Background to this inspection
Updated
20 October 2021
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 was completed by four inspectors. Two who attended the office, one who visited people in their home and one who led the inspection remotely. An Expert by Experience contacted people in receipt of the service or their families to gather their views on the service they received. 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 is in part a domiciliary care agency. It provides personal care to people living in their own houses and flats. The service also provides care and support to people living in ‘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.
Notice of inspection
This inspection was announced an hour before the inspection team arrived on site. We gave a short period notice of the inspection to allow the service to gain consent from people we wanted to visit. Inspection activity started on12 July 2021 and ended on 19 August 2021. We visited the office location on 12 July 2021.
What we did before the inspection
Prior to the inspection we reviewed all the information we held about the service, discussed the service with professionals and stakeholders and reviewed information available in the public domain. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We used all of this information to plan our inspection.
During the inspection
We reviewed care plans and support information in detail for eight people supported by the service and looked at records more generally for a number of others. We reviewed electronic records for care planning, risk management and oversight of the service and received requested information required to review the safe and well led key questions.
We spoke with senior staff on the day of the inspection site visit and spoke with the nominated individual and chief executive as part of the feedback session. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We also spoke with the quality and compliance officer. We sent staff questionnaires to 25 staff and received seven responses, we also gathered feedback via email from five professionals that work with the service.
An expert by experience spoke with six relatives of people supported and one person supported by the service.
After the inspection
When required we sought additional clarity on information received.
Updated
20 October 2021
About the service
One Fylde (Headroomgate) is a domiciliary care agency and supported living service providing personal care to 139 people. At the time of the inspection there were 82 people receiving support in supported living tenancies mostly in shared houses, and 57 people supported by the home care service in their own homes.
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.
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 key questions safe and well led, the service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. People supported lived in houses shared with no more than three other people maximising people’s choice, control and independence. People were supported to live inclusive and empowered lives, supported by staff with the right values and behaviours to support people living with a learning disability and/or autism to lead as full a life as possible. One family member told us, “Staff go out of their way to support (name). They are accessible on the phone and are there if I need them. . I rely on them to help me with (name) to take him out which is vital for his well being."
We had some concerns around the documentation to support people with any associated risks to their health and wellbeing and the safe management of medicines. We found people were supported by enough well-trained staff who had been safely recruited. We also found the provider had taken steps to implement changes in procedures and risk management in the pandemic and staff were knowledgeable in the changes made.
The provider did not monitor the records they kept showing the support provided to people in a comprehensive way to assure themselves of effective oversight. We had some concerns as to how the provider could evidence continuous improvement. However, staff were confident in their role and supported people in line with their wishes. The provider ensured they sought suitable advice from professionals when supporting people with more complex needs.
For more details, please see the full report which is on the CQC website at
Rating at last inspection
The last rating for this service was good (11 March 2020).
Why we inspected
This inspection was triggered in part due to safeguarding concerns raised about the provider. We completed an inspection of this service focusing on safe and well led. We have found evidence that the provider needs to make improvements. Please see the well led section of this report. The provider was developing and implementing new systems and processes and at the time of the inspection there was insufficient oversight of the day to day business to allow proactive service improvement. We have found the provider in breach of the regulation associated with good governance. The overall rating for the service has changed from good to requires improvement.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for One Fylde (Headroomgate) on our website at www.cqc.org.uk.
You can see what action we have told the provider to take at the end of this 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.
We have identified a breach in relation to how the provider collected and reviewed evidence on the services provided to people, we found there was ineffective oversight to ensure concerns which may relate to the whole service were identified. We have also made recommendations in relation to the identification and management of risk and medicines management.
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.