About the service MENCAP – East Cornwall Care Service is a supported living service which provides personal care to 34 people living in 11 settings in the east of Cornwall. Some of the settings had previously been registered as care homes. In supported living, people's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living and this inspection is focused on the quality of care and support people received.
People’s experience of using this service and what we found
We found that staffing levels had improved since our previous inspection. There were now enough staff employed to meet people’s support needs and all planned care shifts had been provided. Staff told us, I think it has got better, [staffing] is pretty good at the moment” and the manager said, “We are pretty good with staffing at the moment.” Relatives recognised this improvement and told us, “Staffing has got better, they have more staff.” All necessary recruitment checks had been completed to ensure staff were suitable for work in the care sector.
Medicines were managed safely and there were systems in place to protect people from financial abuse. Staff had received safeguarding training and understood their role in protecting people from all forms of abuse and avoidable harm.
Staff received regular training updates to ensure they had the skills necessary to meet people’s needs and new staff received appropriate induction training. Staff were well supported by their managers and regular supervision and support had been provided.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests. In one setting, we identified there were a number of significant restrictions in place in relation to access to food and snacks. These restrictions had not been recently reviewed and there was a lack of evidence to demonstrate they were necessary and in the person’s best interests. In another setting, one person’s care plan lacked specific guidance on how staff should provide support when they were upset and anxious. These failings meant the service was in breach of the regulations.
People got on well with their support staff who people told us were, “good fun”. Relatives were confident people were well cared for and told us, “Everybody is quite friendly” and “[My relative] has always been well looked after.” Staff ensured people’s dignity was protected and respected people’s decisions and choices.
People’s care plans were accurate and provided staff with enough guidance to enable them to meet people’s needs. Record keeping had improved and information was kept chronologically. A digital incident reporting system was now in use and all incidents that occurred had been appropriately investigated to identify where learning or any improvements that could be made. Daily records showed people had been supported to engage with a variety of activities, to develop their independent living skills and to take on responsibility for tasks and chores.
The service had again experienced significant management restructuring since our last inspection. A new manager with previous registered manager experience had been appointed to lead the service in the month prior to the inspection. Following the inspection, the new manager applied to the commission to become the service’s registered manager.
The new manager was well respected by the staff team who told us, “[The new manager] is brilliant. She gives you confidence, I am hoping we can hang on to her.”
The provider’s quality assurance processes had failed to ensure compliance with the regulations. However, prior to the inspection, the new manager had identified concerns in relation to the delivery of care in the supported living settings where the breach was identified. They had made arrangement for additional support to be provided to these settings and took prompt action in response to the feedback provided at the end of the inspection process.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at the last inspection
The last rating for this service was Requires improvement. (Report published 05 November 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made. However, the service remained in breach of regulation.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We have found evidence that the provider needs to make improvement. Please see the Effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.
As this is the second time the service has been rated requires improvement 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.