Kent and Medway Domiciliary Care Agency

About the service

Kent and Medway Domiciliary Care Agency is a supported living service registered to provide personal care. The service provides support to people with a learning disability and/or autism living in supported living settings, so that they can live in their own home as independently as possible. At the time of the inspection they were providing support to 12 people who were in receipt of the regulated activity personal care. Not everyone who used 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 also consider any wider social care provided.

People lived in their own flats and had access to their own facilities such as bathrooms and kitchens. There were a number of different locations across Kent where the service was providing support to people.

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

Right Support

The service followed good infection control practice. Staff supported people to have the maximum possible choice, control and independence. People had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

People received support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their flats.

Staff enabled people to access specialist health and social care support in the community. Staff communicated with people in ways that met their needs.

Right Care

Staff understood how to protect people from poor care and abuse. However, there had been an incident of verbal abuse between 2 people living at one of the supported living premises (which was a safeguarding concern), this had not been appropriately reported. Staff had appropriately recorded the incident. The management team had not taken the relevant action to report to the local authority and CQC.

Medicines were mostly managed safely. The provider had not followed NHS choices guidance about paracetamol for people weighing less than 50kg. After we raised this, actions were taken and the provider shared this as a lesson learned with their other registered services across the country. New staff were adequately checked to ensure they were suitable to work with people to keep them safe.

Staff and people cooperated to assess risks people might face. Risks relating to fire safety and flammable creams known as emollients were not always thoroughly assessed, the management team acted on this and shared the learning with the provider. Where appropriate, staff encouraged and enabled people to take positive risks. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. A relative told us, “[Loved one] has said she is happy with them. She is happy living where she is. The actual hands-on staff are wonderful.”

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. A person told us, “I feel safe and this is home.” People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well.

Staff were responsive, supporting people’s aspirations to live a quality life of their choosing. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, were involved in planning their care. People’s quality of life was enhanced by the service’s culture of improvement.

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 inadequate (published 16 March 2023).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, there were still some improvements to make which the provider was working on.

This service has been in Special Measures since 15 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Kent and Medway Domiciliary Care Agency is a supported living service registered to provide personal care. The service provides support to people with a learning disability and/or autism living in supported living settings, so that they can live in their own home as independently as possible. At the time of the inspection they were providing support to 13 people who were in receipt of the regulated activity personal care. Not everyone who used 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 also consider any wider social care provided.

People lived in their own flats and had access to their own facilities such as bathrooms and kitchen. There were a number of different locations across Kent where the service was providing support to people.

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

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.

Right Support

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Not all staff supported people to play an active role in maintaining their own health and wellbeing. One person wanted to be weighed regularly so they could manage their diet, but this was not happening. Staff did not always support people to achieve their aspirations and goals. One person told us they would like to set some goals, but staff had not supported them with this.

Right Care

People were not protected from harm or abuse. Staff had used unlawful restraint on a person, and this had not been reported. People’s individual health risks were not always well managed to ensure they received to care and support needed. Staff were not always respectful when talking about people they supported. For example, one staff member referred to someone as a ‘spoilt brat’. Not all staff understood how to protect people from poor care and abuse. People were not always supported by staff who had the skills and knowledge needed to meet their needs. People’s care plans did not always reflect their range of needs. For example, one person had been prescribed a medicine to help when they felt anxious, this was not included in their support plan, and there was no guidance on when and how to use it.

Right Culture

Staff had failed to ensure risks of a closed culture were minimised, they had not ensured people received support that was based on transparency, respect and inclusivity. Daily notes did not reflect the negative support provided, that staff told us about. People did not always lead inclusive and empowered lives. Some staff were not always supporting people to be as independent as possible. Staff told us they did not always feel supported by senior management at the service. Staff told us they had raised concerns which were not always acted upon.

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 requires improvement (published 16 November 2020)

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulation and we identified further breaches of regulation.

Why we inspected

We undertook this comprehensive 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 safeguarding and allegations of abuse. A decision was made for us to inspect and examine those risks

Enforcement

We have identified breaches in relation to safe care and treatment, assessing people’s health needs, dignity and respect, person centred care and management oversight at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

People lived in their own flats and had access to their own facilities such as kitchens and bathrooms. Services were provided in various locations across Kent.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. For example, staff did not wear uniforms and were not easily identifiable as support workers when in the community with people. People lived in their own flats which were not identifiable as supported living settings as there were no signs on the outside of the buildings.

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

Feedback from people and relatives about the service was positive. One relative said, “In the main it is very good. I don’t have anything to say that’s negative. The quality of care is good.”

However, we found a number of areas where the service required improvement. The concerns we found were almost all at one location where people live.

The management of infection control needed to be improved to reduce the risk of the spread of infection including COVID-19. There were systems in place to protect people from abuse. However, one concern had not been raised through standard safeguarding processes when it needed to be. We made a recommendation about this. Staff had undertaken training in safeguarding. Record keeping including incident reports needed to be improved to ensure that effective learning from incidents was enabled.

People’s needs continued to be assessed. However, some support plans needed to be updated and were missing some details. There were risk assessments in place for people. However, there were areas where these could be improved.

Staff were covering people’s support calls and we found no evidence that calls were missed. However, some staff were working a significant number of hours and a long time without breaks. Since the inspection the registered manager sent us information on how they planned to address this.

Staff had undertaken a range of training. However, some staff were not positive about their training or confident in their abilities to support people. New staff undertook an induction. However, the quality of staff induction had been impacted by COVID-19 as some sessions were not being undertaken. Prior to the inspection plans had not been put in place to address this.

Staffing changes had been made to the management of one location. However, staff feedback at the inspection was not always positive and some staff said they did not feel valued or supported. Audits had not always identified or addressed the concerns we found on the inspection.

People were supported to access healthcare as and when they needed and there was information for people to take with them when they went to hospital. People’s medicines were administered as prescribed.

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 did not review all aspects of Registering the Right Support as the inspection only looked at Safe, Effective and Well-Led. In the areas we covered in the inspection we found the service applied the principles and values of Registering the Right Support. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

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

Rating at last inspection

At the last inspection the service was rated Outstanding (published 26 February 2020).

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 staffing levels, training and inductions, management of incidents and the Infection prevention and control. A decision was made for us to inspect and examine those risks.

We inspected and found there was a concern with staff working long hours, staff induction and training, management of incidents and infection prevention and control so we widened the scope of the inspection to become a focused inspection which included the key questions of safe, effective and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Outstanding to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needed to make improvement in safe, effective and well-led.

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 Kent and Medway Domiciliary Care Agency 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 infection prevention and control, risk assessments, incident reporting and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Kent and Medway Domiciliary Care Agency is a domically care agency providing supported living to people who wanted to live independently in the community. Some people receiving support were living with a learning disability or autism. At the time of the inspection they were providing support to14 people who were in receipt of the regulated activity personal care.

People lived in their own flats in five supported living settings and had access to their own facilities such as kitchens and bathrooms. Services were provided in various locations in Kent including Maidstone, Deal, Dover, Hythe and Ashford. Depending on need, some people had support from wake night staff. Others were supported by sleep-in night staff who could be woken if assistance was required. Some people did not require support at night.

Not everyone who used 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 also consider any wider social care provided.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures 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 using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Feedback from people and their relatives about the service was positive. One relative said, “We cannot thank them enough and would highly recommend their service.” Another said, “[My relative] is happy there. We are pleased with the service.”

The service focused on supporting people to increase their confidence and build self-esteem by ensuring people felt valued. Staff were kind and well-motivated and had gone the extra mile to provide excellent levels of support to people. Promoting independence was at the heart of staffs working practice. There was a strong focus on encouraging people to increase their daily living skills and do things for themselves and some people had become significantly more independent. The service promoted people’s inclusion within society and links with the community. Staff dignity and respect was central to how staff worked.

Support was truly person centred and tailored to people’s needs. People had been involved in choosing their own care staff and planning their own support. Staff had supported people to build relationships within the community and be active in society through social events, participating in education and employment and voluntary opportunities. People’s end of life care had been planned for so that staff understood people’s preferences. If people or their relatives wanted to complain they knew how to do so.

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. People and their relatives were at the centre of planning people’s care. People were very well supported to express their views and make decisions about their support.

Staff had the skills they needed to support people and were well supported. Staff had access to a wide range of training courses which benefited people. Staff were recruited safely and there was enough staff employed to provide people with effective support.

The service was well managed. The registered manager was visible and well known by people and their relatives. Staff told us that they led by example and were positive about the leadership of the service. People were supported to participate in the running of the service, working in the office and arranging meetings and social events. Staff worked well in partnership with other services to improve outcomes for people.

The assessment process was comprehensive and used to develop effective support plans for people. People were very well supported when they went in to hospital and staff provided excellent levels of support to ensure people were involved in decisions about their medical treatment. Healthy living was promoted, and people were encouraged to improve their diet and exercise.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

The service was safe. People’s risks had been assessed and staff knew how to support people to reduce risks. Medicines were managed safely. If concerns arose such as incidents, accidents or safeguarding staff knew how to raise these appropriately and ensure that actions were taken as needed.

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

Rating at last inspection

At the last inspection the service was rated Good overall and Outstanding in Caring.

Why we inspected

This was a planned scheduled inspection.

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.

Kent & Medway DCA provides personal care for 12 people. The service provides personal care to adults who want to remain independent in their own home in the community. Some people also lived in ‘supported living’ settings, so that they can live in their own home as independently as possible.

At our last inspection in May 2016 we rated the service Good overall and ‘Outstanding’ in Caring. At this inspection we found the evidence continued to support the overall rating of Good and continued to be ‘Outstanding’ in the key question of Caring.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

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 care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

The service demonstrated an excellent commitment to providing outstanding care which was embedded into the practices of the staff and the management team.

People had an enhanced sense of well-being and quality of life because staff worked innovatively to enable people to have meaningful experiences and to become active members of the local community. People's privacy was respected, and they were supported to maintain and develop their independence.

Staff were empowered to work creatively and to develop positive therapeutic relationships with people. Staff were proud of the support that they provided to people and the positive outcomes that they had observed.

People were encouraged to be involved in their own care and were involved in developing their own care plans. There were systems in place to seek feedback from people and their relatives to improve the service. People and their relatives told us that they were listened too.

People continued to be protected from abuse. Staff understood how to identify and report concerns.

Medicines were managed safely, and people received their medicines when they needed them.

Peoples' care met their needs. Care plans continued to accurately reflect people's needs.

Risks were assessed and there were mitigations in place to minimise risk and keep people safe.

Where people needed support to eat and drink or access healthcare this was provided, and staff knew how to keep people safe.

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 support this practice. Staff were aware of people's decisions and respected their choices.

There continued to be sufficient numbers of staff who had the skills and knowledge they needed to support people. Staff were appropriately supervised and supported. New staff had been recruited safely and pre- employment checks had been carried out.

Staff and relatives told us the service was well-led and that they had a positive relationship with the provider. The service was regularly audited to identify where improvements were needed, and actions were taken.

Where things had gone wrong incidents were recorded, investigated and acted upon. Lessons learnt were shared and trends were analysed. The service worked in partnership with other agencies to develop and share best practice.

Further information is in the detailed findings below.

Kent and Medway Domiciliary Care Agency is a service registered as a domiciliary service providing supported living to people in their own homes. The service supports adults who have learning disabilities, physical disabilities and mental health needs throughout Kent. At the time of the inspection eight people were receiving a personal care service, although the service provides support to other people as well. Each person had a tenancy agreement and rented their accommodation.

People received support in line with their assessed personal care needs. The support hours varied from a few hours per day/week, one to one allocated hours or 24 hour support. With this support people were able to live in their own homes as independently as possible.

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 care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager of this service oversees the running of the full service and was supported by two deputy managers who were based geographically to manage different areas of the service.

People told us that they felt safe and staff supported them well to enable them to remain in their own home. Potential risks to people in their everyday lives had been assessed and managed to make sure people were as safe as possible. Accidents and incidents were recorded and analysed to reduce the risks of further events.

Staffing levels were sufficient to ensure people’s needs were fully met. Staff numbers were based on people’s needs, activities and health appointments. The registered manger was in the process of recruiting more staff as there were currently full time vacancies. Permanent staff were covering as many shifts as possible and agency staff were also being used. The recruitment selection system ensured that staff were checked and suitable to work with people. People were involved in the recruitment and selection process. Staff were well trained and knew people’s individual needs and how to meet them. Training records were up to date and staff were in the process of receiving regular one to one meetings with their manager and yearly appraisals.

People told us they received their medicines when they should and felt their medicines were handled safely. Health care needs were monitored and met. People were supported with their meals and nutrition to ensure they received a healthy diet.

There was a strong emphasis on personalised care. People were very involved in planning their care and support, this was based on their individual needs and wishes. Care plans detailed what people were able to do for themselves and what support was required from staff to aid their independence wherever possible. The service was innovative and used assistive technology to enable people to be involved in their care and lead their own care and support reviews.

Staff were up to date with current guidance to support people to make decisions. Any restrictions placed on people were done in their best interest, using appropriate safeguards.

People took part in activities of their choice and had very positive relationships with their support staff. There were enough staff available to ensure that people were able to go out in the community whenever they wanted and take part in activities of their choice. People told us how they were supported to visit their family, friends or each other in their flats.

People and their relatives had opportunities to give feedback about the service. Any complaints and feedback were listened to carefully, taken seriously and used to improve services.

People were supported to take control of their lives and this ensured the service was flexible and responded to changes in people’s needs and wishes. Communication aids were used to ensure that people had every opportunity to engage in conversations.

Staff respected people’s privacy and dignity. All interactions between staff and people were caring and kind. Staff were consistently patient, compassionate and they demonstrated affection and warmth in their contact with people.

People told us that they were very happy with the service being provided. There were good relationships between people, the management and staff. People were being supported to live their lives to their full potential. At every staffing level there was a culture of continuous improvement to ensure that people would continue to learn new skills and gain more independence. The service provided outstanding care and support to people enabling them to live fulfilled and meaningful lives.

The leadership and mentoring provided by the registered manager ensured that staff were valued and supported to provide person centred care. The staff had a good understanding of people’s support needs and had the skills and knowledge to meet them.

Staff were very positive and motivated about the support they received from their managers and enjoyed working at the service. Staff were passionate about the care of the people they were supporting.

The provider and managers used effective systems to continually monitor the quality of the service and had action plans in place to improve and develop the service.