Archived: Dorset Learning Disability Service - Domiciliary Care

Dorset Learning Disability Service - Domiciliary Care is a care at home service that currently supports five people with learning disabilities and autism who live in shared supported living. The people living in the home share communal areas and have their own bedrooms.

People’s experience of using this service and what we found

People sought out and received support that was relaxed and natural. Care and respect was evident between people living and staff working in the home.

People were supported by staff who cared about them and were committed to supporting them to live fulfilled lives. Staff were sometimes cautious about how changes in individual’s support plans might impact on both the individuals and the dynamic of group living. They felt able to express any concerns they had.

Whilst the staff team had remained consistent, there had been a sustained period of management change. This had led to some lack of clarity around a shared vision both within the organisation and externally with professionals and relatives. The provider and manager were aware of this and had plans in place to improve understanding. Staff felt supported by their new manager and each other.

The systems in place to monitor the quality and safety of the service were mostly robust and action plans were in place to improve the quality and safety of the support people received.

The manager was aware of tensions between some views held by the team and external professionals. Professionals expressed frustrations about the responsiveness of the team. The manager was working to improve relationships for the benefit of people living in the home.

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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. There was work ongoing to address this.

Right support:

• The layout of the home largely supported people to live independently and make decisions about their lives. There was work scheduled for an independent professional to support the tenants of the property to make agreements about how they used the shared spaces. Care and support plans did not focus on supporting people’s tenancies. Managers told us they would address this.

Right care:

• The care provided was person-centred and promoted people’s dignity, privacy and upheld their human rights.

Right culture:

• The values, attitudes and resultant behaviours of senior staff and the staff supporting people ensured people living in the home were leading more empowered lives within their communities. There was work required to ensure support reflected the legal framework of supported living. Managers told us this work would be carried out. We have made a recommendation about this.

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

Rating at last inspection and update

The last rating of the service was Good (published November 2018).

Why we inspected

We undertook this targeted inspection to follow up on changes that the provider told us they were making across the Leonard Cheshire Disability Dorset Learning Disability Service. The inspection was prompted in part due to concerns received about culture and working in partnership. A decision was made for us to undertake a targeted inspection to examine those risks.

During the inspection we received feedback that identified concerns about whether people were receiving personalised care that is responsive to their needs. We widened the scope of the inspection to become a focused inspection which included the key questions of responsive and well-led. We found people mostly received personalised care and the provider was working to further personalise the support people received.

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.

who live in shared accommodation in two different locations. The buildings that people lived in were either privately owned or provided by a housing association.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated good.

People continued to feel safe and were protected from abuse because staff understood how to keep them safe. Staff were able to discuss the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised. People received their medicines safely. The processes in place ensured that the administration and handling of medicines were suitable for the people who used the service.

There were enough suitable staff to meet people’s needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The premises continued to be appropriately maintained to support people to stay safe.

Staff received training to ensure they had the skills and knowledge required to effectively support people. People were supported to eat and drink according to their likes and dislikes. People who lacked capacity had decisions made in line with current legislation. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

The service had an open culture which encouraged communication and learning. People, relatives and staff were encouraged to provide feedback about the service and it was used to drive improvement. People were supported to engage in activity programmes. People knew how to complain and there were a range of opportunities for them to raise concerns with the registered manager and designated staff.

Staff continued to support people to book and attend appointments with healthcare professionals, and supported them to maintain a healthy lifestyle. The service worked with other organisations to ensure that people received coordinated and person-centred care and support.

There were policies in place that ensured people would be listened to and treated fairly if they complained about the service. Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Further information is in the detailed findings below.

When we last inspected the service in March 2014 we found it was not meeting all the requirements in the areas we inspected. The service did not have sufficient quality monitoring systems in place and had not identified there were inconsistencies in support plans kept in people’s homes and the office. We told the provider that improvements were required and they wrote to us to inform us when the improvements would be made. We found these improvements had been made and there were sufficient quality monitoring systems in place.

The registered manager had deregistered in May 2016. 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. There was an acting manager in post who was covering in the interim. The provider told us they were advertising the post of registered manager. The acting manager had been working as a senior support worker in the service and had a good knowledge of people and staff. They assisted us during and our inspection.

Medicines were managed and stored safely. Medication Administration Records (MAR) were signed to indicate that people’s prescribed medicine had been taken. Prescribed creams were recorded on a cream chart with a body map to provide visual instructions; they were signed as given on the MAR. We saw one person was prescribed cream to be applied which had not been recorded on the MAR; we saw it had been recorded in the persons’ daily record sheet which showed the person had received it. We told the acting manager who took action during our inspection to ensure the cream was recorded on the MAR.

During our inspection a lift broke in one of the locations. The acting manager took swift action to rectify the problem and attended the location to ensure that the situation was being managed and people and staff were supported. The acting manager told us they were developing a contingency plan in case there was a reoccurrence.

People were supported to live as independently as they were able. They had person centred support plans which detailed what was important for them and the amount of support they needed. People told us they were happy with the support they received and we saw positive interactions with people and staff.

People had access to a wide range of activities in the community some of which they accessed with support from staff. Most people attended a variety of organised day care or some chose to spend their day differently. People had one to one time with a member of staff; they discussed with staff what they would like to do. One person was going on a trip pursuing an interest which they were looking forward to.

Staff were enthusiastic and seemed relaxed and confident when carrying out their work. They were able to tell us about peoples likes and dislikes and we heard people being offered choices. People had enough to eat and drink and they were involved in choosing and planning their own meals.

People’s risks were assessed and plans developed to ensure care was provided safely. A variety of risks were assessed which included a moving and handling risk assessment and an eating and drinking risk assessment. Where a risk was identified there was a plan to manage the risk. There were enough staff to meet people’s needs. Staffing was planned around people’s activities and there were regular bank and agency staff to cover any gaps in the roster. Staff were recruited safely.

People had access to healthcare when they needed it. A healthcare professional told us staff communicated with them well and followed their recommendations.

People were treated with dignity and respect and their privacy was maintained. Staff responded positively to people there were two way discussions planning people’s activities and everyday conversations took place. Staff used picture cards to assist with communication and we observed use of gestures to support people with understanding.

Some people who were supported by the provider had been assessed as not having capacity to make some choices and decisions which affected their lives.

We spoke with people and observed that some people were unable to tell us what they thought about the care and support they received.

We found that people's privacy, dignity and independence were respected and spoke with one person who told us they liked living in their home and staff helped them when they needed help.

We found that people were treated with respect and kindness when interacting with staff.

We found care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found staff had completed safeguarding training and demonstrated skills and knowledge in this area.

Staff told us they felt supported and received training, supervision and peer support.

We found the manager did not have an effective enough system in place to assess and monitor the quality of services.

There was a comprehensive programme of training for all staff combined with systems for shadowing new staff and observations of staff in particular aspects of their practice. All the staff we spoke to were consistent in how they described their role and told us they communicated with people by taking time to listen to the person and understand their particular forms of communication both verbal and non verbal. The provider worked closely with other professionals and providers to ensure they promoted the health and well being of people.

We observed positive relationships and interactions between people and with staff in a supportive atmosphere.

We found that staff understood safeguarding and procedures were followed for dealing with reported incidents.

One person told us 'my favourite thing about here is the garden; I can plant things when it is warmer, the staff help me and I don't want to move from here'.