Background to this inspection
Updated
12 October 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
This inspection took place on 6, 18 August and 7 September 2015 and was announced. The inspection was announced 48 hours prior to our first visit. This is in line with our current methodology for inspecting domiciliary care agencies and enables services to ensure that staff are available to speak with us. The inspection was undertaken by an adult social care inspector.
Before the inspection we requested the provider complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well, and improvements they plan to make. We also contacted a social worker and a local authority commissioner who had recent involvement with the service in order to obtain their views about the support provided by Sheffield DCA.
Prior to our inspection visit we reviewed the PIR together with other information about the service in the form of notifications sent to the Care Quality Commission.
During our inspection we visited the provider’s supported living service provided from Leighton View and St. Elizabeth’s Close. These were the two locations which provided the most support hours. We visited and spoke with two people who lived at Leighton View and four people who lived at St. Elizabeth’s Close. Our conversations enabled us to gain people’s views about the service.
On the first day of our inspection we visited both locations and spoke with the registered manager, two support workers from Leighton View and one support worker from St. Elizabeth’s Close. The second day and third days of our inspection focussed on the support provided from St. Elizabeth’s Close. We spoke with two support workers and with the regional manager who attended the second day of our inspection due to the registered manager and the manager of St. Elizabeth’s Close being on leave.
We reviewed a range of records during our inspection visits to the above satellite sites; these included the support files of three people from St. Elizabeth’s Close and three people from Leighton View. We also reviewed a number of records relating to the running of the service. These included policies and procedures, eight staff files, staff training records and quality assurance documents.
Updated
12 October 2015
This inspection was undertaken on 6,18 August and 7 September 2015.
Sheffield DCA provides domiciliary care to adults in the community. It is run by United Response. The service includes support with domestic tasks, support in the community and personal care. Most of the people supported by Sheffield DCA have learning difficulties. The service also supports some older people and people who have physical disabilities.
Sheffield DCA were supporting 19 people at the time of our inspection. Most of the people supported by the service lived in three supported living schemes; either on their own or in shared houses and flats. ‘Outreach’ support to people living in their own homes within other parts of Sheffield was also coordinated from the three supported living schemes. The provider has a central office in Sheffield which oversees the overall coordination and management of the differing areas of the service.
A registered manager was in place. 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 registered manager managed the supported living provision and outreach support provided from Leighton View. Managers were in place at St. Elizabeth’s Close and Grimesthorpe Road, the other two satellite locations where supported living and outreach services were provided from. The registered manager was responsible for ensuring that these locations also met the requirements of the Health and Social Care Act and associated Regulations.
People told us that they received their medicines on time. However, our review of medication records identified a number of shortfalls about the recording of medicines at St. Elizabeth’s Close. For example, we identified shortfalls relating to the recording of four of the seven medicines taken by one person. Additionally, we noted that the medication administration record (MAR) for this person and another person did not accurately record new medicine stocks and medicines ‘carried forward.’ Some MAR charts also lacked a signature to document whether the medicine had been given or refused. These shortfalls meant we were unable to establish the safe administration medicines at St. Elizabeth’s Close.
Our review of care plans highlighted some gaps and inconsistencies about records at both Leighton View and St. Elizabeth’s Close. Our findings made it difficult to establish whether some plans were current and accurately reflected people’s needs. Whilst there was no evidence to suggest that these shortfalls had negatively impacted upon people, the lack of dates and evidence of review within some support plans and risk assessments made it difficult to establish if these documents were current and accurately reflected people’s current needs.
People told us that they felt safe when being supported by Sheffield DCA and also provided examples of how security measures installed by the service had enhanced their sense of safety. We found that there were sufficient staff to meet people’s needs and keep them safe. Conversations with staff and the registered manager demonstrated that they were aware of local safeguarding procedures and had the necessary knowledge to ensure that vulnerable adults were safeguarded from abuse.
There were enough support workers to meet people’s needs and an effective process was in place to ensure that employees were of good character and held the necessary checks and qualifications. Support workers were provided with a range of training to help them maintain and develop their knowledge. Training provided was relevant and in response to the needs of the people they supported.
We found inconsistencies in relation to the frequency of staff supervision and appraisal at the two supported living locations visited. At Leighton View staff supervisions met and, at times surpassed, the providers two monthly timescale. The staff at Leighton View had also received an annual appraisal. At St. Elizabeth’s Close, supervision sessions did not always take place within the providers recommended timescale. There were similar shortfalls with regard to staff appraisals at St. Elizabeth’s Close. The registered manager had identified this shortfall within a recent quality audit and we saw that this had been fed into the regional manager’s action plan.
Our conversations with the registered manager and support workers at the two locations visited demonstrated that they were knowledgeable about the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS). The MCA promotes and safeguards decision–making. The DoLS are part of the MCA and aim to ensure that people are supported in a way which does not inappropriately restrict their freedom.
Support plans contained detailed and person centred information about people’s healthcare needs. When needed, support workers assisted people to attend healthcare appointments and liaised with GPs and other health and social care professionals. Appointments were recorded and people’s support plans were updated with any changes arising from these visits.
People were positive about the caring nature of the support workers. For example, one person described their support workers as, “kind,” and stated, “The staff know me well and are always nice to me.” Our conversations with people and staff demonstrated that Sheffield DCA had a clear knowledge of the importance of dignity and respect and were able to put this into practice when supporting people.
People were provided with explanations and information about the service and were involved in the planning of their care and monthly reviews of their support. Support files at both locations were person centred. The content of each plan was different and clearly evidenced that people had been involved in the range of person centred documents detailing their individual needs, preferences and the people and things which were important to them. Discussions with people and the registered manager demonstrated a commitment to promoting and enabling people to maintain their independence.
People and support workers were positive about the registered manager and the way in which they led the service. A system was in place to continually audit the quality of care provided by the service. We noted that the registered manager’s recent audit for St. Elizabeth’s Close reflected the shortfalls identified during our inspection in relation to medication records, staff supervision and appraisal and people’s records. An action plan had been written by the regional manager to address the above shortfalls. It included clear information about the action required, who was responsible for completing this, how it would be monitored and a timescale for completion.