Archived: Choice Support Wakefield (DCA)

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

People told us they felt safe and their health care needs were met. It was evident from our discussions with staff they had an in-depth knowledge of people's care and support needs. Staff knew about people's interests and how they preferred to spend their time and how they would like to be supported. There were sufficient numbers of suitably qualified and competent staff. Care plans were detailed and person centred. There was evidence of checks carried out to assess and monitor the quality of the service provided.

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 supported this practice.

Further information is in the detailed findings below

Before this visit we had received information of concern about the management of and decision making around the use of people's finances. During our visit we found evidence which partially substantiated the concerns we received. We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were cared for in an environment that was not clean and hygienic. We found people may not be protected from the risk of infection because appropriate guidance had not been followed and staff training in infection prevention and control was not up to date. We have asked the provider to make improvements.

We also found parts of the premises of the two properties we looked at were not being adequately maintained. We have asked the provider to make improvements.

There were not enough staff on duty to meet the needs of the people who were receiving 24 hour care.

Some people's care records were found not to be accurate and up to date. This meant people who lived at the home were at risk of receiving inappropriate care and treatment.

When we spoke with six people who were related or connected with people who used services provided by Choice Support Wakefield they all told us they were happy with the care provided. We spoke with the relative of one person who told us 'With regard to Choice Support it's been great for my relative over the last two and a half years, no regrets, it's the right place for my relative.' Another person told us 'Very, very good, staff very good. I can't fault them in any way; my relative has been there 3 years. It's very good.'

The person we spoke with on a one to one basis told us 'I have been with Choice Support since December last year, they are a new provider for me .Choice Support are better than where I was before.'

Another person we spoke with on the telephone told us 'Yes its fine here. I have been here 13 years. I am much happier than where I was before.'

We looked at the recruitment records for five staff members. We found recruitment practices were safe and relevant checks had been completed. This meant that staff were being properly checked to make sure they were suitable and safe to work with vulnerable people.

Is the service effective?

The service was not effective. The homes did not promote a good quality of life for the people that received 24 hour support.

We looked at three people's care records and saw their individual needs were assessed thoroughly and care and support was developed from an assessment of their needs. However, two of the records we looked at had support plans in place which were not dated and did not show evidence of being reviewed. The other care record we looked at did not contain up to date information regarding the persons current health needs. We saw the person did not have a care plan in place for the dressing of a wound they had.

During our inspection of records at the local office we found there were gaps in the duplicate copies of care planning documentation.

We looked at the training records for staff and saw some staff had not received up to date training. Records we looked at we showed staff had not completed training in infection control. This showed staff did not have the appropriate knowledge and skills to perform their job roles. We have asked the provider to make improvements.

People who used the service, relatives and staff told us they felt people received good care.

Is the service caring?

Staff who worked at one of the homes we visited were kind and caring. We saw people were supported by kind and attentive staff who obviously knew people well. However, the provider had failed to take appropriate action where issues were identified which impacted on peoples' care, safety and welfare. We have asked the provider to make improvements.

In another home we visited, the deputy manager told us a person's room had been 'X proofed' (X being the person's name). We judged this to be disrespectful of the person. We also saw a person who lived at the home was sitting on incontinence products on the sofa in the main lounge. This area was in full view of any visitors who came to the property and also other people who used the service. We judged this was not dignified for the person.

One of the six people who were related or connected to people who used the service told us 'Basically ' I am happy with Choice Support.' Another person's relative told us they had been very involved in the care planning for their relative. 'We virtually wrote it. We were absolutely included in every minute detail of the care plan. But it is our relatives care plan and they are involved in it. Choice Support work hard and try to ensure the care plan is implemented.'

Is the service responsive?

The service was not responsive. Accidents and incidents at one of the homes had not been followed up appropriately to ensure the risk of recurrence was minimised. We have asked the provider to make improvements.

We saw a note in the 'communications book' in another home stated that one person's GP had telephoned the home to ask why staff had stopped using a particular dressing of the person's wound. The GP had not given this instruction. This meant people were not receiving care as prescribed by external healthcare professionals.

We spoke with the manager of one of the homes who told us people using the service were unable to access the local community unless enough staff were on duty to facilitate this. This meant people were restricted in the type of activities they could engage in.

Is the service well-led?

The service was not well-led. Whilst there were systems in place to evaluate care the assessment and monitoring of the quality of the service provided was not effective. Issues we found during the inspection had not been identified by the provider. Therefore, people were not protected against the risks of inappropriate or unsafe care particularly in relation to the environments in which support was provided, infection control and record-keeping.

The leadership and management at the homes where people received 24 hour support did not assure the delivery of high quality, person centred care. We have asked the provider to make improvements.

We looked at the care records of four people who used the service. We found people's needs were assessed and care was planned and delivered in line with their individual plan. We saw that care plans were person centred, detailed and provided clear guidance to staff about how people's care and support should be delivered.

The five members of staff we spoke with, about their understanding of protecting vulnerable adults, had a good understanding of safeguarding adults. They could identify types of abuse and knew what to do if they witnessed bad practice.

We looked at how new staff were recruited and this included a review of three staff records. We saw that a structured recruitment process had been followed. Members of staff had an enhanced Disclosure and Barring Service (DBS) check in place. This meant the provider had satisfied themselves that staff were suitable to work with vulnerable adults.

We spoke with people who used the service, who told us that they were aware of the complaints process and felt that complaints were responded to.