This focused inspection of Allerton C&S SW (a supported living domiciliary care service for 16 people) found a Good service across all inspected key questions, with staff demonstrating safe, person-centred practice aligned with Right support, right care, right culture principles. Minor issues were identified around topical medicines management, care plan currency, delayed mental capacity assessments, and inter-agency communication, all of which were being actively addressed.
Concerns (5)
moderateCare planning: “Some risk assessments and care plans needed review. For example, to ensure they were up to date, accurate or included enough information for staff to support people safely.”
moderateCommunication with families: “One professional said, 'I have concerns around the lack of communication [from managers] with the other agencies involved in my client's care'. Another added, 'I need to hear more from them'.”
minorMedication management: “one person's cream was not stored in the medicine cupboard and did not have an expiry date on it. In addition, there was no body map to show where the cream should be applied.”
minorConsent / capacity: “There had been delay in carrying out assessments of some people's mental capacity, but this had been addressed and decisions were recorded in line with legislation.”
minorStaffing levels: “One of the supported living homes was fully staffed, but others had vacancies. There had been significant staffing changes within the past six months.”
Strengths
· People and relatives reported feeling safe, with staff described as kind, considerate and hardworking.
· Staff received training on safeguarding, medicines administration, MCA, and specialist complex needs.
· The service worked effectively with a range of healthcare professionals including GPs, dentists, neurologists and audiologists.
· Staff were positive about management support, describing managers as approachable and available 24 hours a day.
· The provider demonstrated commitment to learning from incidents through disciplinary processes and audit-driven action plans.
Quality-Statement breakdown (19)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood
well-led: Working in partnership with othersGood
caring: Not inspected at this visit – rating carried forward from previous inspection (April 2021)Good
responsive: Not inspected at this visit – rating carried forward from previous inspection (April 2021)Good
This focused follow-up inspection of Allerton C&S SW found that all previous breaches of regulations (13, 12, 19, 18, 9, 20, 17) had been remedied, with both Safe and Well-Led key questions improving from Inadequate to Good. The service was removed from Special Measures, with the provider demonstrating embedded improvements in safeguarding, staffing, governance, person-centred care and duty of candour.
Strengths
· Safeguarding systems improved; staff now notify appropriate persons of concerns and all staff have completed safeguarding training
· Infection control measures embedded, premises clean, PPE plentiful and Covid-19 procedures in place
· Safe recruitment implemented with consistent processes, DBS checks, references and identity verification
· Sufficient staffing levels achieved following recruitment of additional staff, enabling community access
· Medicines recording system simplified eliminating risk of parallel-system errors
South West Independence Limited received a Good rating across all five key questions at its first inspection following re-registration, providing personal care to five people in an assisted living complex in Somerset. The service demonstrated strong person-centred care, consistent staffing, effective governance and a clear leadership vision focused on promoting independence.
Strengths
· People reported high satisfaction with care, noting staff understood their personal preferences, likes and dislikes
· Staff received training specific to complex needs including PEG management, epilepsy protocols and manual handling
· Consistent staff team enabled strong relationships; staff went above and beyond, e.g. arranging an Arsenal letter and trips to Cardiff
· Care plans were personalised, reviewed regularly with people, and contained clear risk assessments and consent documentation
· Registered manager was visible, approachable and had a clear person-centred vision focused on promoting independence
South West Independence Limited Care at Home was rated Good across all five key questions at its October 2018 inspection, maintaining its previous Good rating. The service demonstrated strong person-centred, safe, and well-led practice with no areas of concern identified.
Strengths
· People felt safe and consistently praised the kindness and dedication of staff
· Robust recruitment procedures ensured all staff were thoroughly checked before working with vulnerable people
· Personalised care plans included detailed risk assessments co-produced with people and reviewed regularly
· Safe medication management with staff trained and assessed as competent before administering medicines
· Staff received a comprehensive training programme including condition-specific training (e.g. epilepsy management)
South West Independence Limited Care at Home received an overall Inadequate rating following a focused inspection of Safe and Well-led, triggered by safeguarding and staffing concerns, with seven regulatory breaches identified including safeguarding, safe care and treatment, staffing, fit and proper persons, person-centred care, governance, and duty of candour. The service was placed in special measures due to widespread failures in risk assessment, capacity assessments, infection control, unsafe recruitment, insufficient staffing, and a failure to notify relatives of safeguarding incidents.
Concerns (12)
criticalSafeguarding: “People were not protected from assault by others and staff described how people had become distressed and frightened.”
criticalCare planning: “A member of staff told us, "There was not a lot of information about [Name]. A lot of it wasn't accurate."”
criticalGovernance: “The provider had failed to operate an effective system to monitor the quality of the service.”
criticalStaffing levels: “Staff were unable to provide the assessed staffing needs to others living at the service...there were insufficient staff deployed at the service.”
criticalStaff competency: “One person had complex needs and could display behaviours which challenge. Staff received no specific training...Staff told us, "Our training was not sufficient to support them."”
criticalInfection control: “There was no risk assessment in place to identify and mitigate this risk...We observed a shared hand towel in the communal toilet downstairs at the service.”
criticalConsent / capacity: “There were restrictive practices in place such as locked doors, locked cupboards and one to one support. The lack of any capacity assessments or best interest decisions meant the provider could not be sure that care was being delivered lawfully.”
criticalCommunication with families: “The provider had not acted on duty of candour. People's relatives had not been informed of the safeguarding concerns.”
criticalPerson-centred care: “Significant changes at the service had a negative on people's safety and well-being. Their needs and choices had not been considered.”
moderateIncident learning: “The provider failed to learn from incidents and put measures in place to prevent the risk of recurrence...Staff knew how to report incidents but told us they did not receive feedback.”
moderateRecord keeping: “Systems had not been operated to ensure the accuracy and effectiveness of care records...Shortfalls in care plans and risk assessments had not been identified.”
minorMedication management: “There were no easily accessible protocols for staff about when and how to administer 'as required (PRN)' medicines...agency staff would be unable to understand when the person needed pain relief.”
Strengths
· Staff evidently cared about the people they supported and were focussed on their welfare.
· Documentary evidence of staff training received following inspection showed the majority of staff had received mandatory training.
· The provider sent an initial action plan promptly following feedback and began an investigation with additional management support provided quickly after inspection.
· There were suitable systems in place to obtain, store and administer medicines.
Quality-Statement breakdown (10)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionInadequate
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate