Domiciliary Care Service

Domiciliary Care Service is operated by Hertfordshire County Council (HCC) from a central office within Farnham House, Stevenage. At the time of our inspection, 337 people received care and support from teams of staff who were responsible for specific supported living settings and geographical areas.

Not everyone using Domiciliary Care Service receives the regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

People's experience of using the service and what we found.

Although the provider had a clear visitor’s policy in place to prevent visitors from catching and spreading infections, this was not consistently followed across each setting. At two, out of the three settings we visited, we were not asked to disclose if we had recently experienced any COVID-19 symptoms and our temperatures were not taken, in line with policy.

Staff demonstrated a good understanding of infection prevention and control (IPC) procedures. All staff had received appropriate training and understood the importance of following government guidance in relation to IPC.

There was enough Personal Protective Equipment (PPE) available and we observed staff wearing this in accordance with current guidance. Social distancing measures were in place but there was some local variance in how effectively these were implemented. People were supported by staff to complete any additional cleaning required, in line with individual needs.

People and their relatives told us they were supported to remain in touch via a range of methods, which were assessed on an individual basis. Easy read information had been produced to support people’s understanding of COVID-19 and government guidance. Risk assessments had been completed to manage the risks in relation to COVID-19 and help keep people safe.

Individual setting managers told us there had been some challenges in accessing routine testing for COVID-19, however, this was in the process of being resolved. A comprehensive infection prevention and control policy was in place and had been updated specifically in relation to COVID-19.

Rating at last inspection

The last rating for this service was Good (published 26 April 2019).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in response to concerns received about infection control procedures. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question. We found no evidence during this inspection that people were at risk of harm from these concerns.

Please see the safe section of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Domiciliary Care Service on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Not everyone using Domiciliary Care Service receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them

People’s experience of using this service:

People and their relatives were confident that people were safe and well protected from the potential risks of abuse and avoidable harm. Staff received training about how to safeguard people from harm and were knowledgeable about the risks and potential signs of abuse. Where potential risks to people’s health, well-being or safety were identified, staff were knowledgeable about these risks and knew how to respond safely.

Staff received fire awareness training. Practice evacuations took place to help ensure staff and people knew how to make their way to ‘safe zones’ as quickly as possible. Fire safety equipment was made available including evacuation chairs and slides. Staff had received infection control training, the houses we visited as part of this inspection were clean. Incidents and accidents were recorded, investigated and reviewed by the management team. This helped to ensure steps were taken to identify, monitor and reduce risks.

Safe and effective recruitment practices helped ensure staff were of good character and sufficiently experienced, skilled and qualified to meet the complex needs of people who used the service. People, their relatives and staff confirmed there were enough experienced, qualified staff to meet people’s individual support needs. Regular bank and agency staff covered for staff shortages and unforeseen absences such as sickness. People’s medicines were stored, managed and disposed of safely. Staff were trained and supported people to take their medicines at the right time in accordance with the prescriber's instructions and had their competencies checked by senior colleagues.

People's needs and preferences were assessed and the care provided was based on this assessment. Staff received training and refresher updates in a wide range of subjects relevant to their roles and specific to the needs of the people supported. Newly recruited staff completed an induction programme and did not work unsupervised until assessed as competent to provide care and support in practice. Staff said they felt valued, listened to and were well supported by their management team.

Staff were knowledgeable about people’s nutritional needs, and supported them to eat a healthy balanced diet wherever possible. Staff had good relationships with external professionals who told us they were confident that people received good support from the service. People had access to a wide range of health and social care professionals relevant to their needs. Staff sought people’s consent to the care and support they received, together with that of their relatives where appropriate.

People were positive about the quality of care provided by the staff and managers who supported them. People’s relatives complimented the staff team for the care and support they provided. Staff had developed positive and caring relationships with people and were knowledgeable about their individual needs, personal circumstances and factors that affected their moods and behaviours.

People were fully involved in the planning and reviews of their care and support. Each person had a ‘key worker’ assigned to them who was responsible for ensuring they received the support required to meet their individual needs. People were supported to access advocacy services to obtain independent advice and guidance relevant to their needs where needed. Staff respected people’s privacy and promoted their dignity. Confidentiality was well maintained, and information held about people’s health, support needs and medical histories was kept secure.

People received personalised care and support. Detailed information and guidance had been developed to help staff provide consistent care and support in a person-centred way. People enjoyed a varied and active social life with the encouragement, support and involvement of staff. Staff and management learnt from people’s experiences, concerns and complaints in a positive and responsive way. People and their relatives knew how to make a complaint and said the management team responded to any concerns raised in a prompt and positive way. People were encouraged to give regular feedback about the service they received.

The service supported people who do not wish to move to a clinical setting as they approached end of life. Staff received specific training in this area and hospices were also involved with people’s end of life care and provided advice and guidance as needed.

People and their relatives were positive about how the service was managed. The management team undertook checks and audits in a wide range of key areas to help ensure a safe service was maintained. The management team were clear about the provider’s values and the purpose of the services provided. Staff also understood these values.

Staff told us that managers were effective in their roles, approachable and gave them clear and consistent leadership. People’s relatives told us that managers were good at keeping them informed about developments and changes to the care and support their family members received where appropriate.

The registered managers and site managers were knowledgeable about the people who received support, their needs, personal circumstances and the relationships that were important to them. They ensured that staff had the tools, resources and training necessary to meet the varied needs of all the people they supported. The provider routinely distributed feedback forms to people, staff members, relatives of people who used the service and health professionals to gain their opinions on the service provided.

Rating at last inspection: The service achieved a Good rating at the last inspection in August 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Because of the size and nature of the service our inspection took place over a number of dates, namely; 14, 15, 18, 19, 20, 21, 22 and 25 April, 03 and 12 May and 02 and 10 June 2016. This enabled us to visit and talk with people who lived in different areas, together with relatives and staff members, and gather a range of information relevant to the inspection. The visits were announced which meant that senior representatives of the provider were given a 48 hour notice period before each site visit. This was to help facilitate the inspection and make sure that people who used the service and staff members were available to talk with us.

At our last inspection on 17 and 18 October 2013, we found that the service was not meeting the required standards in some of the areas we looked at. This included some aspects of the care and support people received, the management of medicines, the way in which services were quality assured and how staff were supported to do their jobs. At this inspection we found that the required improvements had been made and that the service was meeting all of the fundamental standards.

There was a manager in post who had registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 and associated Regulations about how the service is run. The registered manager was supported by area managers and a number of unit managers based at and responsible for the day-to-day operation of each site where people received care and support.

People told us that staff helped them stay safe, both where they lived and when out and about in the local community. Staff had received training in how to safeguard people from abuse and were knowledgeable about the potential risks and how to report concerns. Robust recruitment practices were followed and there were sufficient numbers of suitable staff available to meet people’s individual support needs.

Where necessary and appropriate, people were supported to take their medicines safely and as prescribed by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively. Plans and guidance were in place to help staff deal with unforeseen events and emergencies in a safe and effective way.

People and their relatives were positive about the skills, experience and abilities of staff who provided care and support. Staff received training and refresher updates relevant to their roles and the needs of people who used the service. They worked closely with managers and senior colleagues and had frequent opportunities to discuss and review their personal development and performance.

Staff provided appropriate levels of support to help people maintain good health and to attend appointments and access health and social care professionals when necessary. Where appropriate, people were encouraged and supported to eat a healthy balanced diet that met their individual needs and dietary requirements.

People were asked for their consent, views and agreement before any personal care or support was provided. They, together with relatives where appropriate, were also involved in the planning and reviews of the care they received. However, consent and involvement were not always consistently or accurately reflected in their plans of care which is an area that requires improvement.

Throughout our inspection, and at all of the sites we visited, we found that staff supported people in a kind and caring way that promoted their dignity. They had developed positive relationships with the people they supported and were clearly very knowledgeable about their individual needs and personal circumstances. Staff were knowledgeable about people’s background, life histories, and routines and supported them to pursue social interests, hobbies and activities relevant to their needs. The confidentiality of information held about people’s medical and personal histories was securely maintained at the service.

People who used the service and their relatives told us that unit managers and staff members listened to them and responded positively to their views, suggestions and any concerns they had. Everyone we spoke with told us they were encouraged to have their say about their support and how the service operated and knew how to make a complaint if the need arose.

People, their relatives, staff members and professional stakeholders were all very complimentary about the overall management arrangements and, in particular, the unit managers and senior staff responsible for each of the sites where people received support. The registered manager and their management team regularly monitored the quality of services and potential risks in order to drive continuous improvement across the service.

Generally, when asked how the care would be rated from the agency, people told us that services were good. One person told us, 'Staff are very nice, they are helpful when I'm ill, upset or done something wrong...The staff talk about it and help me solve things'. However, a lack of planning and completion of 'purple folders', the records that provided information to health care professionals, meant that there was a risk that people's needs would not be met in a timely way.

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff had not received all the relevant training to ensure that they could care for people to an appropriate standard.

There was not an effective system in place to regularly assess and monitor the quality of service that people received.

There was an effective complaints system available. People told us they felt staff listened to them.

One person told us that they had been unhappy with the care they received from other services and that they were now happy with the care and support they were given. Other people said that they would like more involvement in menu planning and the opportunity to go shopping for food.

We found that sometimes the people were offered an inconsistent service. For example on location we visited closely involved the people in planning and delivering their care while another did not have an up to date care plan.

We found that staff were well trained to meet the needs of the people and we were told that the staff felt very well supported, particularly when they were caring for people with very complex needs.

The provider had included people in how the service was planned to ensure their needs and wishes were recognised and where possible met. People had been involved in the recruitment and selection of staff.