This inspection took place on 22 and 23 March and was announced. We gave the provider 24 hours’ notice of our inspection to ensure there would be someone at the office we could speak with and in order to help us plan the inspection. We last inspected Wigan DCA on 22 January 2014 when we found the service to be meeting all standards inspected. Wigan DCA is a branch of United Response, which is a national charity. The service provides care and support to people living with learning disabilities, physical disabilities, mental health needs and people on the autistic spectrum. The service provides support to people living in shared or single occupancy accommodation as part of a supported living service. Wigan DCA also provides domiciliary or ‘outreach’ support to people living in their own home. We did not inspect this aspect of service provision, as this part of the service was not providing any regulated activities at the time of our inspection. The supported living service was providing support to people living at 18 addresses across the Salford, Stockport and Wigan areas. Wigan DCA had taken over the running of the Stockport service in December 2015.
At this inspection we found the service was meeting the requirements of the regulations. We have made one recommendation for the provider to review guidance in relation to the safe management of medicines.
There was a registered manager in post at the time of our inspection. 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.
We found medicines were being kept safely and had been administered as prescribed. However, at one house we found the administration record did not list the correct medicines on it. Staff had not identified that the administration record was incorrect and had signed to show medicines had been administered when they had not. This meant an accurate record of the medicines given had not been kept.
People told us they felt safe being supported by staff working in their home. We saw risk assessments had been completed and staff were aware of the control measures identified in risk assessments and support plans to reduce risk to people. However, risk assessments were not always clearly laid out and sometimes contained limited information. The registered manager told us they would conduct a review of all risk assessments.
At one house we found hazardous substances including ant powder and bleach were being kept in an unlocked cupboard and there had been no risk assessment in relation to these items. We felt there had not been a risk to the individuals living at that house; however this was also against the services policy on control of substances hazardous to health (COSHH). The registered manager confirmed the items had been removed after we made them aware of this concern.
Staff were positive about supporting people’s independence and had a person-centred approach. Staff at one house told us about how they had supported people to become more independent in making their own drinks through consistency of approach, prompting and using hand-on-hand techniques. Staff had an understanding of supporting positive, considered risk taking. For example they talked about supporting people to gain independence to travel alone.
Care plans were person-centred and contained information on people’s preferences and interests. Current goals had been set for people and staff were able to tell us about some of the goals they had recently supported people to achieve. There was evidence that consideration had been given to supporting people to access employment and education opportunities if this is what they wished to do.
People were supported by consistent teams of the same staff members. Staff told us agency staff were not used by the service. People told us they got on well with the members of staff who provided support to them. They told us staff respected their privacy and dignity.
We saw that staff communicated clearly and respectfully with people. We observed many positive interactions between staff and the people they were supporting. Care plans contained a good level of detail to support staff to be able to communicate effectively with people. There was some accessible format information available for people such as pictorial versions of the safeguarding and complaints policies. One person’s care file also had a pictorial short version of their care plan, which would help involve them in their care planning.
Staff at all but one house we visited told us they had received regular supervision. The registered manager told us they would address the issue of any missed supervisions with the responsible manager. Staff said they felt supported and able to approach their manager with any concerns they might have.
Staff received a range of training, including training in safeguarding and the mental capacity act. Some staff had received additional training, such as training in autism, epilepsy and communication, which would help them provide effective support to people using the service. We noted some gaps in the training matrix, such as with the completion of training in positive behaviour support. However, all staff we spoke with told us they felt they had received sufficient training and felt competent in their roles. The registered manager told us the training matrix needed updating due to the responsible member of staff being absent at that time.
Relatives we spoke with told us they felt the service were effective at meeting their family member’s needs. One relative also told us their family member’s needs had changed significantly in the time they were being supported by the service. They said the service had responded effectively to and ‘embraced’ these changes.
We saw people in the houses we visited were able to help themselves to food and drink and were involved in shopping and preparing meals where they were able to do so. Information about people’s support needs and preferences in relation to food and drink were recorded in their care plans. We saw that support was provided in accordance with the guidance set out in risk assessments and guidance received from health professionals.
We saw a range of healthcare professionals had been involved in people’s support. Health action plans had been completed, which included advice for staff on how best to support people to meet their health needs. One person’s file we looked at contained an out of date appointment checklist. Staff told us this was due to the care file moving over to a new format. Another person required staff to check the condition of their skin. Although staff were aware of this requirement, no record was made. The registered manager told us this had been implemented shortly after our inspection.
Staff told us they would be made aware of any new guidance received through handovers and the communication book. The registered manager told us new procedures had also been introduced whereby team leaders would check staff competence and understanding in relation to any new guidance received.
Regular audits of the quality and safety of all houses was undertaken by service managers. This was in addition to regular checks made at the home in relation to health and safety, medicines and finances for example. At one house we found a three week gap in the weekly medicines check. However, all other checks we viewed had been completed on a consistent basis.
The registered manager took actions based on the feedback we provided on the inspection and updated us as to the progress made against any areas of concern or good practice we highlighted. Staff told us the provider was responsive for requests for resources to improve the service.