Collingswood House

The key question of safe was rated as good at our last assessment. At this assessment the rating has changed to requires improvement. People we spoke with felt safe and protected from the risk of harm and abuse. Systems were generally in place to keep people safe. There was a safeguarding policy, staff had safeguarding training, and they told us they would report any concerns they had. Staff supported people who had capacity to make decisions about risk. Risk assessments for these people were completed to promote independence and minimise risks to people and staff. However, the service had not adequately assessed the safety of people who did not have capacity to consent but were locked within their own homes. This failure put people at risk of harm and the service was in breach of regulation. Staff were not always being given adequate travel time between visits to ensure visits both began on time and were not ended early. Therefore, this was a failure by the service and a breach of regulation relating to how the service was being managed. The service ensured there were sufficient safely recruited staff to carry out visits, and they had received training to meet peoples’ needs. Service managers were working to create a positive learning culture at the service. At our previous assessment in January 2024 the service did not manage peoples’ medication effectively. The service had improved in this area and now effectively administered people’s medication where the service was commissioned to manage and administer people’s medication. The service and their partners in the health and social care system were working together in partnership. However, the service and commissioning Local Authority had not worked together to assess people at risk under the MCA.

The key question of effective was rated for the first time at this assessment and was rated requires improvement. Peoples’ assessments and care plans were generally clear, comprehensive and provided guidance to staff to keep people safe. Each person had a copy of their care plan in their home and they and their relatives were involved in its development and review. However, assessment under the Mental Capacity Act 2005 (MCA) was missing from both peoples’ assessments and care plans. During our assessment in January 2024, we identified the management of the service was lacking knowledge and skills in applying the MCA in community settings. The service management had failed to gain either skills or knowledge about the application of the MCA since then, and so multiple situations where the MCA should have been applied had been missed. Due to this the service was in breach of regulation relating to consent. The service had failed to take its part in maintaining people’s human rights. Staff were being trained to carry out their care role. People were supported by staff to do as much as possible for themselves, to enable them to improve or maintain their abilities. Staff worked with people to support their general health and wellbeing. Although divided into area teams, staff worked well together to travel out of their own area to ensure people’s needs were always met. All care staff and office-based staff worked closely together to ensure all visits were carried out.

The key question of caring was rated for the first time at this assessment and was rated good. Staff were kind, compassionate, caring and enthusiastic. Staff had caring and supportive relationships with people. Staff treated people with dignity and respect when helping them with daily living tasks. Care staff knew about peoples’ individual needs and preferences and this knowledge was used in their care and support.

People’s care planning had current information to promote people’s independence in areas such as their mobility, communication and going out into the local community. Staff were always willing to help in an urgent situation and staff had the skills and knowledge to recognise and know what to do should they visit someone who was in distress.

Staff were being actively supported by the service. The service worked hard to support their staff with team building activities and reward schemes, and staff were positive about their employer.

The key question of responsive was rated for the first time at this assessment and was rated good. Most care and support was person centred and designed around people’s needs, preferences and wishes. However, some people’s care had failed to recognise people’s rights under the MCA and therefore their care was not individualised to them. However, managers and staff often went far beyond what was contractually required of the service.

Staff either got to know people on shadowing visits, or in urgent situations by reading the person’s care plan. People were supplied with the information they needed in a format they could use. The service had a good understanding of discrimination and inequality, and they worked hard to be able to support every person that was referred to them.

Some people did not always feel supported to raise concerns with the management of the service, but the service managers were working hard to make people feel comfortable to approach them whenever they had concerns. Some of the communication between people and the office had been handled poorly but the service management was taking action to improve this. The investigation of complaints had recently been improved but further improvement work was continuing.

The service supported people to plan for the future, so they could make informed decisions in advance of the end of their life. The service provided as much support as they could in the final weeks and days of peoples’ lives.

The key question of well-led was rated as good at our last assessment. At this assessment the rating has changed to requires improvement. Managers in the service were caring and supportive towards staff and the people that used the service. Staff were listened to and were supported in their roles by an approachable management team. Staff recommended the service as a good place to work. The relatively new management team worked closely together to cover all aspects of the delivery of the service. The management team led with integrity, and openness. The management team demonstrated their passion to improve the service and recognised there were areas that still needed further improvement. The service did not yet have an organised approach to assess and learn from feedback about the service. Staff training had improved recently with the arrival of a service training manager. There had been an increase in training that staff were required to do, and further training was planned.

The service had grown considerably over recent years, and the management and coordination of the service had also grown over this period to deliver this larger service. However, the service had limited governance systems and issues such as the lack of MCA knowledge, had not been acted upon by the service management team. We found that there was a failure of governance and management in monitoring visit times. These issues contributed to a breach of regulation.