Archived: The Regard Group - Domiciliary Care Cornwall

The Regard Group – Domiciliary Care Cornwall, is registered both as a domiciliary care agency and a supported living service. It provides personal care to people living in their own houses and flats, and to people living in a 'supported living' setting, so they can live as independently as possible.

People's care and housing are provided under separate contractual arrangements. The CQC does not regulate premises used for supported living; this inspection looked at people's care and support.

People using the service lived in five Supported Living settings in Cornwall. Houses in West Cornwall included Govis House, Fox House, Meadow View and Connexion Street and one supported living setting in East Cornwall called Buttermill. Not everyone using the service received a regulated activity; CQC only inspects the service being received by people who are provided with the regulated activity of 'personal care', for example which includes help with tasks such as personal hygiene and eating. Where they do, we also take into account any wider social care provided.

Since the last inspection the provider decided to close two of its Supported Living settings, Meadow View and Connexion Street.

The service was able to support a maximum of 44 people but only 16 people received personal care. This included one person at Govis House, four people at Fox House, five people at Meadow View and five people at Buttermill.

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 guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

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

Right support:

The model of care and setting did not always maximise people's choice, control and independence and measures had not been taken by the provider to mitigate this. We visited three supported living settings. One setting we visited was in a rural location and there was an absence of local amenities and public transport options. The other two settings were near to the centre of towns and had access to the local community and amenities.

One supported living setting gave the appearance of being a registered care home due to the way it was structured and managed. This was not in line with the principles of Supported Living.

People were not always supported by enough staff on duty who had been trained to do their jobs properly. People did not always receive their medicines in a safe way. People were not always protected from abuse and neglect. People's support plans and risk assessments were not always clear and up to date.

Right care:

There was a lack of person-centred care, and the support people received did not promote dignity, privacy and human rights. People's needs and preferences were not always known or respected. Staff did not always have, or display, the skills and knowledge to meet people's needs. People did not have a choice in which agency provided their care.

Right culture:

The ethos, values, attitudes and behaviours of some leaders and care staff did not ensure people using the service led confident, inclusive and empowered lives. People were not empowered and lacked choice and control over their lives through their limited knowledge of opportunity and limited staffing levels in the service. People did not always receive person- centred support to live meaningful and active lives. People did not have opportunities to form community connections and make choices about who they lived with and the support they received.

The provider had not taken the opportunity, since the last inspection, to implement effective change to ensure the service met the regulations, reflected best practice expected by Right Support, Right Care, Right Culture, and offered improved outcomes to people. As a result, the culture in the service, staff ability to implement best practice and the opportunities offered to people remained poor.

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

Relatives, staff and some health and social care professionals expressed concern about how peoples care needs were being met and felt the service at some supported living settings was not safe.

People, relatives, health and social care professionals and staff were concerned about the lack of consistent leadership in the services, and high staff turnover. Some of the staff in two of the five settings commented they felt morale was low and that communication could be better.

People, relatives and staff lacked confidence that any concerns they had would be listened to or acted upon.

People were not always supported by consistently caring and suitably trained staff. Staffing levels were not sufficient to meet people's care needs in a person-centred way. This was confirmed by feedback received from people living at the service, relatives and staff. Health and social care professionals also raised concern about the lack of consistent staffing and leadership which impacted on the care provided to people the provider supported.

The delivery and planning of care were not consistently person-centred and did not always promote good outcomes for people. Support plans did not contain detailed and person-centred information and therefore they did not always accurately reflect the needs of those who used the service.

Support plans were not always updated as people's care needs changed. People’s care needs were not monitored or reviewed to learn how to improve the quality of life for the person.

Health and social care professionals raised concerns that people’s health care needs were not met in a timely manner.

The service did not always follow the legal framework for making particular decisions in the person’s best interests.

Information about how some people communicated was limited, which meant their needs were not fully understood. Information provided to people was not always provided in a format that was tailored to their needs.

People spent most of their days in the service doing repetitive activities, which although meaningful to the person in the context of the limited opportunities available to them, did not assure us each person was living a full and meaningful life.

The provider had submitted monthly reports to us to demonstrate how they were addressing the concerns raised at the previous inspection. However, the provider had failed to effectively monitor the service's performance and ensure that high quality care was provided. Regional managers had completed audits which had identified significant issues with the service's performance prior to this inspection. However, action was not effective to address and resolve these quality issues.

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 3 March 2021) and there were multiple 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 was still in breach of regulations.

At a comprehensive inspection in July 2018 the service was rated Good (published 28 August 2018) it was rated ‘Good’ in the domains of effective, caring, responsive and well led. It was rated ‘Requires Improvement’ in safe domain due to the numbers of safeguarding incidents recorded and staffing issues.

In July 2020 we undertook a focused inspection (published 24 August 2020) We received concerns in relation to management of the service and the quality of care and support that was being provided. There had been a number of safeguarding concerns raised by other professionals. At this inspection we only looked at the safe and well-led domain. We found that there were two breaches of regulation, safeguarding service users from abuse and improper treatment and good governance. We requested an action plan from the provider to understand what they would do to improve the standards of quality and safety.

In November 2020 we undertook a further focused inspection (published 12 January 2021 and supplementary report on the 3 March 2021)) The inspection was prompted in part due to concerns received about people's safety, staffing and leadership. A person using the service sustained a serious injury. The information CQC received about the incident indicated concerns about the leadership of the service, the safety of people using the service and the quality of care and support that was being provided. At this inspection we only looked at the safe, effective and well-led domains. We found that there were six breaches of regulation: person- centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, staffing and good governance.

We imposed conditions on the providers registration following the inspection in November 2020. We have received monthly reports addressing the areas of safeguarding service users from abuse and improper treatment, staffing and good governance.

We requested an action plan from the provider to understand what they will do to improve the standards of quality and safety in the breaches of regulation of person-centred care, need for consent and safe care and treatment. We met with the provider on a regular basis.

The service remains rated Inadequate. This service has been rated Inadequate for the last two consecutive inspections.

Why we inspected

This focused inspection was carried out to follow up on action we told the provider to take at the last inspectio

The Regard Group is registered both as a domiciliary care agency and a supported living service. It provides personal care to people living in their own houses and flats, and to people living in a 'supported living' setting, so they can live as independently as possible.

People's care and housing are provided under separate contractual arrangements. The CQC does not regulate premises used for supported living; this inspection looked at people's care and support.

People using the service lived in five locations around the surrounding area of West Cornwall. Locations included Govis House, Fox House, Meadow View and Connexion Street and one location in East Cornwall called Buttermill. Not everyone using The Regard Group received regulated activity; CQC only inspects the service being received by people provided with the regulated activity of 'personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

The service was able to support 44 people but only 16 people received personal care. This included one person at Govis House, four people at Fox House, five people at Meadow View, one person at Connexion Street and five people at Buttermill.

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

Relatives and staff told us they did not feel one of the services was safe. Safeguarding concerns had not always been consistently reported by staff and management in a timely manner. Staff were not always clear of their roles and responsibilities in relation to safeguarding.

People, relatives, health and social care professionals and staff were concerned about the lack of consistent leadership in the services, and high staff turnover. Staff morale was low. All commented that communication was poor.

People, relatives and staff lacked confidence that any concerns they had would be listened to or acted upon.

People were not always supported by consistently caring and suitably trained staff. Staffing levels were not sufficient to meet people's care needs in a person-centred way. This was confirmed by feedback received from people living at the service and some staff.

The delivery and planning of care were not consistently person centred and did not always promote good outcomes for people. Support plans did not contain detailed and person-centred information and therefore they did not always accurately reflect the needs of those who used the service.

Staff did not receive effective support from the management team and lacked understanding of their roles and the principles of providing high-quality care. The lack of robust management meant there was no consistent oversight of the service.

There were no effective processes in place for assessing and monitoring the quality of the services provided and to ensure records were accurate and complete. Systems had failed to identify that people were not always protected from avoidable harm. Safe care practices were not always recorded accurately within people's care records. Action had not been taken to make all necessary changes and sustain improvements following the concerns found in our previous inspection report.

The registered manager resigned in September 2020. A registered manager has been appointed and aims to commence this post in January 2021. The registered manager role is that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

The service provides care and support to people living in five ‘supported living’ settings. However, the supportive living services are also used for office space and have communal areas, which is not in line with the principles of Supportive living.

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 guidance CQC follows to make assessments and judgments 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:

The model of care and setting did not always maximise people's choice, control and independence and measures had not been taken by the provider to mitigate this. One service we visited was in a rural location and there was an absence of local amenities and public transport options. The other service was in a town and had access to the local community and amenities.

Right care:

There was a lack of person-centered care and the support people received did not promote dignity, privacy and human rights. People's needs and preferences were not always known or respected.

Staff did not always have, or display, the skills and knowledge to meet people’s needs. People did not have choice in who provided their care.

Right culture:

The ethos, values, attitudes and behaviours of some leaders and care staff did not ensure people using the service led confident, inclusive and empowered lives. People were not empowered to have choice and control over their lives. People did not always receive person centered support to live meaningful and active lives. People did not have opportunities to form community connections and make choices about who they lived with and the support they received.

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 requires improvement (published 24 August 2020) and there were two breaches of regulation. At this inspection we found not enough improvements had been made and the provider was still in breach of regulation

Why we inspected

The inspection was prompted in part due to concerns received about people’s safety, staffing and leadership. A person using the service sustained a serious injury. The information CQC received about the incident indicated concerns about the leadership of the service, the safety of people using the service and the quality of care and support that was being provided. This inspection examined those risks.

As a result, we carried out 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 Requires Improvement to Inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, 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.

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.

During the inspection process we held a meeting with the senior managers to consider if we needed to take urgent action to ensure people’s safety. Senior managers provided us with an action plan and provided assurances that they would respond to immediate concerns raised.

We have identified two continued breaches and four new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to Safeguarding service users from abuse and improper treatment, person-centered care, safe care and treatment, staffing and good governance.

You can read the end of this report for the action we took. This includes asking for an action plan and placing some conditions on their registration to drive improvement.

Follow up

We will request an action plan for 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.

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.

The Regard Group is registered both as a domiciliary care agency and a supported living service. It provides personal care to people living in their own houses and flats, and to people living in a 'supported living' setting, so they can live as independently as possible.

People's care and housing are provided under separate contractual arrangements. The CQC does not regulate premises used for supported living; this inspection looked at people's care and support.

People using the service lived in five locations around the surrounding area of West Cornwall. Locations included Govis House, Fox House, Meadow View and Connexion Street and one location in East Cornwall called Buttermill. Not everyone using The Regard Group received regulated activity; CQC only inspects the service being received by people provided with the regulated activity of 'personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

There were 44 people being supported but only 12 received personal care. This included one person at Govis House, two people at Fox House, five people at Meadow View, one person at Connexion Street and three people at Buttermill.

The service had not been developed and designed fully in line with the principles and values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that includes having control, choice, and independence. People using the service should also receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

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

The outcomes for people did not fully reflect the principles and values of Registering the Right Support for the following reasons, lack of choice and control and limited inclusion.

Safeguarding concerns had not been consistently reported by staff and management. Staff were not always clear of their roles and responsibilities in relation to safeguarding.

People were not being supported by consistently caring and suitably trained staff. This was confirmed by feedback received from people living at the service and some staff.

Feedback from managers and staff were that managing people’s anxieties was reactive rather than proactive. People’s support plans did not always inform, direct or guide staff in what actions to take to recognise when people were becoming distressed and how to support them.

Systems were not always implemented to ensure the effective management of medicines. Staff who were administering medication were not always trained and did not have their competencies checked to ensure correct procedures were followed.

Staff did not receive effective support from the management team and lacked understanding of their roles and the principles of providing high-quality care. The lack of robust management meant there was no consistent oversight of the service.

There was a lack of quality assurance processes in place to monitor the quality and safety of the service. There was a clear lack of provider oversight and they had not ensured effective and competent management was in place

In March 2020 a regional manager was appointed. Due to recent safeguarding concerns the regional manager completed an audit and developed a comprehensive action plan to address the shortfalls which have placed people and staff at risk. This was reviewed at the inspection, however the actions were not yet completed

The service provides care and support to people living in five ‘supported living’ settings. However, the supportive living services are also used for office space and have communal areas, which is not in line with the principles of Supportive living.

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 25 August 2018).

Why we inspected

We received concerns in relation to management of the service and the quality of care and support that was being provided. There had been a number of safeguarding concerns raised by other professionals. As a result, we carried out a focused inspection to review the key questions of safe 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 Requires improvement. This is based on the findings at this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Regard group- DCA Cornwall on our website at www.cqc.org.uk.

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 the safety of people and the risk of harm and the management and monitoring of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

The Regard Group is registered both as a domiciliary care agency and a supported living service. It provides personal care to people living in their own houses and flats, and to people living in a ‘supported living’ setting, so they can live as independently as possible.

People’s care and housing are provided under separate contractual arrangements. The CQC does not regulate premises used for supported living; this inspection looked at people’s care and support.

People using the service lived in four locations around the surrounding area of Redruth or in their own homes. Locations included Govis House, Fox House, Meadow View and Connexions. Not everyone using The Regard Group receives 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 take into account any wider social care provided. There were 30 people being supported but only 11 received personal care. This included one person at Govis House, two people at Fox House, four people at Meadow View, three people at Connexions and one person living in their own home in the community.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

The registered manager had been in post since the service commenced in June 2017. The service had recently had a change of management structure and the current registered manager was being supported by a second manager. This manager planned to become the future CQC registered manager of the service. At that point, the current registered manager would apply to CQC to be deregistered from their role at the service.

The organisational changes in the management structure had been necessary following a growth in the service and the registered manager role had increased. The registered manager was supported by service managers, team leaders and senior support workers. There had also been a high number of safeguarding concerns about one location in particular; this also required a regular use of agency staff to support ongoing gaps on the staff rota. These had generated a number of concerns which were being dealt with by the service and the local authority safeguarding team.

People were protected by staff who were safely recruited, trained and supervised in their work. They underwent a thorough recruitment process and undertook training relevant to their role. Supervisions were held regularly and staff felt these were useful.

Staff felt included, valued and that their opinions mattered. They felt able to raise any concerns or questions. Staff felt supported by management and felt the changes in management were for the better. Staff were very positive about the management team and their ability to lead the staff team.

Staff were encouraged to move up the ladder at the service and were supported to do this by management.

Staff had received training in safeguarding and knew what to do in the case of suspected abuse. They had been appropriately trained in medicines and people received their right medicines at the right time. People were encouraged to eat a healthy balanced diet and staff supported them to do their own shopping and maintain their independence.

People had personalised care and support plans in place. The service was not risk averse and supported people to take risks to live a fulfilling life. People had communication passports in place so staff knew their preferred way of communication. People had access to health and social care professionals when needed and advice was followed. Staff accompanied people to GP’s, dentists, hospital and opticians.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible: the policies and systems in the service support this practice. Staff understood the Mental Capacity Act 2005 and how it applied in their daily practice. Any decisions made in people’s best interests were carried out and recorded with all the appropriate people involved.

People were encouraged to undertake activities, hobbies and interests of their individual interests. Some of these were in house but the majority took place in the community. People were supported to take part in paid employment if possible.

People were treated by staff who were kind, caring and compassionate. Staff worked with people who had similar interests or who would get on well together. A key worker system was in place with a named staff member to support people’s wellbeing.

There were a number of quality assurance processes in place and the service was committed to improving its practice. There was a complaints policy and procedure in place in a format people could understand and use.