The overall rating for this service is inadequate and the service is therefore in special measures.

About the service: Grazebrook Homecare is a supported living service providing personal care to seven people with learning disabilities, and physical disabilities and adults aged 65 years and over.

People’s experience of using this service:

People told us they felt safe using the service but we found care and treatment was not always provided in a safe way. The provider had continued to fail to update care plans and risk assessments for peoples changing needs.

The provider continues to fail to ensure people’s care plans and risk assessments contained accurate and up to date guidance. Risk to people was not identified therefore no plans were put in place, exposing people to harm.

No action had been taken to reduce re-occurring risks. Analysis of incidents and accidents was not kept. There was a lack of good governance and oversight therefore, audits had not been completed since the last inspection.

Systems and processes were not effective in assessing, monitoring and mitigating the risks relating to environmental health, safety and welfare of people. Environmental Audits had not taken place since the last inspection.

The provider had not undertaken capacity assessments since the last inspection, it was unclear whether people had agreed or consented to care and treatment or had contributed to the development of their care plans. The local authority had not been notified of people who were deprived of their liberty. The provider did this on the day of inspection

Rating at last inspection: Rated inadequate (report published 22/02/19)

Why we inspected: In the previous inspection we found a breach of regulations. The provider

informed us what they would do to meet the requirements. The information shared with CQC about

the management of risks indicated potential concerns about the safe care and treatment of people

and a lack of governance and oversite. This was a focused inspection that examined those risks.

The inspection took place on 14 February 2019

Enforcement

Full information about The Care Quality Commission’s (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Follow up

As we have rated the service as inadequate, the service will be placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspect again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not, enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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 overall rating for this service is inadequate and the service is therefore in special measures.

About the service: Grazebrook Homecare is a supported living service providing personal care to seven people with learning disabilities, and physical disabilities and adults aged 65 years and over.

People’s experience of using this service:

People told us they felt safe using the service but we found care and treatment was not always provided in a safe way. The provider had failed to update care plans and risk assessments for peoples changing needs.

The provider failed to ensure people’s care plans and risk assessments contained accurate and up to date guidance. Risk to people was not identified therefore no plans were put in place, exposing people to harm.

No action was taken to reduce re-occurring risks. Analysis of incidents and accidents did not take place. There was a lack of good governance and oversight therefore audits and checks were ineffective.

Systems and processes were not effective in assessing, monitoring and mitigating the risks relating to environmental health, safety and welfare of people. Audits did not take place on a regular basis.

The provider had not undertaken capacity assessments, it was unclear whether people had agreed or consented to care and treatment or had contributed to the development of their care plans. The local authority had not been notified of people who may be deprived of their liberty.

People were supported to access health care services when they needed. People and their relatives told us staff were good at monitoring their health needs. Staff had completed mandatory training.

Staff treated people with kindness and respect. People said they liked the staff and relatives said they could talk to staff. People and relatives were confident if they raised a complaint, it would be dealt with appropriately.

Rating at last inspection: Rated good (report published 29/03/2016)

Why we inspected: This was a planned inspection based on the ratings at the last inspection. The

inspection took place in 15 January 2019

Enforcement

Full information about The Care Quality Commission’s (CQC) regulatory response to more serious concerns found in inspections and appeals is added to reports after any representation and appeals have been concluded.

Follow up

As we have rated the service as inadequate, the service will be placed in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspect again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so that there is still a rating of inadequate for any key question or overall, we will act in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

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.

This inspection took place on 17 February 2016 and was announced. We gave the provider 48 hours’ notice that we would be visiting the service. This was because we wanted to make sure staff would be available to answer any questions we had or provide information that we needed. We also wanted the registered manager to ask people who used the service if we could contact them.

The service is registered to provide personal care and support to people in their own homes and at a supported living service. People who use the service may need support or care due to old age, learning disability or physical disability. At the time of the inspection the service was providing support and personal care to seven people in four separate supported living services. Supported living enables people who need personal or social support to live in their own home supported by care staff instead of living in a care home or with family. The levels of support people received from the service varied, according to their assessed needs and levels of independence. This was the first inspection of this service.

There was 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.

People were supported by staff who had received training in how to recognise possible signs of abuse and how to report any concerns. Staff were aware of their responsibilities in this area and what actions they should take. All staff spoken with were confident that if they did raise any concerns, that they would be listened to and acted upon.

Staff were recruited appropriately and there were sufficient number of staff to meet people’s needs. Staff received induction training which included shadowing senior colleagues before starting work. Ongoing training was in place in order to develop staff skills and systems were in place for management to assess the effectiveness of the training provided.

People were supported to live their lives in the least restrictive way possible, staff understood the requirements of the Mental Capacity Act [MCA] and Deprivation of Liberty Safeguards [DoLS], and what it meant for the people they supported.

People were supported with their nutrition and health care needs.

People told us that the staff who supported them were kind and caring and helped them maintain their independence.

People were involved in developing how they wanted to be supported and were encouraged to be as independent as possible and achieve their aspirations.

People were confident that if they had any concerns, they would be dealt with appropriately.

The registered manager and staff group were described as supportive and approachable. Staff performance was monitored and efforts were made to ensure staff were well supported in their roles.

A number of audits were in place to assess the quality of the service provided but had failed to identify a number of issues highlighted by the inspection.. The registered manager and staff regularly sought feedback from the people they supported.