Blay Domiciliary Services

At the time of the inspection, the location did not offer care or support for anyone with a learning disability or an autistic person. However, we assessed the care provision under Right Support, Right Care, Right Culture, as it is registered as a specialist service for this population group.

About the service

Blay Domiciliary Services is a domiciliary care service. It provides care for people living in their own homes. CQC regulates the personal care and support. There were 262 people who received personal care at the time

of the inspection.

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

Health and safety concerns were not always included in people's care and treatment plans. The risks were not always mitigated effectively because the guidance for staff did not follow good practice guidance or adapted control measures to make sure the risk was as low as is possible.

Staff did not ensure that people's medicines were available in the necessary quantities at all times to prevent the risks associated with medicines that are not administered as prescribed. Administration of people medication was not always recorded accurately.

When people lacked mental capacity to make informed decisions, or give consent, staff did not always act in accordance with the requirements of the Mental Capacity Act 2005 and associated code of practice. As a result, people were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider did not have fully effective systems and processes such as regular audits of the service to assess, monitor and improve the quality and safety of the service. Information about people were not always up to date, accurate and properly analysed or reviewed. Provider's processes to minimise the likelihood of risks and impact of risks on people who use service were not fully effective.

Staff received training on how to protect people from abuse and knew the procedure to follow to report concerns. People and their family members were mostly happy with the care, however some told us that staff would benefit from further training and coaching. The provider was already aware of this and was actively seeking way to improve staff skills and provide opportunities to develop.

People received support from staff that had undergone recruitment checks. Staff worked within the providers' policy and procedure for infection prevention and control.

Staff worked collaboratively with other partner agencies and health professionals to support people with achieving good outcomes.

Staff enjoyed their job and felt supported by the management. The management were aware of any concerns shared by people and worked on finding way to resolve issues and concerns.

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 18 July 2022).

Why we inspected

The inspection was prompted in part due to concerns received about risk management and medicines. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We inspected and found there was a concern with assessing people's mental capacity, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led sections of this full report.

Enforcement

We have identified breaches in relation to safe care and treatment, mental capacity assessments and governance at this inspection.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

About the service

Blay Domiciliary Services is a domiciliary care service. It provides care for people living in their own homes. CQC regulates the personal care and support. There were 65 people who received personal care at the time of the inspection.

Not everyone who used the service received personal care. 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 using this service and what we found

At the last inspection the principles of the Mental Capacity Act (MCA) had not been followed when people lacked the capacity to consent to their care. We saw that improvements had been made and where people lacked capacity to consent an assessment had been completed. However, further improvements were needed to ensure assessments were decision specific.

At the last inspection there was insufficient information to show relatives held appropriate legal authorisation for any care related decision making. This had now been addressed and clear documentation was in place to evidence where relatives held legal authorisation. This included details of what the authorisation covered.

Staff received training on how to protect people from abuse and knew the procedure to follow to report concerns. People and their family members spoke highly of the staff and management team. People told us staff were polite, caring and friendly towards them. Systems and processes were in place to support people’s safety. People’s needs, including their safety in relation to care were assessed and monitored.

Where people were supported with their medicines these were managed safely. Medicines were administered by staff that had received training and had their competency to administer medicines assessed.

People received support from staff that had undergone recruitment checks. Staff worked within the providers policy and procedure for infection prevention and control and followed current government guidance related to COVID-19.

Quality monitoring was undertaken and kept under review by the provider to drive improvement. The views of people and their relatives were sought including involvement in decisions relating to their care.

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 for this service was requires improvement (published 29 April 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has improved to good.

Follow up

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

Blay Domiciliary Services is a domiciliary care service. At the time of the inspection they were providing personal care to 75 people who lived in their own homes. CQC only inspects where people receive personal care. Personal care is help with care related to personal hygiene and eating. Where people do receive personal care, we also consider any wider social care provided. The domiciliary care service operated from the provider’s office in Derby.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive ways possible and in their best interests. The policies and systems in the service did not support this practice. The provider had not trained or checked staff competency on the Mental Capacity Act and how it related to the people they cared for.

Statutory notifications had not been submitted as required. Notifications are changes, events or incidents that providers must tell us about. The provider had not submitted these for allegations of abuse in a timely manner.

People received safe care and the provider had assessed and acted to reduce risks to people. Staff had been trained and understood how to report safeguarding concerns to help prevent people experiencing harm. The management team had an overview of staff deployment at all times. This helped them to respond and coordinate staff to ensure people’s care was provided in a timely manner. The provider had completed checks on staff as part of their recruitment process; these checks helped the provider recruit staff who were appropriate for the job role. The provider had processes in place for staff to follow to help ensure the safe management of medicines and the effective prevention and control of infection. The service identified learning from any incidents to help it improve.

Assessments had been completed on people’s health and care needs. Staff had been trained in most areas relevant to people’s needs and the provider had systems in place to check staffs’ competency and understanding. People’s nutritional and hydration needs were met. The service worked with other health and social care professionals to ensure people received effective care.

Staff were friendly and caring to people. People were involved in their care and this was promoted by the provider’s systems and processes. Staff worked to promote people’s dignity and independence and treated people respectfully.

People experienced responsive and personalised care. The provider regularly reviewed people's care with them to ensure it remained responsive to their needs. People’s communication needs were assessed and met. Complaints had been investigated thoroughly and openly; any lessons learnt had been identified.

The provider’s governance systems were not always effective. This was because they had not ensured staff were trained and had their competence checked in the MCA and had failed to submit notifications in a timely manner.

The provider had checked on people’s satisfaction with their care and checked that care was safe and delivered in line with the provider’s expectations. Where shortfalls were identified, the provider had taken steps to ensure the service improved. People and staff felt involved and listened to; they felt the management team were open and approachable.

We have identified a breach of regulation 11 (Need for consent) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the principles of the MCA had not been followed when people lacked the capacity to consent to their care. We identified a breach of regulation 18 (Notifications of other incidents) of the Care Quality Commission (Registration) Regulations 2009. This was because statutory notifications had not been submitted as required. We have made a recommendation around quality assurance and governance arrangements to support continuous learning and improvements.

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 23 August 2017)

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the effective and well-led sections of the report.

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.

We last inspected this service in March 2016 and rated the service as good overall.

There was a registered manager 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 2008 and associated Regulations about how the service is run.

People were supported by staff who understood the risks people faced and knew how to make people feel safe. Risk assessment records required further development to ensure they were accurate and included measures to reduce the risk of harm. Staff had good knowledge of how to identify abuse and the action to take if abuse was suspected.

People were supported by a sufficient number of staff which helped to keep them safe and meet their needs. Staff were recruited using a thorough recruitment procedure which was consistently applied.

People who required support to take their medicines received assistance to do so when this was needed.

People were supported by staff who were suitably trained and supported to meet their needs. People's rights to give consent and make decisions for themselves were encouraged. Further work was needed to ensure records reflected people's legal rights were protected in line with the Mental Capacity Act 2005.

People were supported to have sufficient to eat and drink. Staff understood people's health conditions and provided appropriate care and support to enable people to maintain their health and well-being.

People were treated with compassion and respect. People were able to say how they wanted their care to be provided. Staff recognised and upheld people's right to privacy and dignity.

People's needs were assessed. Care plans were person centred and were regularly reviewed. Care plans were not always sufficiently detailed to provide staff with the information and guidance to meet people's needs.

Some people experienced late calls and which had an impact on their care which was not always provided in a timely way. The registered manager had identified appropriate action to resolve this.

The provider had a complaints procedure in place that supported people to share their concerns and make complaints. People and their relatives confirmed they felt comfortable to raise concerns and complaints about the service.

There were comprehensive systems in place to monitor the quality of the service and identify where improvements were needed. People and staff were able to express their views about he service. The registered manager was committed to developing and improving the service to ensure people received quality care.

Blay Domiciliary Services is a domiciliary care service providing care and support to people living in their own homes. The office is based in the city of Derby and the service currently provides care and support to people living in Derby and surrounding areas. At the time of our inspection there were 116 people using the service.

Blay Domiciliary Services had 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.

People told us they felt safe with the staff and the support they received. Staff knew how to recognise signs of abuse and who to raise concerns with. People had assessments which identified actions staff needed to take to protect people from risks associated with their specific conditions, although some of these needed to be improved with additional information. People were supported to take their medicines as prescribed.

People confirmed that staff usually stayed for the time allocated for the call but some people told us that staff were often late for the call. People were not always notified that carers were running late. People knew how to make a complaint and most people found the service to be approachable and responsive to their concerns. A small number of people felt that the service did not listen or act upon their concerns.

The provider regularly sought the views of people who used the service and their relatives. People told us they were happy with how the service was managed overall. Some people felt that office staff were not approachable and could be abrupt at times.

People were supported by the number of staff identified as necessary in their care plans to keep them safe. There were robust recruitment and induction processes in place to ensure new members of staff were suitable to support the people who used the service.

Staff had the skills and knowledge to ensure people were supported in line with their care needs and best practice. There was effective communication between office staff and care staff and regular supervisions which supported staff to meet people's needs.

People made decisions about their care and support needs. Staff sought consent before they supported people and showed respect for people's choices and decisions. People's plans of care reflected the support they required and promoted people's independence.

Where necessary, people were supported to eat and drink and access other health care professionals in order to maintain their health.

People told us they were happy with the support they received and had developed positive relationships with staff. People found the staff to be kind and caring. Staff understood their role in supporting people to maintain their privacy and dignity. Staff were knowledgeable about the needs of people and took into account their preferences. The provider had plans to develop the format of people's care plans to ensure care was provided in a person-centred way.

The provider had established processes for monitoring and developing the quality of the care people received. These included observations of working practices and audits on care records.

We received positive feedback overall about the care and management of the service from social workers who had been involved in commissioning services for some people who used the service. They confirmed that they received occasional complaints from people using the service around late calls but had not received any complaints about the quality of the care the service provided.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, and the records we looked at. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

Risk assessments were in place for things such as moving and handling and the workplace environment. Control measures had been put in place. This meant that people's needs were met and people were kept safe. People and their relatives confirmed they felt the service was safe. One person said, 'Yes I feel safe, staff treat me with consideration and respect. Another person said, 'Yes, I feel very safe.'

Documented procedures were in place for the Mental Capacity Act 2005. We were not able to see any mental capacity assessments or best interest decisions on day the day of inspection. This was because the people whose records we looked at were thought to have capacity. Staff had received training in the Mental Capacity Act 2005. This meant that systems were in place to safeguard people as required.

People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had been trained in safeguarding vulnerable adults and knew what to do in the event of suspected abuse.

Recruitment practice was safe and thorough. Disciplinary procedures were in place along with systems for staffs return to work following absence. This was to ensure people's safety was maintained. People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

Is the service effective?

People experienced care and support that met their needs. People told us how they were supported. The trainee manager told us they worked with other agencies to ensure people's health and social care needs were met. One person said, 'The staff cope very well with me.' One relative said, 'The occupation therapist came out to assess how staff showered X.' People confirmed that they were involved in decisions about their care. This meant that people received care in the way they wanted.

Regular audits and checks took place. Issues identified were acted on. This meant the service had effective systems in place to identify improvements and continually meet people's needs.

Is the service caring?

People were supported by kind and considerate staff. Staff we spoke with told us how they supported people. People and relatives confirmed staff were caring, respectful and polite. One person said, 'Yes the staff are very good and very caring.' Another person said, 'Yes the staff are very caring. It is a very good service.'

People's preferences, likes, dislikes and diverse needs had been recorded and care and support had been provided in accordance with people's wishes. People were involved in their day to day care and were supported to maintain their independence. One person said, 'Staff always ask me what I want help with.' A member of staff told us that they gave people choice. They gave an example of asking the person if there was enough butter on their toast or if they would like more. People and their relatives told us they were always treated with respect and consideration. This meant people's diversity and individuality were promoted and respected.

Is the service responsive?

People were treated with respect and dignity by the staff. This was confirmed by people we spoke with. Care plans had been developed that took into account people's needs and wishes. These were reviewed regularly. People told us they received the same group of care staff which provided continuity. Staff demonstrated a good understanding of people's needs.

People were given choices and supported to make decisions themselves. All people we spoke with were happy with the care they received. However a few people commented that communication could be improved when staff were running late. One person said, 'If someone cannot come they get someone else.' Another person said, 'Yesterday there was a crisis on a previous person's call but no one rang me to let me know.' Another person said, 'They always ring me if they are going to be late.'

People told us they would contact the office if they were unhappy about anything. We saw a copy of the complaints procedure. The trainee manager told us that a copy of the complaints procedure was kept in the care file in people's homes. This was confirmed by people we spoke with. The trainee manager told us there had been no complaints since the last inspection.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. This was confirmed by records we saw. Staff told us they felt supported and said that the training opportunities were good. Staff were aware of their roles and responsibilities and had opportunities to raise any issues or concerns. People we spoke with were positive about the service and care they received. People confirmed they thought the service was well led.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints and concerns. People's views were gained and people had access to a copy of the complaints procedure. This reduced the risks to people and helped the service to continually improve.

The service had a quality assurance system in place. Audits were undertaken regularly. We saw records of home visits and home assessments that audited all aspects of the service. This meant the quality of the service was able to continually improve.

People told us they were happy with the care they received. One person said 'The staff are lovely, they are so kind and caring'. People told us they had a good relationship with care workers and were kept informed of any changes. We were told staff arrived on time and stayed for the agreed time period. If their regular care worker could not attend they were informed in advance. People told us 'they are very rarely late, but if they are someone from the office rings to let us know'.

No one we spoke with had experienced any difficulty receiving medication and all felt care staff were well trained and competent to administer medications safely. People felt enough staff were available to meet their needs and that those staff were well trained and supported.

People and their relatives told us they felt they could raise a concern with the provider and were confident it would be dealt with. Everyone we spoke with told us they had the opportunity to feedback their opinions of the service and could raise an issue. One person told us 'I could ring the office and they would deal with it straight away'