United Response - York DCA

York DCA is owned by United Response and provides services to people with a wide range of complex needs in community settings, such as people's own homes and supported living houses. The service provides domiciliary care and support services from the registered office location in the centre of York.

At the time of this inspection, the provider was providing personal care and support for twenty seven people in villages outside the City of York who had a learning disability or autistic spectrum disorder.

The provider is required to have a registered manager in post and on this inspection, there was a registered manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 registered manager will be referred to as 'manager' throughout the report.

At the last inspection in May 2016 the provider was rated as required improvement. This was because they were in breach of two Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches were in Regulation 12 Safe care and treatment and Regulation 17 Good governance.

We asked the provider to submit an action plan regarding the breaches identified and during this inspection the actions were met. No further breaches were identified during this inspection.

Systems and processes were in place that helped keep people safe from harm and abuse. Staff had completed safeguarding training and knew the signs of abuse to look out for and how to raise any concerns.

The provider ensured there were sufficient skilled and qualified staff to meet people's individual needs and preferences. People received their care and support from regular staff that ensured continuity and consistency.

People received their medicines as prescribed and safe systems were in place to manage people's medicines. Staff were trained in medication administration and their competency was checked regularly.

People were supported to pursue a wide and diverse variety of social activities relevant to their needs, wishes, culture and interests. Arrangements were in place for people to maintain links with the local community, friends and family.

The provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

People were supported to have maximum choice and control of their lives and care workers supported them in the least restrictive way possible; the policies and systems in the service support this practice.

People and relatives were encouraged to be involved in their care planning as much or as little as they wanted or were able to be. People's records of their care were reviewed and included up to date information that reflected their current needs.

Care workers had a good understanding of people's needs and were kind and caring. They understood the importance of respecting people's dignity and upholding their right to privacy.

There was an effective complaints procedure for people to raise their concerns and these were responded to.

There were systems of audit in place to check, monitor and improve the quality of the service. Associated outcomes and actions were recorded with timely outcomes and these were reviewed for their effectiveness.

The provider worked effectively with external agencies and health and social care professionals to provide consistent care.

Everybody spoke positively about the way the service was managed. Staff understood their levels of responsibility and knew when to escalate any concerns. The manager had a clear understanding of their role and responsibilities and requirements in regards to their registration with CQC.

This service was registered by the Care Quality Commission (CQC) on 6 December 2010 and was previously inspected in August 2013 when it was found to be compliant with the regulations.

York DCA is owned by United Response and provides services to people with a wide range of complex needs in community settings, such as people's own homes and supported living houses. The service provides domiciliary care and support services from the registered office location in the centre of York. At the time of this inspection, the registered provider was providing personal care and support for twenty seven people in villages outside the City of York who had a learning disability or autistic spectrum disorder.

The registered provider is required to have a registered manager in post and on this inspection, there was a registered manager registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 who used the service told us they felt safe and we found that care workers had received training in safeguarding people from abuse and knew how to protect people from avoidable harm. The registered provider had a safeguarding policy and procedure and we saw concerns were investigated and actions implemented because of those investigations.

People received care and support from care workers who understood and responded to people’s individual wishes, preference and needs. There were sufficient numbers of appropriately trained staff with the required skills and knowledge to support people and this provided people with consistency of care.

The registered provider undertook a variety of recruitment checks to help ensure care workers recruited were considered suitable to work with vulnerable people. We saw care workers underwent an induction programme to gain a fundamental understanding of providing care for people that included areas of mandatory training. Care workers received training in privacy, dignity and confidentiality during their induction. The induction was followed by a period of shadowing experienced care workers until the care worker was deemed competent to provide care and support on their own. The registered provider recognised the importance of building relationships between people and the care workers and people told us they had been involved in the recruitment process.

We saw that accidents and incidents were recorded. These were logged onto a quality assurance system where they were investigated and analysed for trends. Feedback was provided and investigations were used as a learning tool to mitigate further instances.

The registered provider had a medication policy and procedure in place. Care workers responsible for the administration and management of medication had received comprehensive training and undertook observations before being allowed to work with medication on their own. Despite this, we saw that medication was not well managed or recorded and information was not always available to ensure people received their medication in a safe and timely way. This was a breach of Regulation 12 (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Care workers had received training and understood the requirements of The Mental Capacity Act (MCA) 2005. Care workers we spoke with understood the importance of ensuring people consented to the care and support they provided. However, information in people’s care files was not always up to date or consistent meaning care workers did not have the correct information available to make informed decisions and to provide care and support to people in line with their assessed needs. It was not always clear where best interest decisions had been agreed that the information documented was detailed enough to ensure that the care provided was in the person’s best interest or the least restrictive option. Accurate and complete records had not been maintained and the registered provider had not robustly assessed, monitored or mitigated the risks. This was a breach of Regulation 17 (2) (b) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw people were kept safe from the risk of emergencies in their home. People had a risk assessment in their care files for the environment and a personal emergency evacuation plan (PEEP). PEEPs are documents, which advise of the support people need to leave the home in the event of an evacuation taking place.

People were supported to maintain good health. Care plans contained detailed information to ensure people were not at risk of malnutrition. We saw peoples dietary requirements noted in their care plans that included details of food likes, including any religious dietary requirements and information on supporting people with good nutrition and hydration.

The support people received varied dependent on their individual circumstances. Appropriate professional advice was identified where necessary to ensure people's health needs were supported.

Care workers told us they felt well supported and we saw good communication and relationships between care workers, management, people who used the service and outside agencies such as the local authority and health workers. We received positive feedback about the leadership and there was a high degree of confidence in how the service was run.

Management understood how to meet the conditions of their registration with the CQC.

People who we were able to speak with told us that they felt they were involved in decisions about their care and were treated with respect. People also told us that they received good support, with comments including 'The staff supports us well'. We saw from people's care plans that people were supported to live as independently as possible. The agency had carried out sufficient assessments of the needs of each person, and they kept this under review, to enable appropriate care and support to be given.

The agency supports some people with their medication. People told us they received their medication at the right time. Staff had received training about this and people were supported to take the medication they needed safely.

We reviewed the level of staffing working for the agency. People we spoke with confirmed that there were enough staff to meet their care needs.

The organisation had systems in place to make sure people were well safely cared for. This included detailed policies and procedures and quality monitoring systems. This helped to ensure that people were happy with the service they received.

One person said 'It's very good. The people (staff) are very kind. They help me.' They told us they had been food shopping that day. They explained that everyone decides together what meals they were going to have. They said that they would tell their key-worker if someone had been unkind to them, or hurt them. They said 'I'm very happy.'

The three relatives also told us they were very satisfied with the care. They commented 'All the care is lovely. Marvellous.' And 'Every time we visit Y is always clean and tidy. They go out a lot more than if they were at home.' A third person said 'We've got no complaints at all. X really enjoys it there. They're settled and happy. We're so pleased.'