Croydon Borough

Updated 13 July 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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by one inspector.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 48 hours' notice of the inspection. This was because it is a small service and we needed to be sure that the registered manager would be in the office to support the inspection.

Inspection activity started on 10 May 2022 and ended on 20 May 2022. We visited the office location on 10 May 2022.

What we did before the inspection

We reviewed information we had received about the service since it was registered with CQC.

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make.

We used all this information to plan our inspection.

During the inspection

We spoke with the relative of the person who used the service about their experience of the care provided. We spoke with four members of staff, including the registered manager, care workers and the operations manager.

We reviewed a range of records. This included one person's care records and multiple medicines administration records. We looked at two staff files in relation to recruitment and supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

Updated 13 July 2022

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.

About the service

Croydon Borough is a domiciliary care agency providing personal care to older people, people living with dementia, people living with physical disability and people living with learning disabilities or autism. The service was providing care to one person at the time of the inspection. The person was living with a learning disability.

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

Right Support

The service provided the person with the right support. Staff supported the person to take part in activities they liked doing and attend a local day centre, so they had a fulfilling and meaningful everyday life. The service made adjustments for the person and their relative so they could be fully involved in discussions about how the person received support, such as holding meetings at the person's home. The service worked with the person and their relative to plan for when the person experienced periods of distress. Staff supported the person and their relative so the person could access specialist health care support in the community. The service supported the person and their relative to make decisions following best practice in decision-making. Staff supported the person with their medicines in a way that achieved the best possible health outcome. Staff communicated with the person in ways that met their needs.

Right Care

The service had not always provided the person with the right care. The provider had not always provided the person with sufficiently trained and experienced staff. Some of the staff used to provide the person with care when their usual care workers were not available had not received training to work with epilepsy, learning disabilities, behaviours that some people may find distressing and PEG (percutaneous endoscopic gastrostomy) tube support. PEG is a procedure in which a flexible feeding tube is placed through the abdominal wall and into the stomach and allows nutrition, fluids and/or medicines to be put directly into the stomach, bypassing the mouth. Staff had not always followed medicines administration guidance and best practice. We found no evidence the person had been harmed. However, this meant the person had sometimes not received the right care.

Staff promoted equality and diversity in their support for the person. They understood their cultural and religious needs and preferences and provided them with culturally appropriate care. The person received kind and compassionate care and staff respected their privacy and dignity. Staff understood and responded to the person's individual needs. The person had individual ways of communicating, including using body language and sounds for example and the person could communicate with staff because staff supported them consistently and understood their individual communication needs. The person's care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture

The service was not always sufficiently person-centred. The provider had not always provided the person with replacement staff that had personalised information about them. The provider had not always understood and assured quality performance. They had not regularly carried out audits and the audits they had carried out were ineffective because they had not identified the issues we found during our inspection.

The person received good quality care, support and treatment the majority of the time because their usual care workers were trained and experienced and had good knowledge about them and could meet their needs and wishes. Staff knew and understood the person well and were responsive, supporting theirs and their relative's aspirations for them to live a quality life of their choosing. Staff turnover was very low, which supported the person to receive consistent care from staff who knew them well. The person and their relative were involved in planning the person's care. The provider obtained feedback from the person's relative about the quality of support provided to the person.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

Follow up

We will request an action plan from 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.