Background to this inspection
Updated
17 January 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 Care Act 2014.
Inspection team
The inspection was carried out by an adult social care inspector.
Service and service type
This service provides care and support to people living in 3 ‘supported living’ settings, 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.
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.
There was no registered manager in post at the time of the inspection. A new manager had been appointed two weeks prior to the inspection.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we intended to visit each setting and needed to gain consent before visiting.
Inspection activity started on 16 November 2022 and ended on 24 November 2022. We visited the location on 16 and 21 November 2022.
What we did before the inspection
We reviewed the information we had received about the service since the last inspection as part of the planning process. 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.
During the inspection
We met and spoke with 7 people who the service supported, 8 staff and the new manager. We also spoke by telephone with 4 people’s relatives and the providers nominated individual.
We looked at records relating to people’s care and the management of the service. This included 4 care plans and associated risk assessments, medicine administration records (MARs) and staff recruitment and training records.
We also asked the service to send us records relating to the day to day management of the service and quality assurance audits. This information was reviewed in detail after the site visit.
Updated
17 January 2023
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
Carmel Care & Support Limited Camborne is a supported living service which supports people with learning disabilities and autistic people. The service supports people living in 3 different settings in Camborne. Two settings were shared houses where people had their own bedrooms with shared cooking, lounge and bathroom facilities. The other setting consisted of bedsit style flats where each person’s accommodation was self-contained.
At the time of our inspection 19 people were living in these settings, 16 of whom received support with 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.
People’s experience of using this service and what we found
Right Support
The model of care did not maximise people’s choice, control and independence. 2 of the 3 settings inspected were operating as if they were care homes as opposed to supported living settings. Rolling staff rotas had been developed which improved staff wellbeing but restricted people freedoms and choices. There was limited evidence people were supported to do as much as possible for themselves and in one setting a communal weekly menu was in use. This indicated people’s choices in relation to meals was limited.
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; the policies and systems in the service did not support this practice. Staff and managers did not fully understand their role in assessing people’s capacity to make specific decisions. Where people lacked capacity and there were restrictive care practices in place these practices had not been reported to the local authority.
People were supported to participate in work placements and encouraged to access the community independently where possible.
The service appropriately supported people to raise concerns about their rooms with the accommodation provider.
Right Care
The provider had not safely supported people with their medicines. Medicine administration records had not been accurately completed and staff had not been provided with clear guidance on the use of ‘as required’ and emergency medicines.
Staff cared for the people they supported and understood their role in ensuring people were protected from all forms of abuse and discrimination. People’s decisions and choices were respected.
Staffing levels had recently improved and, with support from agency staff, the service had been able to consistently provide the level of support people required. Recruitment practices were safe.
The providers infection prevention and control procedures were appropriate, and staff used PPE in accordance with current guidance.
Right Culture:
The service did not have a registered manager and there had been significant management changes in recent months. A new acting manager had been appointed two weeks prior to the inspection. Staff and relatives were complimentary of the new managers approach.
There were appropriate staff induction procedures in place and staff training had been regularly updated to ensure staff had the skills necessary to meet people’s needs. Staff told us they were well supported by the new manager.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for the service was Good published on (20 July 2021). At this inspection the services rating has changed to Requires Improvement.
Why we inspected
This inspection was prompted by information we had received which indicated there had been issue in relation to management turnover at the service.
As a result, we undertook a focused inspection of Carmel Care & Support Limited Camborne to review the key questions of Safe, Effective and Well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carmel Care & Support Limited Camborne on our website at www.cqc.org.uk.
Enforcement and Recommendations
We have identified breaches in relation to the management of risks and the assessments of people’s capacity to make specific decisions at this inspection.
Please see the action we have told the provider to take at the end of this report.
We have also recommended the provider seeks advice on how to ensure the service provides support in line with current best practice.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.