West Lanc's Domiciliary Service

West Lanc's Domiciliary Service is a domiciliary care service providing personal care and supported living to people in their own homes. There were 46 people receiving care from the service at the time of the inspection. All of the houses where people lived were located locally to the providers location address.

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

Medicines were being managed safely, we made a recommendation in relation to staff competency checks. People told us they were safe and investigation into allegations of abuse had been completed. Safe recruitment was taking place. The regional manager told us there was an ongoing recruitment programme. Some people told us more staff were required in the tenancies.

Training and supervision was ongoing however the training matrix identified some training had not been undertaken for some time we made a recommendation in relation to training. The regional manager confirmed they would review the training matrix to ensure it was up to date. Relevant capacity assessments had been completed. People, relatives and the records we looked at confirmed they had been reviewed by relevant professional to support their needs.

People received good care, feedback from people, relatives and professionals was positive about the care provided. Staff understood the importance of the care they provided.

Care plans had been completed, the regional manager confirmed that they would take action to ensure reviews were completed to ensure they were up to date. Activities were taking place however these had been impacted since the COVID-19 pandemic. Complaints were being dealt with, positive feedback was seen.

All of the staff team were supportive of the inspection and information was provided promptly. People were positive about the management team, however some feedback from staff was that they were burnt out. The regional manager confirmed their plans going forward to make improvements with the new manager who had applied to register with the Care Quality Commission. A range of audits was taking place, team meetings and questionnaires had been completed however people confirmed these had not occurred for some time.

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. 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 model of care and setting maximised people’s choice, control and independence. Care was person-centred and promoted people’s dignity, privacy and human rights. The values, attitudes and behaviours of leaders and care staff ensured people lead confident, supportive and empowered 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 last rating for this service was good (published 8 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.

West Lanc’s Domiciliary Service is registered to provide personal care for people living in their own homes and who have a learning disability or autistic spectrum disorder. At the time of our inspection the service was supporting 39 people.

The service had a registered manager in post. 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.

At our last inspection on 8, 9 and 14 November 2016, we asked the provider to take action to make improvements in relation to mental capacity assessments, risk management, safe care and treatment and good governance, this action has been completed. We asked the provider to send us an action plan. This was to show what they would do and by when to improve the key questions of safe, effective and well-led to at least good. During this inspection we found improvements had been made to the assessments for mental capacity, risk management arrangements and strategies to ensure care and treatment was provided in a safe way. Systems for assessing and monitoring the quality of service provided had also improved. The actions had been completed and therefore the service was meeting the requirements of the current regulation.

Individual and environmental risk assessments were in place which identified measures to take to reduce any risks to people. Fire risk assessments and essential checks had been completed to ensure the environments were safe for people and staff.

People who used the service were protected from abuse. Systems were in place to act on any allegations. Staff we spoke with were knowledgeable in the actions to take to deal with any allegations. Staff understood how to protect people’s equality and diversity and human rights and we were provided with examples of this.

Staffing levels supported the delivery of care for people. Recruitment procedures were in place and ensured staff were recruited safely for the role in which they were employed. Staff told us and records we looked at confirmed they had received up to date and relevant training that supported the delivery of care to people.

We saw improvements had been made in relation to how people were protected from unlawful restrictions. 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.

People were supported to access health professionals. People were registered with a general practitioner and annual health reviews had taken place.

People and relatives told us they were happy with the care they received. It was clear positive and meaningful relationships had been developed between people and staff. Staff treated people with dignity and respect. Equality, diversity and human rights were recognised when planning and delivering care to people.

Care files recognised alternative forms of communication that would ensure people were consulted and were able to make decisions about their care, no matter what their abilities

Records were detailed and included information about how to deliver people’s care. Where people were nearing the end of their life, records were detailed and comprehensive that would support the delivery of care to them.

People had access to a variety of activities of their choice. We saw people planning for and undertaking activities during our visits to their homes.

There was a system in place to deal with any complaints and the procedure for complaints was available in all of the addresses we visited. We asked for further information from the registered manager in relation to one complaint. We saw complimentary feedback had been received.

We received positive feedback about the management team and the registered manager. The service held regular team meetings that provided staff with updates and information about the service. The service asked for feedback about the care people received and we saw complimentary comments had been received.

Systems to monitor the quality of the service were in place. We saw a variety of audits taking place which included regular checks by the management team.

The inspection of this service took place across three dates; 8, 9 and 14 November 2016, this was the first time the service had been inspected under the comprehensive methodology. The service was given 24 hours’ notice prior to the inspection so that we could be sure someone would be available to provide us with the information we required.

The registered manager of the service was present at the registered office base throughout our inspection, and the inspectors were able to contact the registered manager if needed. 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 a lack of consistency in the way people's risk had been assessed and managed. The risks to people were not always sufficiently managed to avoid harm. We looked at how people were protected from bullying, harassment, avoidable harm and abuse. We found that the service had policies and procedures in place. However, these were not always being followed.

A central register of accidents and incidents was held by the registered manager in order for these to be monitored. However, we did find incidents that had not been reported to the team leader or management in order to be followed up.

We looked at how the service managed people’s medicines. We examined medicine administration records [MARs]. MARs did indicate that people received their medicines at the times specified and records were signed.

We checked how staff had been recruited, we saw records which showed the provider had undertaken checks to ensure staff had the required knowledge and skills and were of good character before they were employed at the service.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). We looked at how the service gained people's consent to care and treatment in line with the MCA. We found that the principles of the MCA were not consistently embedded in practice.

We saw the service had a detailed induction programme in place for all new staff and that staff were required to complete the induction prior to working unsupervised. We found that the service promoted staff development and had a rolling programme to ensure that staff received training appropriate to their role and responsibilities. Staff told us they felt well supported by management and we saw evidence that regular supervisions were being held.

The staff approached people in a caring, kind and friendly manner. We observed positive interactions throughout the inspection. We spoke with relatives of people who used the service to gain their views and received consistent positive feedback about the staff and about the care that people received.

Care plans were regularly reviewed however, amendments to documentation following a change in a person’s needs were not always undertaken. We have made a recommendation with regard to this.

People were supported and encouraged to take part in activities, which they enjoyed. We found there was a clear assessment process in place, which helped to ensure staff had a good understanding of people's needs before they started to support them.

The service had a complaints procedure. People who used the service and their representatives told us they felt confident that their complaint would be taken seriously and fully investigated. A system for recording and managing complaints and informal concerns was in place.

There were quality-monitoring systems in place, however some of these were not as robust as they could have been. Although systems were established and in place to allow for oversight of accidents and incidents these were not always operated effectively.

All of the staff members we spoke with reported a positive staff culture. During the inspection, the management team were receptive to feedback and keen to improve the service. They worked with us in a positive manner and provided all the information we requested.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to safe care and treatment, consent and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.