Lincolnshire Domiciliary Care Branch

Lincolnshire Domiciliary Care Branch is a domiciliary care agency. It provides personal care to 104 people living in their own homes. The service is registered to care for children between 13 and 18 years, younger and older adults, people with learning disabilities or autism, mental health and physical disabilities. Not everyone who used the service received personal care. The Care Quality Commission (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.

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 and what we found

We made a recommendation because some positive behaviour support plans and risk assessments were not up to date and did not include important information from other health and social care professionals. The service had been using high levels of agency staff, however permanent staff had been recruited and this was improving. Staff told us staffing levels were enough to meet the needs of people. Systems and processes were in place to ensure people were protected from abuse. Staff received regular safeguarding training and demonstrated they were knowledgeable about how to protect people from abuse.

Staff received regular training and told us the training provided them with the knowledge to do their jobs effectively. People were supported to eat and drink what they had chosen. People living in shared accommodation benefited from good person-centred support to purchase chosen ingredients and cook meals independently of their housemates. Staff worked well with colleagues across the organisation to ensure that people were getting good opportunities to socialise and engage in activities of their choice.

Staff sought consent from people before delivering care. Staff received training regarding the Mental Capacity Act (MCA) and were knowledgeable about the subject. 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.

Staff knew people well and were kind and compassionate. People told us they liked their support staff and that they were kind to them. Staff knowledge was good around privacy, dignity and independence. People were given the opportunity to express their views regularly and were involved in their own care.

People were receiving care and support which was responsive to their needs, however care plans were not consistent. Some care plans lacked the person-centred detail to ensure important information about 'how' to support people was included. Terminology used in some care plans was negative. Some recent care plans included better detail, but this needed to be embedded. The provider was aware of the need to standardise support planning and was planning to implement a nationally recognised electronic support planning system in the near future.

The management structure had recently changed which improved the support provided to the staff team. There was no registered manager in post at the time of the inspection, however, applications had been submitted for two registered managers at the location. Leadership in the service promoted a culture which was open and inclusive. Staff were consistently complimentary about the support they received from their managers and team leaders. The team worked with a range of health and social care professionals and had built good links in the community.

Governance systems were in place to ensure oversight and scrutiny of practice within the service. Plans were in place to ensure the service developed and improved. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

The last rating for this service was Good (published 31 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

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.

Lincolnshire Domiciliary Care Branch is registered to care for children between the ages of 13 and 18 years, younger adults and older people. In relation to these people, it can provide personal care for people who need support due to a learning disability, autism, mental health problems or a physical disability.

The service covered the whole of Lincolnshire but in practice most of the provision was in Bourne and the Deepings, Grantham and Lincoln. In total, the service operated 26 supported living addresses in which 82 people were accommodated. In addition, there was a total of 12 people who used the domiciliary care service. The service’s main office was in Bourne but it also had a satellite office in Grantham.

At our last inspection we mainly focused on the provision in Bourne. At this inspection we principally focused upon the provision in Grantham. We did this in order to extend our evaluation of the service. In the Grantham area there were 17 people accommodated in three supported living addresses. In addition, there were six people using the domiciliary care service.

Lincolnshire Domiciliary Care Branch is operated by a company that is the registered provider. There was a registered manager in post. 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 2008 and associated regulations about how the service is run. In this report when we speak about both the company and the registered manager, we refer to them as being, ‘the registered persons’.

In relation to both of the services, staff knew how to respond to any concerns that might arise so that people were kept safe from abuse. People had been supported to avoid the risk of accidents and they had been helped to manage their medicines safely. There were enough staff to provide people with the support they needed and background checks had been completed before new staff had been appointed.

Staff had received training and guidance and they knew how to support people in the right way. People had been assisted to plan and prepare their own meals and they had been supported to receive all of the healthcare assistance they needed.

Staff had ensured that people’s rights were respected by helping them to make decisions for themselves. The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had worked with the local authority to ensure that people only received lawful care that respected their rights.

People were treated with kindness, compassion and respect. Staff recognised people’s right to privacy and promoted their dignity. Confidential information was kept private.

People had been consulted about the support they wanted to receive and they had been given all of the assistance and encouragement they needed to be as independent as possible. People had been supported to pursue their work commitments, hobbies and interests. There was a system for quickly and fairly resolving complaints.

People had been consulted about the development of the services. In addition, they had been assisted to liaise with their landlords about making improvements to their homes. Quality checks had been regularly completed to ensure that people reliably received all of the support they needed. Staff were supported to speak out if they had any concerns and good team work was promoted. People had benefited from staff acting upon good practice guidance.

People had been given information about the support they could receive and they had been assisted to make decisions about things that were important to them.

People said that they had received all of the support they needed. Records confirmed that assistance had been provided in a safe, reliable and responsive way.

People had been supported to safely manage their medication.

The provider employed enough staff to give it the capacity it needed to consistently meet people's needs for support.

We saw that a range of quality checks had been completed to help ensure that people reliably received the help at home they needed.