Background to this inspection
Updated
10 April 2020
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. This was a targeted inspection to check on specific concerns we had about staff recruitment and safeguarding processes.
Inspection team
This inspection was carried out by three inspectors.
Service and service type
This service provides care and support to people living in a ‘supported living’ setting, 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.
The service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
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 reviewed information we had received about the service since the last inspection. We sought feedback from the local authority contracts monitoring and safeguarding adults' teams and reviewed the information they provided. We contacted the NHS Clinical Commissioning Group (CCG), who commission services from the provider, and the local Healthwatch for their feedback. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all feedback received to plan our inspection.
During the inspection
We spoke with one person who used the service and two relatives about their experience of the care provided. Some people declined to speak with us others were unable to communicate with us. We spoke with eight members of staff including the nominated individual, the registered manager, the service manager and support workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included recruitment records for 19 members of staff and recruitment policies and procedures. We also reviewed three people’s care records and multiple medication records. A variety of other records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We reviewed newly created risk assessments.
Updated
10 April 2020
About the service
Waymarks Limited provides personal care and social support to people living in their own homes in a 'supported living' setting. At the time of our inspection there were seven people receiving the regulated activity. Support workers staffed each house 24 hours a day. Following our visit to the service, the provider changed address and is now operating from a different location.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
People’s experience of using this service and what we found
Staff recruitment was not safe. People were at risk of potential harm as staff did not have adequate pre-employment checks or risk assessments. Staff recruitment records were not always present. Governance arrangements were not effective to ensure there was robust oversight of the service.
The provider and registered manager had not investigated or reported to the local authority some safeguarding concerns staff had raised. Where incidents had been recorded, management monitored these to check action was taken.
Medicines were administered safely. However, management had not ensured staff member’s competency to give people medicines had been checked every six months as the provider expected. Staff kept accurate records of the medicines they had given.
Staff did not have regular opportunities to have one to one supervision. Staff had completed the training they needed. Staff supported people to have enough to eat and drink and to access health care services. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People's needs were assessed when they started receiving the service. This was used to develop a brief support plan called ‘a support plan light’. The provider was transferring care plans into a more detailed format, so they contained more information about the support people needed. One complaint had been fully investigated and resolved.
The new service manager was making improvements and providing more effective oversight of the service. A detailed quality assurance audit had been completed and an action plan developed. People, relatives and staff had opportunities to give feedback about the service.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 4 October 2017).
Why we inspected
We undertook this initially as a targeted inspection to check on a specific concern. This was prompted in part by a statutory notification that was sent to CQC of an alleged incident. This incident is subject to a criminal investigation. This inspection did not examine the circumstances of the incident.
CQC are currently trialling targeted inspections, to measure their effectiveness in following up on a Warning Notice or other specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.
We widened the inspection to a comprehensive inspection after the first visit to assess whether there were any additional risks to people using the service.
We have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this full report.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Enforcement
We have identified breaches in relation to the suitability of staff, record keeping, good governance and safeguarding. Please see the action we have told the provider to take at the end of this report.
Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
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.