HF Trust - Oxfordshire DCA

HF Trust Oxfordshire DCA is a supported living and domiciliary care service providing personal care to people with a learning disability and/or autistic people living in shared or individual accommodation. Personal care is help with tasks related to personal hygiene and eating and any wider social care provided. At the time of the inspection the provider supported 82 people in 24 supported living settings across Oxfordshire.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support:

Not all premises were of a quality to meet people’s assessed needs. In one setting, a person was at risk of harm due to their support needs increasing. The registered manager had identified this and was in the process of evaluating suitability of premises.

We have made a recommendation about consulting current and best practice guidance about expected standards of supported housing accommodation to reduce the risks of people living in potentially unsafe premises.

Most staff understood how to protect people from poor care and abuse. However, we found not all processes had been followed when people were potentially at risk of further harm. The registered manager had reflected on this and taken action to ensure reporting and investigation took place in line with the provider’s policy and procedures.

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 supported people to have as much choice, control and independence as they could.

Staff had received training and had competency assessments to ensure they had the skills to work with people.

Right Care:

People and their relatives told us they received care from staff who were kind and compassionate. Staff protected and respected people's privacy and dignity. They understood and responded to their individual needs. The service had enough suitably skilled staff to keep people safe. People who had individual ways of communicating could interact comfortably with staff because staff had the necessary skills to understand them and knew them well.

Right Culture:

There was an effective registered manager in place who had identified where improvements were needed. The registered manager ensured people were supported by staff that knew them well so they could be responsive in supporting people's needs. People received good quality care and support because trained staff could meet their needs and wishes. The staff we spoke with felt the registered manager was approachable and supportive and took action when needed.

People and their relatives had confidence and felt well supported by the service.

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 15 March 2018).

Why we inspected

The inspection was prompted in part by notification of an incident following which a person using the service sustained a serious injury. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of falls. This inspection examined those risks.

For those key questions 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 HF Trust - Oxfordshire DCA 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.

Rating at last inspection

At our last inspection in December 2015 we rated the service good. Since our last inspection, the local authority had been monitoring two of the location addresses as a result of concerns raised. Services are sometimes monitored under the local authority safeguarding measures called ‘Serious Concerns’. This requires the provider to work with the local authority to make improvements and provide regular reports to update on actions taken to improve the service. We spoke with the local authority safeguarding and contract teams and were informed that the service was no longer in the ‘serious concerns’ process due to the improvements made. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection 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 remained safe at the service. Staff knew how to recognise safeguarding concerns and what to do if they suspected any abuse. Risk assessments were carried out to promote people’s well-being and recognise people’s individual abilities. There were enough staff to keep people safe and the provider followed safe recruitment procedures. Medicines were administered in line with guidance.

People continued to receive support from effective staff. People’s needs had been fully assessed to ensure that staff had guidance to meet these needs. Staff were knowledgeable, skilled and had the relevant skills and experience. Records confirmed staff received regular supervision sessions and they told us they were well supported.

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 support this practice.

People were supported to access health professionals when needed and staff worked closely with various external professionals to ensure people’s health needs were met. People were given choice about what they ate alongside appropriate support to ensure a balanced diet.

The service continued to support people in a kind and caring way. People were treated with kindness and as individuals. People were involved in decisions about their care needs and the support they received. People’s dignity, privacy and confidentiality were respected, and they received person centred care that included access to information that met their needs.

The service remained responsive to people's needs and ensured people’s changing needs were recognised and appropriate changes to support were implemented promptly. People were supported to raise concerns if necessary. 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.

The service was well-led by experienced and motivated registered managers who ensured staff put people at the forefront of the service delivery. There was an open and positive culture that valued and engaged people, relatives and staff. Staff and relatives had confidence in the skills of the management team and had noted improvements in recent months. The registered managers had good systems to monitor the quality of the service provided. The service worked well with various external professionals to ensure people received the input they needed from all sources.

Further information is in the detailed findings below.

People we spoke with told us they were treated with respect and given privacy. One person said "They [the staff] have to knock if they want to come in my room". People were encouraged to maintain their independence. A person we spoke with told us "I help to prepare the dinner and wash up afterwards".

People received support appropriate to their needs. A person told us "the support workers help me with my shopping. I love the staff. I really do".

People receiving support felt safe and care staff were well trained to spot and report abuse. One of the people we spoke with said "it's nice living here. Staff are nice and kind". Care staff we spoke with were knowledgeable about various forms of abuse and knew how to report abuse if they recognised it. A member of care staff we spoke with said 'I know I can contact the local Learning Difficulties team'.

The provider operated appropriate recruitment procedures. We saw that checks were carried out before care staff were permitted to start work.

The provider had effective systems in place to monitor quality and safety. Monthly quality audits were carried out in each of the homes where people received support.

We found that people were protected against the risks associated with medication. There were effective recruitment procedures in place to ensure that staff were of good character, had the relevant skills and experience and were physically and mentally fit to perform the role. People were also protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.