An Darach Care Lincolnshire

About the service

An Darach Care Lincolnshire is a community supported living service. The service provides personal care support to young adults who live in their own homes independently in the community. At the time of the inspection the service was providing care for 13 people who experienced needs relating to learning disabilities and autism. Each person had a tenancy agreement in place. At the time of the inspection there were four supported living houses, with between two to four people living in each house. There were staff supporting people in each house 24 hours a day.

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

Right Support

People were supported to have maximum choice and control over their lives. The Mental Capacity Act (MCA) principles were followed when assessing mental capacity and in making best interests' decisions. Improvements had been made at the service to ensure that people were encouraged and supported to be as independent as possible.

Care plans focused on people’s strengths. The registered manager was working with one of the staff teams to ensure a consistent approach across the service.

Right Care

Peoples care, treatment and support plans had been improved since our last inspection to be more person centred. People were supported by using communication styles that met their needs.

People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. This included people who had individual ways of communicating, using body language, sounds and Makaton (a form of sign language), pictures and symbols, so they could interact comfortably with staff.

People were supported by kind and caring staff who had received appropriate training. People’s families told us they felt their relatives were safe at the service. Staff had received training on how to recognise and report abuse and they knew who to report to.

Right culture

Since our last inspection, the provider had made improvements, to the management structure, with the appointment of a registered manager who had oversight of all four homes. The registered manager had been working with staff teams to challenge areas of poor culture. Not all staff had been receptive to these changes and had left the service. The provider had ongoing challenges with recruitment and used agency staff to ensure staffing levels were effective and met the needs of the people at the service. The provider worked with agencies to ensure the same staff worked at the service in order to ensure consistency for the people who were being supported. Agency staff received the same training as the long-term staff team in order to understand and work with people around their specific needs.

People's quality of life was enhanced by the service's culture of improvement and inclusivity. The changes to the management team and structure of the service was beginning to show a positive impact on people's lives.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The rating at the previous inspection was requires improvement (published 14 October 2021). At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The overall rating for the service has changed from requires improvement to good. Based on the findings at this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We undertook this inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17 (Good governance) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 (Staffing), of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, had been met. All had been met.

We also undertook this inspection to assess that the service is applying the principles of Right support right care right culture.

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.

About the service

An Darach Care Lincolnshire is a community supported living service. The registered office is in the village of Swinderby in Lincolnshire. The service provides personal care support, to young adults who live in their own homes independently in the community. At the time of the inspection the service was providing care for 15 people who experienced needs relating to learning disabilities and autism. Each person has a tenancy agreement in place. At the time of the inspection there were four supported living houses, with between three to four people living in each house. There were staff supporting people in each house 24 hours a day.

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

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. The lack of management oversight at the service meant people did not always receive care appropriate to their needs. Some of the accommodation did not allow people the space they needed. Some care plans represented people in a negative manner.

The experience of people using the service varied depending on which supported living house they were living in. The management structure of the service did not promote consistency across the four homes.

Staff at the service were not always trained and confident in managing people’s complex behaviours. Staff in one of the homes, were using a method of restraint in order to contain a person. This method is not an approved technique for use in this service. This meant people were at risk of avoidable harm.

There was not always enough staff to give the people living at the service the support they needed and to keep them safe from harm. People did not always receive the staff support they needed in order to access the community safely.

Risk assessments and care plans at the service were not always effectively reviewed to ensure staff guidance was in place. The registered manager and senior staff did not have good oversight of the service.

People were not always supported to eat in their chosen area of the home. This was due to conflict with other people living at the service.

Care records were not always written in a person-centred way. There was evidence of derogatory language used in care plans. This put the service at risk of becoming a closed culture.

Overall, people received their medicines safely. However, due to staffing levels there was a risk of medicines not being given in a timely manner. Staff did not always have sufficient written guidance to administer medicines safely.

Safe recruitment checks were in place and completed before staff commenced their employment. The service relied on staff supplied by agencies. Safe recruitment for these staff was also covered in the providers safe recruitment policy.

PPE was available for all staff. Infection prevention and control best practice guidance had been implemented by the provider.

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 outstanding (7 September 2017).

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about people’s care, staffing levels and the safety of the people receiving care at the service. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with the providers management and oversight of the service, so we widened the scope of the inspection to become a fully comprehensive inspection which included the key questions of Safe, Effective, Caring, Responsive and Well-led.

The overall rating for the service has changed from outstanding to requires improvement. This is based on the findings at this inspection.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for An Darach Care Lincolnshire on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment, staffing levels at the service, person centred care, as well as how the service was managed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

An Darach Care has its registered office head office located in the village of Swinderby in Lincolnshire. The service provides personal care support for adults who live in their own homes independently in the community. At the time of our inspection the service was providing care for 23 people who experienced needs related to learning disabilities and autism. Each person had a tenancy agreement in place and people lived in their own homes in six supported living houses located both in Lincolnshire and Cambridgeshire.

The last inspection took place between 24 and 25 August 2015. The result of this inspection was that the service was rated ‘Good.’ At this inspection we found the service was 'Outstanding.'

The registered person’s employed two registered manager’s to run 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. In this report when we speak about both the company and the registered managers we sometimes refer to them as being, ‘The registered persons’.

People were fully involved in making decisions about their lives and the care they received, how they wanted to be supported and how they spent their time. Care was given in ways which ensured their privacy and dignity was fully respected. The registered person's and staff were creative in overcoming any obstacles to achieving kind and compassionate care. People’s personal information was maintained in ways which ensured it was kept confidential.

Staff found creative ways to enable people to live as full a life as possible. People were supported to access to a wide range of activities and educational opportunities to enable them to maximise their potential as individuals. People and their relatives were involved in regularly planning and reviewing their care. People and their relatives understood how to raise any complaints or issues they had and the registered persons took action to respond to and address any concerns raised with them.

Staff knew how to quickly recognise and report any concerns they had for people’s safety in order to ensure people were kept safe from harm. The registered persons had assessed potential risks to people. When any accidents or incidents had occurred they had reflected on these and put preventive measures in place. They had also developed further strategies to reduce the risk of them occurring again.

People who needed staff assistance to take their medicines were supported safely to do this. The registered persons had also ensured there were clear arrangements in place for ordering, storing, administering and disposing of medicines.

Staff were recruited safely and were well trained, developed and supported to undertake the roles they were employed to do. There were sufficient numbers of staff available who were deployed in the right way to meet people’s care needs.

People had access to all of the healthcare support they needed. People also had access to a varied diet and were supported to eat and drink enough to promote their health and well-being.

The registered persons had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act requires that decisions are taken in people’s best interests.

The registered persons promoted an open and inclusive culture within the service and people and their relatives were consulted with about the development of the service.

There was a range of audit systems and quality checks in place which ensured the service was continually monitored so that any changes or improvements needed could be identified quickly and acted upon. These systems enabled the registered persons to keep reflecting on and developing the service whilst keeping people at the centre of that process.

Below is a summary of what we found. If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

There were three people receiving care and support in this service on the day of our inspection. We spoke with one person who told us they were satisfied with the care and attention shown by staff and confirmed if they needed anything, staff would respond promptly. They said, "I like it here."

We found evidence that learning had taken place from incidents and investigations and appropriate changes were implemented to improve the service.

We looked at medication administration including medication charts. We reviewed records for the receipt, administration and disposal of medicines. We found records were complete and people had received the medication they had been prescribed.

We found the provider had systems in place to ensure people's safety and well-being. The service was subject to regular review and actions were taken to minimise risk.

Is the service effective?

People told us the care they received met their needs. Direct questions to people who lived at the home was not appropriate, however through general discussion people indicated to us they had been involved in planning the care they received.

Our discussions with the registered manager demonstrated the provider was fully aware of each person's individual care needs. Care plans and risk assessments were in place to be able to respond to frequently changing health care needs.

Is the service caring?

The people who lived at the service had Autistic Spectrum Disorders (ASD). We saw staff interacted with people with a structured and helpful approach. Staff helped people to develop social skills and manage stress.

We saw the service used schedules and timetables to give the necessary structure and visual cues to people with ASD.

Is the service responsive?

We reviewed three people's care records and found they included assessments of their individual needs and contained clear guidelines for staff to follow. This ensured people's health and personal care needs were met. People's care records included a life history and a record of the individual's needs and preferences.

People had access to activities that were important to them and had been supported by staff to fully participate in the activity.

Is the service well led?

We found the service had systems in place to assure the quality of care they provided. The way the service was run had been regularly and robustly reviewed. We were satisfied that the recruitment systems the service had in place ensured people

working at An Darach Care had been suitably vetted for their posts. This meant people who lived at the service were protected from the risks associated with unsuitable staff.

The service benefited from effective leadership.

We observed staff speaking to people and noted they spoke politely and patiently to people. we saw staff supported people to make decisions about their daily activities.

When we looked at the daily records we found they reflected the care people were assessed as requiring.

Overall we observed people were supported by skilled and experienced staff who understood their roles and responsibilities in order to provide safe care to people. We saw staff had received training and support to provide them with the skills necessary to meet the needs of people.

During our visit we looked at care plans and found they included information about the support people required and people's personal preferences.

We saw consent to support was recorded and considered by staff when delivering care.

Risks were identified and effective plans were in place to support the management of the risks.

We looked at medicine records and found they were completed according to the provider's policy for the administration of medicines. It was clear from the records if people had received their medicines.

We observed people received appropriate nutrition and records recorded details of people's nutritional needs.

One relative told staff communicated well with them to ensure people's needs were met, 'If something in the service needs to be changed, we are always consulted.'

We saw people who used the service were supported to be as independent as possible. This included responsibility for the housekeeping of their bungalow.