Background to this inspection
Updated
7 May 2022
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.
As part of this inspection we looked at the infection control and prevention measures in place. This included checking the provider was meeting COVID-19 vaccination requirements. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by an inspector, a CQC senior manager and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. Registered managers and providers have legal responsibilities for how they run the service and for the quality and safety of the care provided.
Notice of inspection
We gave 48 hours’ notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for ‘best interests’ decisions about this.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service.
The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. We used information gathered as part of monitoring activity to help plan the inspection and inform our judgements.
We used all of this information to plan our inspection.
During the inspection
We spoke with eight people, two managers, one senior manager and four care workers. We reviewed a range of records. This included five people's care records and multiple medicines records. A variety of records relating to the management of the service, including policies and quality monitoring of the service, were reviewed.
Inspection activity started on 24 November 2021 and ended on 10 January 2022. We visited the location’s office on 25 November 2021. We also visited the provider’s supported living services where care workers are carrying out care, on 24 and 25 November 2021.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We continued to review records shared electronically. We spoke with seven relatives about their experience of the care provided. We looked at medicine management and quality assurance records. We spoke with five staff for their feedback of the service.
Updated
7 May 2022
About the service
Domiciliary Services is a care agency providing personal care and support to people living in their own homes. People lived in a supported living service with shared facilities with between two and five people who share their home. At the time of our inspection 15 people were using the service. Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.
People’s experience of using this service and what we found
People gave different views about the quality of care they received. People and their relatives were complimentary about the care workers who supported them. Some relatives commented that their family members individual care needs were not always met.
People had their medicines as prescribed. However the medicines administration records were of a poor quality and not completed accurately.
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.
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 the underpinning principles of Right support, right care, right culture.
Right support: Model of care and setting does not maximise people’s choice, control and Independence. People were not always able to go out to do things they enjoyed which impacted on their independence.
Right care: Care is not always person-centred and does not always promotes people’s dignity, privacy and human rights. People and their relatives were not involved in care planning and records were not accessible to read for some people.
Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. The systems in place did not always promote an environment that promoted people’s choice and independence.
The monitoring systems in place were not robust because these did not find and address the concerns we found with the quality of medicines and care records.
People had care assessments and support plans in place, however we found people’s records were not always updated on the new computerised system and people’s care files contained the previous provider’s care documents.
There were mixed views of the staffing levels at the service. While the staff rotas planned for sufficient staff there were times when staff were not available and/or deployed to support people to enjoy the things they liked to do.
Staff were regularly tested for COVID-19 and had access to sufficient supplies of personal protective equipment [PPE] to reduce the risks of infection.
Staff understood the provider's safeguarding procedures, staff told us they had completed training on abuse and knew how to report concerns.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection:
The last rating for this service was good (6 April 2018).
Why we inspected
We undertook this inspection as part of a random selection of services rated Good and Outstanding.
Enforcement and recommendations
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 monitor the service and will take further action if needed.
We have identified breaches in relation to person-centred care, consent, safe care and treatment, good governance and staffing.
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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.