Xen Care Services Also known as Support Haven Ltd

Where they do receive personal care, we also consider any wider social care provided. At the time of inspection there were 27 people who used the service and received personal care.

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

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.

The provider was not always able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture. We signposted the provider to relevant information. We have made a recommendation the provider fully assesses the care and support provision at Kare Plus Ipswich to embed the principles of right support, right care, right culture into care planning and delivery.

In the 6 prior weeks to the start of our inspection a new management team had taken over the day to day running of the service. Improvements had been made and were ongoing regarding care planning and risk management and a new electronic care planning system was being implemented. Further work was needed to embed the new governance and oversight arrangements as at the time of the inspection it was too soon to assess their overall effectiveness.

This was a focused inspection to follow up on the previous breach of regulations and to check improvements had been made to mitigate the risk. We found that progress had been made and was ongoing regarding safe care and treatment and the service was no longer in breach of this regulation. However, the service remained in breach of regulation 17, as progress to their governance and oversight arrangements since our last inspection was slower than expected. The provider advised this was due to some personnel changes that had impacted on the delivery timescales.

Right Support:

People were supported by a staff team who were safely recruited and received training relevant to their role and to meet people’s needs. This included The Oliver McGowan Mandatory Training on Learning Disability and Autism. This is the government’s preferred and recommended standardised training for health and social care to undertake.

People received their medication as prescribed and staff adhered to infection prevention and control procedures in line with legislative requirements and recognised best practice guidelines.

Right Care:

Improvements had been made and were ongoing to the provider’s systems to assess and manage risks safely for people. People were supported to have maximum choice and control of their lives and for staff to support them in the least restrictive way possible and in their best interests; the polices and systems in the service to support this practice were being reviewed.

The majority of feedback from people and their relatives about their experience with Kare Plus Ipswich was positive and they were satisfied with their care and support arrangements. Where personal care was provided people said this met their needs, they were treated with respect, consent was sought and they were complimentary about the approach of staff.

On occasion where people had an issue the provider had acted appropriately to address this. We did signpost the provider to a quality care concern during the inspection.

Right Culture:

The provider's governance arrangements did not provide assurance the service was consistently well led. The systems and processes to oversee the quality assurance of the service were not robust and effective, as they had not identified the shortfalls we found during our inspection and regulatory requirements were not always being met.

Systems for auditing had been introduced but needed further development to consistently analyse, report and evidence the actions taken and where applicable lessons learnt. We signposted the provider to seek support in this area and were encouraged by them contacting support from relevant professionals including the local authority.

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 this service was requires improvement (published 13 April 2022). We found breaches of the regulations. At this inspection we found some improvement had been made, the level of risk had reduced, but the provider remained in breach of the regulation regarding good governance.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the well-led section of this full report.

Enforcement and Recommendations

We have identified a continued breach in relation to good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation that the provider research current guidance and best practice in supporting people who have a learning disability and autistic people.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

Risk assessments were not in place and there were no managements plans in place to guide staff on how to reduce the risk of harm.

Medicines were not always managed in a safe way. Medicine administration records were not always accurately completed, and there were no medicine profiles or controls for overseeing the arrangements in place.

Incidents were not reviewed in a systematic way to reduce the likelihood of a reoccurrence.

While some training for staff was provided, it was not specific to the needs of the people they supported. There were no competency assessments to check staff’s understanding of what they covered on training or spot checks to review care delivery.

Assessments and care plans did not always contain enough information. We have made a recommendation about the assessment process.

The management oversight of the service needed improvement and audits developed to monitor the quality of care.

Staff were clear about escalating safeguarding concerns to the management of the service but were not clear about the role of the Local Authority.

People told us they were supported by a consistent team of care staff who stayed for the allocated time.

Recruitment processes were not robust and we identified shortfalls in referencing and risk assessments. Disclosure and Barring checks were undertaken.

Infection control procedures were in place and staff wore personal protective equipment and undertook some testing but not consistently in line with the government guidance. Screening of visitors to the office was not undertaken.

Support was provided to people with eating and drinking as outlined in their assessment, and there were systems in place to enable staff to record what people ate and drank.

The recording of best interests decisions needed improvement and we have made a recommendation regarding this.

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.

Relatives described the care staff as friendly and kind. Although there was a lack of detail in care plans, staff demonstrated that they knew people well.

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

Rating at last inspection

This service was registered with us on 07 December 2020 and this is the first inspection.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.