Three Counties Care Services Ltd

Staff described some differences in the way they supported the person with personal care, which meant the person was at risk of inconsistent care. The provider agreed to ensure all care support documents would be checked and updated so they all reflected the same needs and risks. Staff were able to tell us about the person's likes and dislikes and daily notes also showed the person was supported to choose how to spend their time.

Systems were not in place to assess and monitor safety, risk and quality. Checks were not being made of care plans, risk assessments and other care documents to ensure they were accurate and effective. Checks were not in place to ensure infection prevention control measures were being followed correctly and medications were being administered safely. The provider told us they planned to introduce checks to improve oversight of safety and quality.

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 support this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The model of care provided the person with choices about their day to day life, but there was insufficient evidence the person was actively involved in their care planning and risk management. This meant the person may not feel fully involved in their care planning and they may have opinions and preferences which had not been identified. The provider agreed they would actively ensure the person was included in care plans and risk assessments in the future. Language used by staff was not always respectful, for example, staff referred to the person's home as 'a unit.' Staff were able to describe the person's likes and dislikes and told us the person was at the centre of their care. There was no evidence to suggest the person was being unnecessarily restricted, but systems were not in place to ensure staff fully understood what the restrictions were and what they meant for the person. This meant there was a possible risk of the person being unnecessarily restricted in the event of them becoming distressed or unwell, or when being supported by a staff member who did not know them so well. The provider agreed they would look into new training for staff to enable them to better understand the mental capacity act and its implications for the person. The provider had not established effective systems to ensure the person was fully included in their care plan and risk assessment, but staff told us, and daily notes indicated the person was supported to choose how they spent their time.