Barnsley Disability Services Limited

Barnsley Disability Limited Services is a domiciliary care service providing personal care to people in their own houses and flats in the community. At the time of our inspection there were 15 people using the service. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of the service and what we found:

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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

Right Support

People and their relatives were happy with the care they received. People received care and support from staff who knew them well and understood their individual needs and preferences. There were enough staff to meet people's needs and keep them safe.

People’s care plans were comprehensive and personalised. Risks to people were assessed and managed. People were supported with their medicines and their dietary needs by staff trained and competent to do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People were supported by staff who were exceptionally kind and caring. Staff protected and respected people's privacy and dignity. Staff provided personalised care and support to promote people's wellbeing, enhance their quality of life and to achieve positive outcomes. Staff were trained and understood how to protect people from poor care and abuse. The service worked well with other agencies to do so.

Right Culture

Staff were safely recruited and provided continuity in care. Staff received an induction and training which included areas of care and support, infection prevention and control, and person-specific training. Action was taken to ensure systems to monitor staff training was kept up to date. Risks to people were managed effectively and safely and people and their relatives were involved in planning their care.

Quality systems were in place to monitor the quality of service to enable the provider to improve the service and the lives of people supported. The registered manager understood their role and responsibilities. Staff placed people's wishes, needs, and rights at the heart of everything they did. The management and staff worked with external agencies and health and social care professionals.

People and their relatives told us they felt confident to approach the management team and their feedback or complaints would be listened and responded to. The management team had a shared commitment to the culture and values of the service, where people remained at the centre of their care and support.

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

Rating at last inspection

The last rating for this service was Good (published 20 October 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Barnsley Disability Limited Services on our website at www.cqc.org.uk.

Follow Up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At our last inspection in May 2017 the service was given an overall rating of ‘Requires Improvement’. Areas needing attention included risk assessments, staff recruitment and staff supervision. We asked the registered provider to submit an action plan outlining how they were going to address the shortfalls we found, which they did. At this inspection we found improvements had been made in the areas previously highlighted and the governance of the service was more robust.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Barnsley Disability Services Limited’ on our website at www.cqc.org.uk.

Barnsley Disability Services is a domiciliary care agency which provides care services, including personal care, to people with a range of disabilities who are living in their own houses and flats in the community. At the time of the inspection it was supporting 15 people who needed assistance with their personal care, such as their personal hygiene.

The service had a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission [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.

People told us they received the care and support they needed from staff who were caring, friendly, helpful and compassionate.

People were supported safely. Potential risks to individual people, and the environment they lived in, had been assessed and these were reviewed as needed. There were robust systems in place to reduce the risk of abuse.

Where people needed support taking their medication this was managed safely by staff who had been trained to carry out this role.

Recruitment processes had been improved to make sure essential checks were made prior to new staff commencing work. This helped to ensure only staff suitable to work with vulnerable people were employed. Staff had undertaken a range of training that aimed to meet people’s needs, while developing staffs’ knowledge and skills. Staff took part in periodic meetings with the management team to provide them with the support they needed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People’s privacy and wishes were respected and they were treated with dignity.

Where needed people were supported to maintain a balanced diet, and their dietary needs and choices were met.

People were supported to maintain relationships with people who were important to them and to participate in social activities within the community and at home.

People’s needs had been assessed before their care package started and involvement in planning care had been encouraged. Plans were person-centred and gave clear guidance to staff on supporting each individual person. Staff worked closely with other social and healthcare professionals to ensure people received a service that met all their needs.

People knew how to raise any concerns and felt comfortable doing so. No complaints had been raised since the last inspection, but a system was in place to record, investigate and resolve any complaints received.

People were consulted about their satisfaction in the service provision and systems were in place to make sure company policies were followed. All the people we spoke with told us they were very happy with the way the service was run. People spoke positively about the registered manager and how staff delivered care.

Further information is in the detailed findings below.

There was a manager at the service who was registered with CQC. A registered manager is a person who has registered with the Care Quality Commission 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 visit to the agency office took place on 11 May 2017. The registered manager was given short notice of the inspection, because the location is a domiciliary care service and we needed to be sure the registered manager would be available.

The service was last inspected on 13 October 2016. The overall rating was requires improvement and a requirement notice was issued for regulation 18, staffing and a warning notice for regulation 12 safe care and treatment and regulation 17 good governance. Concerns in staffing related to staff receiving adequate supervision and appraisal, concerns about safe care and treatment was related to full and complete risk assessments and management of medicines and for good governance it was about the systems and processes in place to ensure staff received adequate supervision and appraisal, that full and complete risk assessments were in place and that medicines were managed safely. We checked and found that whilst there had been some improvements there were still some areas that required further improvement to meet regulation 17. You can see what action we told the provider to take at the back of the full version of this report.

Staff had received training so they had the skills to carry out their role and this was updated regularly. Staff had also received and annual appraisal. Observations of their work practice had commenced, but individual supervision meetings had not taken place, which meant there was no formal arena for staff and manager to discuss work performance and personal development, in accordance with the service’s own policy.

We found there were arrangements in place to ensure people received medicines at the right time.

Care records reflected the care delivered to people and the care and support they described to us.

Risk assessments had been reviewed to assess identified risk relevant to the health, safety and wellbeing of people, for example, supporting people with their finances, medicines, where people used staff transport and equipment. However, these required further improvements as some of this information was generic and contradictory.

Quality assurance systems had been improved, but these required further improvement to ensure compliance with the service’s own policies and procedures and that safe systems of work were in place for the management of people’s finances.

There was a strong person centred and caring culture at the agency. (Person centred means that care is tailored to meet the needs and aspirations of each person, as an individual.) The vision of the service was shared by the management team and staff. People had confidence in the service. Staff and people who used the service told us they thought the service was well-led.

Staff told us they worked as part of a team, that Barnsley Disability Services Limited was a good place to work and staff were very committed to providing care that was centred on people's individual needs.

Staff had a good understanding of what to do if they saw or suspected abuse or if an allegation was made to them.

There were sufficient staff to meet people’s needs and provide a regular team of care staff to people who used the service. Recruitment information required improvement to demonstrate those staff were suitable to work with people who used the service.

People told us the service provided good care and support. They told us the staff were caring, kind and respected their choices and decisions. Staff were familiar with people’s individual needs and were able to describe how they maintained people’s privacy and dignity.

People told us staff sought people’s consent to care and treatment, but we found records were not available to support legal requirements when decisions were made in people’s best interests.

People were supported with their health and dietary needs, where this was part of their plan of care or in an emergency.

People and relatives told us when they raised any issues with staff and the registered manager; their concerns were listened to and acted on.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a manager at the service who was registered with CQC. A registered manager is a person who has registered with the Care Quality Commission 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 visit to the agency office took place on 14 October 2016. The registered manager was given two days notice of our visit. We did this because the registered manager is sometimes out of the office and we needed to be sure that they would be available.

The service was last inspected on 30 April 2014 and was meeting the requirements of the regulations we checked at that time. This is the first rated inspection of the agency.

Staff had received training so that they had the skills to carry out their role and this was updated regularly, so that people were cared for by staff received effective care. Staff received regular checks of their work, but supervision meetings and appraisal were not carried out.

Care records had been reviewed, but did not always reflect the care delivered to people and the care and support that they described to us.

Some risks to the health, safety and wellbeing of people who used the service were assessed and action was taken to minimise those risks, but we found care plans and risk assessments contained either none or insufficient information for supporting people with their finances, medicines, where people used staff transport and equipment.

There were quality assurance systems in place to monitor the quality and safety of the service provided, however the registered manager had already recognised these systems required improvement to allow them to assure themselves of the quality of service delivery and that they met regulations.

There was a strong person centred and caring culture at the agency. (Person centred means that care is tailored to meet the needs and aspirations of each person, as an individual.) The vision of the service was shared by the management team and staff. People had confidence in the service. Staff and people who used the service told us that they thought the service was well -led.

Staff told us they worked as part of a team, that Barnsley Disability Services Limited was a good place to work and staff were very committed to providing care that was centred on people's individual needs.

Staff had a good understanding of what to do if they saw or suspected abuse or if an allegation was made to them.

There were sufficient staff to meet people’s needs and provide a regular team of care staff to people who used the service. Recruitment checks showed those staff were suitable to work with people who used the service.

People told us the service provided good care and support. They told us the staff were caring, kind and respected their choices and decisions. Staff were familiar with people’s individual needs and were able to describe how they maintained people’s privacy and dignity.

Staff sought people’s consent to care and treatment.

People were supported with their health and dietary needs, where this was part of their plan of care or in an emergency.

People and relatives told us when they raised any issues with staff and the registered managers, their concerns were listened to and acted on.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We considered all the evidence against the outcomes we inspected to help answer our five key questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

There were risk assessments in place for people using the service in relation to their support and care provision. Therefore people were not put at unnecessary risk, however people also had choice and remained in control of their own decisions. This meant that people's independence was promoted and they were not restricted from engaging in and accessing the wider community.

Systems were in place to make sure that the manager and staff learned from events such as accidents, incidents, complaints and concerns. Policies and procedures were used to protect people from unsafe practices. This reduced the risk to people and helped the service to continually improve.

However, the medication policy was not sufficiently detailed, for example there was no explanation as to the types of medication assitance available. We also found that some people were being assisted with medication where they should not have been. This meant there was a risk to people's care and welfare regarding their medication.

Staff received training in the Mental Capacity Act 2005 (MCA) and safeguarding to ensure that people were safeguarded appropriately in line with current legislation. We saw however, that relevant resources were not readily available for staff, for example the code of practice for the MCA.

Recruitment practices were safe, thorough and effective procedures were in place to ensure staff were suitable for the role.

Is the service effective?

People's health and care needs were assessed and they were involved in compiling their own support plans. Specialist needs such as specific equipment for moving and handling had been identified in care plans where this was required. Information had been taken into account from other professionals and organisations which demonstrated that a holistic approach was undertaken with regards to support.

Is the service caring?

People using the service told us, 'I wouldn't want any other service', 'they're really good, really caring' and 'I cannot praise the carers enough, they're excellent, I class them as part of our family'.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People were supported and encouraged to complete tasks to promote their independence. People were assisted to access the community and and care workers helped people take part in community activities.

People knew how to make a complaint if they were unhappy and said they would tell staff and would feel comfortable in doing so.

Care plans were reviewed by staff on a regular basis and in response to any changes in needs. People told us that they could make amendments to their support and the service would accommodate their needs.

Is the service well-led?

The manager and staff worked with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance and audit system in place and staff were monitored by the provider to ensure they were providing suitable care and support. Feedback was sought from people using the service on a regular basis so that improvements could be made and good practice could be recognised.

Staff told us they were clear about their roles and responsibilities. Discussions on best practice, improved ways of working and knowledge sharing were common throughout team meetings, supervisions and informal discussions.