Caerus Care Limited

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. Just prior to our inspection starting the provider had moved to a new address.

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

Based on our review of is the service safe, effective and well-led questions, the service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support

Some risk assessments were not recorded and care plans lacked detail how staff should manage risk. Medicines administration records did not always reflect safe medicines administration. People were supported to have maximum choice and control of their lives and staff supported them with decisions that were in people’s best interest. However, a lack of recorded best interest decisions, meant there was a risk that the restrictions in place might not be the least restrictive.

Some audits were not as effective as they could have been, such as for the detail in care plans and risk assessments, medicines administration, mental capacity assessments and best interest decisions.

The nominated individual who was also the registered manager addressed these matters promptly, but until we highlighted these, actions had not been taken. Staff however were clear on exactly how to administer these medicines in a specific way and supported people with their medicines in a way that respected their independence.

We have made a recommendation in the well-led section of this report for the provider to seek support and ensure that audits and records are accurate and up to date and reflect care in people’s best interests.

Staff supported people to be cared for as safely as practical. Staff complied with measures designed to reduce the risk of infections spreading. Staff focused on people's strengths and promoted what they could do, enabling the opportunity for people to lead fulfilling and meaningful lives. One relative told us how proud they were at what their family member had achieved and how happy and settled they now were.

Staff supported people to achieve their goals and go on to further achievements. A staff member said, "Seeing [person] now safely at home with the right equipment means they are making good progress in their own time but with some support, regaining their independence."

Staff received effective training in the use of restraint and were confident in their ability to deploy this training should it ever be needed. At the time of our inspection no person required physical restraint. Any restraint would be in an emergency situation as a last resort and for the shortest time possible. Staff supported people to make decisions following best practice in decision-making.

Right Care

Staff focused on and promoted people's equality and diversity, supporting, and responding well to their individual needs. This changed people's lives for the better. One person said, “My life has been changed so much. I can travel independently.” Staff’s perseverance in listening to what the person wanted. One relative told us how much more their family member could now do and how well staff understood their communications in ensuring the person was given equal opportunities.

People or their legal representative helped create and review their care plans when they chose to, and as such were a reflection of the support they needed and what people could do independently. Staff had training on how to recognise and report abuse, and had the skills to help protect people from poor care and abuse, or the risk of this happening. The service worked with other agencies to do so.

The service had enough appropriately skilled staff to meet people's needs and keep them safe. All those we spoke with felt people were safe and had enough support to do this. Staff's diligence and persistence enabled people to achieve their aspirations. People lived a meaningful life and staff supported people to gain independent skills. People were supported to communicate in their preferred way including a few words and visual prompts.

People received care that supported their needs and aspirations, was focused on their quality of life, and followed best practice. One relative told us the service always went the extra mile and said, “They go above and beyond. Staff have transformed my [family member’s] life. They used to be calling me on the phone all the time, but now they are settled and so happy there. If there were any concerns they would ring me but they have told me they love it.”

Right Culture

People were supported by staff who understood best practice in relation to people's strengths, impairments, or sensitivities for people with a learning disability and/or autistic people may have. Staff knew people well and responded to their needs and wishes. One relative told us the service had made a huge difference to their family member saying, “I am not generous in giving accolades but I can only speak good of them. They go over and beyond. I can’t praise them enough.” Staff put people's wishes, needs and rights at the heart of everything they did. Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

People, relatives, staff and health professionals had a say in how the service was run. The ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service led confident, inclusive and empowered lives.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 28 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also prompted due to concerns about the management of risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We have found evidence that the provider needs to make improvements. Please see the well-led sections of this full report. 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 requires improvement. This is based on the findings at this inspection.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Not everyone using Caerus Care Limited receives a regulated activity. CQC only inspects the service being received by people being provided with ‘personal care: help with tasks related to personal hygiene and eating. Where they do we also take into account and wider social care provided. There were 12 people receiving the regulated activity of personal care on the day of our inspection.

We inspected the service on 20 November 2017. The inspection was announced. In October 2015 we conducted a comprehensive inspection of the service. We rated the service as ‘good’. At this inspection we found the service remained ‘good’.

The service had a registered manager in post. A registered manager is a person who has registered with CQC to manage the service. Like registered providers (‘the provider’) 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.

There were sufficient numbers of staff to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively. Training and supervision systems were in place to provide staff with the knowledge and skills that they required to meet people’s needs effectively.

The registered manager and staff understood their responsibility in ensuring that they were using the correct equipment and had received training to ensure they safely helped people to mobilise.

People were provided, where required, with food and drink that met their individual needs and preferences.

People’s medicines were managed safely and staff worked closely with local surgeries and pharmacies to ensure people had access to support with their medicines and healthcare appointments/needs when required. Staff received training to ensure safe and effective infection prevention and controls were in place.

Staff supported people to make everyday decisions in the least restrictive way possible. The policies and systems in the service supported this practice. Staff respected people's privacy and dignity and encouraged people to be as independent as they could be.

People’s individual risk assessments were reviewed and updated to take account of changes in their needs. Staff knew how to recognise and report any concerns to keep people safe from harm. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.

Arrangements were in place to ensure the quality of the service provided for people was regularly monitored. We found that people who used service and their relatives were encouraged to share their views and give feedback about the quality of the care and support provided.

Further information is in the detailed findings below