Archived: Destiny Care Support

About the service

Destiny Care Support is a supported living service providing personal care to seven people with a learning disability at the time of the inspection. The service can support a maximum of 10 people. The service is located in a large residential building set on a quiet rural lane.

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

People had not been protected from the risk of harm. Risks to people from the environment had not been safely managed. People had a range of health needs such as around choking and fluid intake but these were not being managed safely.

Staff had not been recruited safely. We asked the provider to take immediate action to provide assurance that all staff working at Destiny Care Support had the necessary checks and suitability to work at the service.

Staff did not have the skills and competencies to carry out their role. For example, one person at risk of choking needed staff that were trained in dysphagia [swallowing difficulties] but no staff working at the service had this. Staff had not had regular supervision or appraisals. People were not having their fluid levels monitored effectively.

People were not being supported to maximise their independence. For example, staff had been writing people’s care plans and writing the menu. People told us they were not involved in cooking their main meal, despite some people being interested in cookery.

People did not have goals or plans to learn new skills in place. People with communication needs did not have visual planners when these could help them. Activities for people were not person centred.

The provider did not have sufficient oversight of the service and governance systems were not effective in driving improvement. There was no manager registered with CQC in day to day control of the service, as they had left at short notice prior to our inspection.

People had mental capacity assessments and where necessary best interest decisions were made where people lacked capacity. The policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

People had been protected from abuse and staff understood their role in safeguarding people. People told us they liked the staff and were happy living at Destiny Care Support.

Right support:

• The model of care and setting did not always maximise the choice people had, and peoples independence was not enhanced.

• The provider’s office where they managed the support from was located in the same main building as people’s rented accommodation. This may make it difficult for people to choose support from another provider, although their tenancy allows this.

• People did not have identified goals and aspirations and staff did not consistently support people to achieve greater confidence and independence. The service had not routinely sought paid or voluntary work, leisure activities and widening of social circles.

• The service was located in a rural setting on a secluded lane and accessing the community often required staff support, which meant some people had to wait to access activities or shopping. Other people could access the community independently via taxis or local transport links.

Right care:

• Care was not person-centred and had failed to promote people’s dignity and human rights.

• People did not always receive their care in a way that empowered them or promoted their independence.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services led confident, inclusive and empowered lives.

• The provider had not been alert to the culture within the service and had not spent enough time with staff and people and discussing behaviours and values.

• The culture in the service was not always positive. Staff told us that morale was low and they were unable to say what the vision and values of the service were.

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 Inadequate (published 11 November 2021) and there were 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 not enough improvements had been made and the provider remained in breach of regulations.

Why we inspected

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The inspection was prompted in part due to concerns received about the environment and the fitting of specialist equipment. A decision was made for us to inspect and examine those risks.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to, person centred care, safe care and treatment, good governance, staffing and notifying CQC of significant events at this inspection.

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 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.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At the time of our inspection everyone living at Destiny Care Support received 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

Systems to protect people from abuse and neglect had not been safely implemented. Risks to people were not being managed as safely as possible. Medicines were not being managed effectively or safely and this put people at risk of not having prescribed medicines when they needed them or as directed. Lessons had not always been learned when things went wrong.

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. People had not been supported to understand restrictions, or to ensure any decisions to keep people safe were the least restrictive measures.

People were at risk of not having their health needs met. For example, some health conditions had not been care planned effectively. Risks around peoples eating and drinking needs had not been mitigated, so people may not have had enough to eat or drink for good health.

Staff had not always had the correct training they needed to carry out their roles safely. Staff supervisions had not been carried out as planned.

Quality audits were not effective in identifying shortfalls in the service. The registered manager and provider had not completed sufficient audits to identify where improvements were needed. Statutory notifications had not been sent to CQC and we found multiple breaches of Regulations.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support:

• Model of care and setting did not always maximise people’s choice, control and independence.

• The service was located in a rural setting on a secluded lane and accessing the community often required staff support, which meant some people had to wait to access activities or shopping. Other people could access the community independently via taxis or local transport links.

Right care:

• Care was not person-centred and failed promote people’s dignity, privacy and human rights.

• People did not always receive their care in a way that empowered them or promoted their independence.

Right culture:

• Ethos, values, attitudes and behaviours of leaders and care staff did not ensure people using services lead confident, inclusive and empowered lives.

• The culture in the service was not always positive. People sometimes felt not listened to and lessons were not learned to improve service delivery.

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 12 July 2018).

Why we inspected

We received concerns in relation to safeguarding concerns and the safe management of risk. As a result, we undertook a focused inspection 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.

The overall rating for the service has changed from Good to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well led sections of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to consent, safe care and treatment, safeguarding people from abuse, good governance, staffing and notifying CQC of significant events at this inspection.

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 continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Not everyone using Destiny Care Support received the regulated activity. CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection two people were using the service, however only one was provided support with personal care.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection, we rated the service as requires improvement with one breach to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During this inspection, we found significant improvements had been made and the provider is now meeting the regulations.

The person was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, the provider did not always understand who could legally give consent on the person’s behalf. We have made a recommendation.

Staff had a good knowledge of how to keep the person safe and how to recognise signs of abuse. There were individual in-depth risk assessments completed, which were person and task specific. Where risks had been identified, actions had been taken to manage the risks and promote the person’s choices. Staff were aware of the person's needs and followed guidance to keep them safe. There were sufficient numbers of staff to ensure their safety.

Staff had the skills and knowledge to support the person’s needs. This was achieved through induction, training, regular supervision and team meetings. Nutritional needs were met. The person was given choice and control over what they wanted to eat and drink while still encouraged to make healthy choices. They were also encouraged be independent when preparing food. The person’s health and social well-being was promoted through regular input from professionals.

The care plan was detailed and tailored to their individual needs. Staff knew the person they cared for well and understood their specific communication and behavioural support needs. Staff had supported and encouraged the person to engage with a variety of social activities of their choice and this had improved with time and patience. Staff treated them with kindness, compassion and respect and promoted their independence and right to privacy.

From our observations and views from professionals and staff, it was clear the registered manager was thought highly of. They sought feedback from professionals and relatives to improve the service and responded quickly to any issues or concerns. The management team promoted a strong team work ethos which made staff feel appreciated in their role.

Further information is in the detailed findings below.

Destiny care support is registered as a domiciliary care agency. The service operates from a small office which is adjoined to a residential service which is also owned by the provider. At the time of our inspection two people were using the service, only one of whom required support with personal care.

There was a registered manager in post, a registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

The provider had not taken appropriate actions to assess environmental risks in relation to people using another of the provider’s facilities.

Although staff had received training and were clear on their support responsibilities with day to day decisions in regard to the Mental Capacity Act; the provider had not ensured they had collected up-to-date information in regard to people’s advocacy status.

The provider could not be assured they were effectively supporting a person in line with professional health care guidance for a specific health care condition due to omissions in collecting relevant information.

The provider had failed to established robust systems which allowed them to observe care staff whilst they were undertaking care delivery. This impacted on the effectiveness of staff supervision.

Although the provider had systems to determine people and their relative’s satisfaction with the service received; we found a response to relative feedback had not been undertaken in a timely manner.

The provider had begun to engage with a range of health care professionals to ensure they were able to support a person’s with their complex sensory needs; however they acknowledged they had not fully explored all available referral options.

The providers quality assurance systems had failed to identify the areas of improvement we found during the inspection. For example there had been shortfalls in recording when there had been unforeseen interruptions to when care was not delivered in line with support plans. The provider had not ensured they had clear oversight of the service and provided adequate support to the registered manager.

Friendly and genuine relationships had been developed between people and staff. We heard staff offering clear explanations to people in ways they understood. Staff were seen to be kind and caring in their approach to people.

People were supported by, sufficient numbers of experienced staff. Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work for the provider.

People and their relatives spoke positively about the leadership and said they could approach them about any issues they felt required raising.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.