Courage Limited

We assessed the following quality statements: Safeguarding, Involving people to manage risks, Safe and effective staffing and Medicines optimisation.

Improvements were required to recruitment and staff deployment. Safe recruitment processes were not always followed, and staff did not always attend care visits within the time they were expected. The provider was monitoring people’s care calls and recent improvements had been made.

Staff training records did not reflect staff had received all the training required to carry out their role. The service is a specialist service that is used by autistic people or people with a learning disability and not all staff had received training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role.

We found breaches of the legal regulation in relation to safeguarding and safe care and treatment. Staff did not always identify allegations of abuse or make referrals in line with policy. Staff did not always assess risks to people's health and safety or mitigate them where identified. Risk assessments were incomplete and did not include risks we identified during our assessment. People’s medicines were not always administered safely.

We assessed the following quality statements: Assessing Needs and Consent to care and treatment.

People received an assessment of their needs before receiving support from the service. However, this information was not always updated in people’s care plans when their needs changed.

People were asked to consent to their care and told us staff respected their wishes. However, the systems in place did not always support this practice.

We assessed the following quality statements: Independence, choice and control.

People provided mixed feedback about how staff supported their independence and choices. People were involved in planning their care as much as they were able.

We assessed the following quality statements: Equity in experiences and outcomes.

People were aware of how to provide feedback on the care but not all people were confident this would always be responded to. Records of complaints lacked detail to ensure these were followed up appropriately. People were provided with information in an accessible way that met their needs.

We assessed the following quality statements: Shared Direction and Culture, and Governance, Management and Sustainability.

Improvements were required to ensure the effective management and oversight of safeguarding, incidents and accidents, care plans, risk assessments and medicines. Improvements were needed to ensure safe recruitment practices were implemented as well as ensuring mental capacity assessments were correctly completed and staff training records were up to date. The processes in place to assure the quality of the service were not always effective and staff did not always feel supported in their roles by the management team.