Opportunities for Adults and Children

Updated 14 April 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 2 Inspectors and an Expert by Experience. 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 a ‘supported living’ setting, so 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations. At the time of our inspection there was not a registered manager in post. The provider had identified a member of staff who recently applied to become registered with CQC.

Notice of inspection

The inspection was not announced. Inspection activity started on 21 February 2023 and ended on 13 March 2023. We visited the location’s office on 21 February, 22 February and 13 March 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We visited four 24 hour supported living houses. We spoke with 8 relatives, 7 people, the provider’s representative, the the Acting Operations & Quality Lead, 6 house managers and we obtained feedback from 9 support workers. We reviewed 7 people’s care plans, we looked at staff training records, staff recruitment records, safeguarding incidents and accident reports, quality and compliance records and we checked whether the provider was compliant with the requirements of the MCA.

Updated 14 April 2023

About the service

Opportunities for Adults and Children provides care and support for people who may have a learning disability, mental health needs or autistic people. At the time of the inspection, 54 people were receiving support.

The provider had a several 24 hour supported living houses, each with their own allocated house manager and staff team. Other people living in the community received care and support under the same registration.

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

The provider failed to ensure sufficient numbers of suitably skilled, qualified, and experienced staff were deployed to meet people’s needs at all times.

People were not always provided with appropriate support to manage their medicines, and monitoring medication administration was not carried out effectively.

The provider did not always conduct robust assessments to determine risk. Risk was not always managed effectively.

The providers governance systems were not embedded and on occasions failed to drive improvement in a reasonable timescale.

Safe recruitment processes had not always been thoroughly followed. We have made a recommendation about this.

Decisions made in people’s best interest were not always assessed in line with the requirements of the Mental Capacity Act 2005. Records failed to demonstrate referrals had been made to the Court of Protection when this was required.

We received mixed feedback from people, relatives, and staff about the quality of care provided and the organisations leadership and governance procedures.

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.

Right Support: Model of care and the setting failed to consistently maximise people’s choice, control, and independence

People were not always supported to have maximum choice and control of their lives and staff did not always support people in the least restrictive way possible.

Right Care: Care was not always person-centred and, at times failed to promote people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff sometimes failed to ensure people using services lead confident, inclusive and empowered lives.

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 2 November 2019).

Why we inspected

We received information of concern relating to the quality of care provided, the leadership within the organisation and the arrangements in place for governance. As a result, we undertook a focused inspection to review the key questions of safe 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 requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We identified breaches in relation to regulation medicines, staffing and quality assurance processes. Please see the action we have told the provider to take at the end of this report. We have also made a recommendation in relation to recruitment shortfalls found at this inspection.

During our inspection, the provider sent us various action plans, records and correspondence demonstrating they had responded promptly and appropriately regarding the concerns we identified. The provider also contacted the local authority safeguarding team to share information of concern.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Opportunities for Adults and Children on our website at www.cqc.org.uk.

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.