Archived: Positive Community Care Recovery Services

Positive Community Care Recovery Services is a ‘supported living’ service. The service provides personal care to people with a range of needs including learning disabilities, autistic spectrum disorder, physical and sensory disabilities, mental health conditions and older people who may be living with dementia.

Not everyone who used the service 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. At the time of our inspection the service supported 78 people but only nine people received personal care.

The service was not fully developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service did not always receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

We found the service had not always taken appropriate measures to protect people from the risk of avoidable harm. Risk assessments did not consistently identify hazards or safe measures in response to people’s specific needs.

Robust recruitment practices were not always followed to make sure staff were suitable. The service had a safeguarding policy and procedure, but this was not in line with current national legislation. This meant the service did not always follow the proper procedures to protect people or alert statutory agencies. Planned and actual rotas did not always accurately reflect the level of staff required or the identity of all staff. There was no system in place to show how agreed levels of staff support were transferred to staff rotas to meet people's needs.

The storage of people’s medicines was well managed and records indicated people received their medicines as prescribed. However, we found written guidance did not always provide enough detail about ‘when required’ medicine for staff to follow.

There was a lack of comprehensive and robust oversight by the registered manager and provider. Shortfalls had been missed and action was not taken to prevent the service from falling below an acceptable standard. People's care planning documentation and management records were not always complete, accurate or contemporaneous.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. We have made a recommendation that the provider works to the principles of mental capacity legislation.

The service did not always (consistently) apply the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people did not fully reflect the principles and values of Registering the Right Support due to limited inclusion. For example, care plans and key working records did not consistently demonstrate how people were involved in decisions about their care.

The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drivers of improvement.

As part of thematic review, we carried out a survey with the registered manager at this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.

The service did not always support people effectively in line with positive behaviour support (PBS) principles. Staff did not always receive suitable training to support people in accordance with their PBS plans. Restrictive intervention practices were not always clearly understood by staff or identified in people’s positive behaviour support plans.

People were supported to access healthcare services and staff co-ordinated effectively with health care practitioners to promote people’s health. The service had recently improved staff communication systems to make sure people received continuity of care.

Relatives and people told us they were happy with the care and support they received from staff, with comments such as; “I am a very happy parent. The new team leader is 10 out of 10. My [family member] enjoys his company and their face tell me they are happy” and “[Staff] are very caring and look after [family member’s] needs. The staff go beyond the call of duty.”

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 17 April 2019 and this is the first inspection.

Why we inspected

The inspection was prompted in part by notification of a specific incident. Following which a person using the service sustained a serious injury. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of scalding. We also received concerns in relation to allegations of inadequate staffing levels and lack of management response to safeguarding concerns to protect people from the risk of avoidable harm. This inspection examined those risks.

We have found evidence that the provider needs to make improvements. Please see all key question sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Since our inspection the provider has taken action to mitigate the risk or scalding and are progressing with their action plan to address other concerns highlighted.

Enforcement

At this inspection we have identified breaches in relation to, safe care and treatment, safeguarding people from abuse and improper treatment, good governance, staffing levels, suitable staff and informing the Commission of incidents.

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.

The overall rating for this service is 'Inadequate' and the service is 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 six 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.