Archived: In Out and About Community Support Office

The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2015. More information about this is in the full report. This service has not been inspected since 2015 because the provider ceased to provide the regulated activity of personal care between 2016 and 2018.

People’s experience of using this service:

• The person was protected from avoidable harm. The risks to their safety had been appropriately assessed and acted on. Environment and evacuation risk assessment were not in place at the time of the inspection. Immediate action was taken to address this. The person received support from a small and consistent team of staff. The person did not receive support from staff with their medicines. There were no infection control risks. The registered manager had the processes in place to investigate and act on any accidents and incidents. To date, there have been none.

• The person’s care and support was provided in line with their assessed needs and protected the person from discrimination. Most staff training was up to date, action was being taken to address the shortfalls. Staff felt supported to carry out their role. Staff supported the person to lead a healthy and balanced lifestyle. The person was supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

• Staff had built a meaningful, kind and caring relationship with the person. Staff treated the person with respect and dignity and listened to and acted on their views. The person’s privacy was respected. Effective processes were in place to store records safely and in line with data protection legislation.

• The person received person centred care and support that considered their choices and preferences. Staff supported the person to achieve their agreed goals. The person was supported to access the community. Efforts had been made to provide information in a format the person could understand. No complaints had been received, but there were appropriate policies and procedures in place to act if there was. End of life care was not provided.

• Improvements had been made to the overall governance of the service. An additional member of staff was in place to support the registered manager with maintaining high quality records. Records viewed were now comprehensively completed and reviewed. The views of the person were used to help improve and develop the service. Staff enjoyed working at the service and felt respected and valued. Quality assurance processes were in place to help inform the provider of the quality of the service provided.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (Published May 2015).

Why we inspected:

This was a planned inspection.

Follow up:

We will continue to review information we receive about the service until the next scheduled inspection. If we receive any information of concern we may inspect sooner than scheduled.

Throughout this inspection we focused on these five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

A relative of a person who used the service told us, 'Staff are there to support [family member] with bathing and choosing the right clothes. They [family member] would wear a t-shirt and shorts all day if staff weren't there to help. They help keep them safe.'

Care plans contained limited information for staff on how to assist a person with their personal care in areas such as washing and bathing. Care plans were not reviewed or updated regularly.

The provider did not have sufficient processes in place to ensure that people were kept safe from abuse. Safeguarding polices did not contain sufficient guidance for staff to follow if they felt a person had been abused. The registered manager was not aware of notifiable incidents, such as allegations of abuse that were required to be forwarded to the CQC.

The registered manager told us they were aware of the principles of deprivation of liberty safeguards (DoLS), but stated it was unlikely, due to the nature of the support they gave to people who used the service, that one would need to be implemented.

There were limited policies and procedures in place for the safe handling and administration of medication. Staff had received no training in this area.

Is the service effective?

Relatives spoken with told us they were involved with decisions relating to their family member's care. One relative we spoke with told us, 'We are involved fairly regularly with reviews, we are asked to contribute to decisions.' Another said, 'They [staff] talk to me, they keep me involved.'

Mental Capacity assessments were not completed where required. The Mental Capacity Act (MCA) is legislation used to protect people who might not be able to make informed decisions on their own about the care and support they received. Staff knowledge of the principles of the MCA was limited.

Risk assessments were not always regularly reviewed or updated and we could not judge whether they reflected each person's current level of care and support needs.

Staff did not always receive regular supervision or appraisal of their work nor, at the time of the inspection had they received sufficient training for their role.

We asked members of staff whether they felt appropriately trained for the role they undertook. One person said, 'I have worked in this role before so I have the experience. However there has not been a lot of training here, although we do get help with NVQ's. We do suggest training to the manager. It wasn't always acted on, but it has improved recently.'

Is the service caring?

Due to the nature of the service we were unable to view staff interact with people who used the service. However one relative we spoke with said, 'They [staff] help [family member] a whole lot more than I can. They help them in the community; the care they provide is absolutely fantastic.' Another relative said, 'The staff seem to know what they are doing. I have worries about them.'

Is the service responsive?

We saw the registered manager had started to implement a contingency plan where there would be clear guidelines for them and staff to follow should they need to respond to an emergency, such as; evacuation of the office premises or if they had a power failure. However this had not yet been completed and therefore we were unable to judge its effectiveness.

Is the service well-led?

There were limited systems in place to monitor the quality of the service provided. Care plans were not reviewed regularly and risk assessments did not contain sufficient information for us to judge whether they reflected each person's current level of need.

People's views on the quality of the service received were encouraged, but not formally reviewed or recorded.

Incidents were investigated and the registered manager made recommendations in order to prevent them reoccurring. However there was no system in place to monitor whether the recommendations had been acted on by staff or their effectiveness in reducing the risk to people who used the service.

There was no complaints register in place.

People spoke positively about the registered manager. A member of staff told us, 'The manager has improved. He is great with the people we support. He has now improved the communication with staff as well, which is great.' A relative we spoke with said, 'The manager is a decent guy, he seems to do his best.' Another relative said, 'The manager is really 'hands-on', he communicates really well with us.'

The provider may wish to consider de registering their service with us until such time they require to provide this regulated activity.

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