. These included ten people’s care records and eight people’s medication records. We looked at staff records in relation to recruitment, training and other records relating to the management of the service, including finance checks and audits, policies and procedures and quality assurance records.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance and records relating to the management of the service.
Updated
27 April 2022
About the service
Sequence Care Supported living provides care and support to 32 people living in five supported living settings. CQC does not regulate premises for supported living; this inspection looked at people’s care and support.
People’s experience of using this service and what we found
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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of the key questions of Safe and Well-Led. The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture
Right Support
People were supported to promote and maintain their independence. People were able to choose how they wanted to spend their day and things they wanted to do in the community. Staff supported people to achieve this and maintain their relationships with relatives.
Right Care
People received care based on their preferences and treated with respect. We observed positive interactions between people and staff. People were comfortable approaching staff when they needed support and we observed staff respected people’s choices.
Right culture
Some features in individual schemes were similar to a ‘care home’ setting and communal areas encouraged potential closed cultures.
We found safeguarding procedures were not effectively established in relation to safeguarding people’s finances, there was limited learning in relation to managing accidents and incidents and identifying lessons learnt, risks to people were not effectively assessed or managed, medicines administration for ‘as and when required medicines’ (PRN) and people’s allergy status were not recorded properly. There was a number of audits in place to monitor the quality of service, however these were not robust enough to identify the issues we found during this inspection. Joint working with other healthcare professionals including an internal multidisciplinary team was not always effective.
Relatives told us they felt people were safe and staff knew their needs well. Appropriate recruitment checks had taken place before staff started work. There were enough staff available to meet people’s support needs, this included the use of agency staff. Staff followed appropriate infection control practices.
The service took the views of people and their relatives into account through surveys and meetings. Staff meetings were held so staff had the opportunity to share good practice. Staff told us they felt supported by management.
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 March 2019).
Why we inspected
The inspection was prompted in part due to concerns received from the local authority in relation to safeguarding in relation to physical and financial abuse and whistleblowing concerns. A decision was made for us to inspect and examine those risks.
As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
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.
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 Sequence Care Supported Living on our website at www.cqc.org.uk.
Enforcement
We have identified breaches in relation to safeguarding, risk, accidents and incidents 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.