Archived: Buckinghamshire Domiciliary Care Agency

The provider sent us an action plan which outlined how they intended to become compliant.

We returned to the service on the 2 September 2014 to check if improvements had been made.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were protected from the risk of financial abuse as mental capacity assessments and best interests meetings were undertaken in line with the Mental Capacity Act 2005. Where people were assessed as lacking capacity, the correct procedures were followed in line with the legal framework.

Is the service effective?

We found the provider had addressed concerns raised during our visits on the 1 and 6 May 2014. We found there was now an effective procedure in place to ensure complaints were handled appropriately and mental capacity training was scheduled or completed by staff within the seven services.

Is the service well-led?

The provider used a 'Compliance Confirmation Tool' (CCT) to monitor and assess the quality of the service. We found where actions were identified; action or outcomes had been clearly recorded as being undertaken or achieved. Quality monitoring visits were undertaken regularly to all the services to ensure the quality of service provision.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

We found people were placed at the risk of financial abuse as financial arrangements were not arranged in line with the Mental Capacity Act 2005, or in people's best interests. Where people were as lacking capacity, the correct procedures were not followed in line with the legal framework. This placed people at risk.

We found staff and management were knowledgeable around identifying the potential risk of abuse. Staff had received training and refresher training to ensure their knowledge and learning was up to date. Where safeguarding concerns had been raised, these had been dealt with in line with the provider's and local authorities' policy and procedures.

Is the service effective?

We saw all people had an allocated keyworker who was responsible for undertaking and recording monthly meetings to ensure people were happy with the care they were receiving. We saw one person was supported to attend counselling sessions. One service had arranged to work closely and made plans with the local learning disability nurse to overcome one person's fear of dentists. This demonstrated good person centred practice. We found where people were assessed as lacking capacity, no effective procedures were in place to monitor how people's best interests were promoted. We found complaints were not always followed up and managed in line with the provider's policy. Easy read 'how to make a complaint' documents were not always readily available for people who used the service.

Is the service caring?

One person told us 'It's really lovely living here.' We saw staff actively engaged with people who used the service. We observed one person was supported to make their own hot drinks. Another person was supported by a member of staff to attend counselling. We saw good examples of person centred practice, for example, it was noted one person was supported to collect hand creams as they enjoyed the sensory experience. We also saw one person was supported in meeting healthy and safe sexual needs.

Is the service responsive?

We saw people were promoted and supported to access community interests and to maintain their independence. We spoke with staff members who were knowledgeable about the support people received, and how best to promote their independence. People's care plans and risk assessments were reviewed annually to ensure they reflected current needs. Arrangements were in place to deal with foreseeable emergencies to ensure the welfare of people who used the service.

Is the service well-led?

The provider used a 'Compliance Confirmation Tool' (CCT) to monitor and assess the quality of the service, however, where actions were identified; it was not always evident what action or outcomes had been undertaken or achieved. Quality monitoring visits were undertaken regularly to all the services; however, for example, issues with mental capacity assessments had not been identified or acted upon in a timely manner in line with the provider's policy.

We found a support plan in place for each person. Plans included information required to coordinate people's support. However, we found gaps in key sections of some plans. Plans were not in a format which supported people's involvement in their own plan. The plans were being reviewed and person centred plans (PCPs) were being developed. One person outlined their PCP for us. The PCP had been developed with the person in a format which suited them and supported their involvement in their plans for independent living.

Staff recruitment procedures were satisfactory and protected people. Staff had been given training to support people. We had concerns about some aspects of management. The service had experienced a significant turnover of managers in recent years. There were gaps in routine monitoring by managers. The service was now implementing an improvement plan. The plan included the placement of practice development staff to work alongside people and staff in two services for six months. The initiative aimed to improve the service's effectiveness in helping people to lead more independent lives.