United Response - Spire DCA

United Response – Spire DCA is a supported living and domiciliary care service providing personal care. The service provides support to people with a learning disability and autistic people. At the time of our inspection, 47 people were using the service.

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.

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

Right Support: Staff were recruited safely, there were sufficient numbers of staff with the necessary training to support people safely and meet their individual needs. People were protected from the risk of abuse and relatives told us they felt the service was safe. Risks to people and staff had been assessed and people's care plans were regularly reviewed and updated.

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.

Right Care: Medicines were managed safely, and we were assured that the provider had sufficient infection, prevention and control measures in place. People received care in a safe and consistent way and people’s care plans detailed information on the monitoring and preventative actions staff were required to take to reduce risks which had been identified.

Right Culture: People were supported to maximise their independence and to pursue hobbies of interest to them. Staff felt valued and well supported by the management team. The registered manager understood their responsibilities and regularly reviewed the quality of the service through the audit systems in place.

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 requires improvement (published 07 February 2020).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and medicines concerns. A decision was made for us to inspect and examine those risks. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

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 changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for United response – Spire 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.

United Response – Spire DCA provides personal care to people with a learning disability or autistic spectrum disorder, who may also be living with physical disability. People received care in their own private single or multi-occupancy living accommodation via individual private tenancy agreements. At the time of our inspection there were over 100 people using the service.

Not everyone who uses 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 consider any wider social care provided. At this inspection there were 27 people who received personal care.

The service is developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This aims to ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence.

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

From extensive service reconfiguration during 2019, management and leadership had not always been consistent or effectively ensured for people’s care. This meant the quality, consistency and effectiveness of peoples’ care, including related communication and care plan record keeping; had not always been fully ensured, to achieve consistent outcomes. Staff had not always received effective support and supervision for their role. The provider had recognised and begun to implement related service improvements, to rectify this. However, these were not yet demonstrated as fully completed, embedded or ongoing for people’s care.

The providers safeguarding, staffing and risk management arrangements for people’s care, helped to protect people from the risk of harm or abuse. People felt safe when they received care from staff at the service and their relatives felt they were safe there.

The provider had taken action when things went wrong at the service, to help prevent any reoccurrence and ensure people’s ongoing safety.This included to ensure people’s medicines were safely managed and that people received their medicines when they should.

Staff were trained to provide peoples’ care and supported them to maintain or improve their health and nutrition. This was done consultation with relevant external health professionals when needed. People were supported to have maximum control of their lives and staff supported them in the least restrictive way possible. The provider’s related policies and systems supported this practice.

People received care from kind, caring staff who ensured their dignity, equality and rights in their care. Staff had good relationships with people and their relatives. They knew people well, including what was important to people for their care and how to communicate with them in a way they understood. People were informed, involved and supported to help agree and make ongoing decisions about their care and daily living arrangements.

Overall staff supported people to maintain relationships, follow their interests and take part in activities that were socially and culturally relevant or important to them. The service does not provide for end of life care. Management action was assured to improve staffs skills and knowledge, to support meaningful conversations with people when needed, in relation to death, loss and bereavement.

Managers and staff understood their role and responsibilities for people’s care and strove to ensure a person-centred approach and positive service culture within given resources. The provider and registered managers had met with regulatory obligations for their registration.

The provider regularly sought to engage with people, staff and relatives to help inform and support people’s equality and diverse needs in their care. The provider and staff worked with relevant stakeholders, such as health, educational, social care providers and voluntary organisations; to help inform, improve or enhance people’s care experience. Management improvements had commenced to fully ensure the consistency and effectiveness of people’s care from this.

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 December 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

This inspection took place on 21 September 2016. The service is run from an office in the Staveley area. The provider was given 48 hours' notice because the location provides a domiciliary care service and we wanted to make sure the registered manager was available. In addition we also carried out visits to people using the service on 6 October 2016.

There were two registered managers at the service. 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.

The service was following the guidance in people’s risk assessments and care plans and the risk of unsafe care was reduced. People’s records were up to date and indicated that care was being provided as detailed in people’s assessments. The records had been updated to reflect changes in people’s care needs. Medicines were managed safely.

People were safeguarded from abuse because the provider had relevant guidance in place and staff were knowledgeable about the reporting procedure. The provider's arrangements for staff recruitment and deployment helped to make sure there were sufficient staff who were fit to work at the service to provide people’s care.

Staff understood their roles and responsibilities for people's care and safety needs and for reporting any related concerns. The provider's arrangements for staff training and their operational procedures supported this.

The principles and requirements of the Mental Capacity Act (2005) were being met. People were supported by staff who knew them well. Staff were aware how to promote people’s safety and independence. People were provided with information to support them to make day-to-day decisions.

People received appropriate support to plan and manage their meals and nutrition. This was done in a way that met with their needs and choices. People’s health needs were met. Referrals to external health professionals were made in a timely manner.

People and their relatives told us the staff were caring and kind and that their privacy and dignity was maintained when personal care was provided. People and their relatives were involved in the planning of their care and support.

There was a complaints process in place. The leadership of the service was praised by external professionals and relatives and communication systems were effective. Systems to monitor the quality of the service were inclusive and identified issues for improvement.

One family member we spoke with said, 'I have seen my relative's confidence grow daily. Staff support them to learn new things and they are encouraged to do as much as they can. My relative is always telling me how happy they are.'

On the day of the inspection we found there were effective recruitment and selection processes in place and the appropriate checks were made before staff began work.

Both members of staff we spoke with told us their work had been observed by a supervisor to ensure people using the service received support in line with their care plan. When we looked at the staff files we found evidence that observations on staff's work had been recorded and feedback given to staff to improve their practice.

We found evidence that staff received training on record keeping. This included why record keeping is important, legal requirements and how records keep people who use the service safe.

We saw person centered care plans which described people's needs and how they wanted to be treated. We saw staff use Makaton sign language to communicate with one person.

A healthcare professional from the community learning disability team told us that the care people received was person centred and that staff listened to the advice of the professionals in the team. He also told us he had been involved in people's service reviews.