Background to this inspection
Updated
20 March 2021
The inspection
This was a targeted inspection to check on a specific concern we had about staff recruitment and staff working hours, medicines incidents and some areas of management.
Inspection team
This inspection was carried out by one inspector.
Service and service type
This service provides care and support to people living in five ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. This included information of concern sent to us by members of staff. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.
A condition of the provider’s registration is for them to send us monthly action plans for this service, which we also reviewed. We used all of this information to plan our inspection.
During the inspection
We spoke with three members of staff, the registered manager and regional manager. We reviewed a range of records. This included three staff files in relation to recruitment and staff rotas. A variety of records relating to the management of the service were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality monitoring, staff agency usage and staff and house meeting minutes. We contacted one professional and two relatives for their views on care and support provided.
Updated
20 March 2021
About the service
HF Trust – Wiltshire DCA is a domiciliary care agency providing personal care to eight people who have a learning disability. People lived in a ‘supported living’ setting. Supported living services enable to people to live in their own home and live their lives as independently as possible. Not everyone using 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
People had their medicines as prescribed however, some medicines records required updating and more detail was required in others to make them robust. Quality monitoring had been carried out, however it had not identified all the concerns we have found at this inspection. Risks had been assessed and recorded and reviewed regularly. We found two risk assessments that required updating.
People felt safe receiving care and support from suitable staff who had been recruited following the required pre-employment checks. More staff had been recruited since our last inspection, but there was still a reliance on agency staff. Where agency staff were used the service tried to use the same agency staff to provide consistent support.
People were able to access healthcare services and supported to do so by the staff team. Health action plans were in place and a health check was carried out annually. Staff used handovers to communicate with each other and share information. 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. Staff were supported and had been trained in a range of areas. Staff spoke positively about the training they received.
People were involved in their care and support where appropriate. Support was provided to help people maintain relationships that were important to them. People were able to join in ‘voices to be heard’ meetings which were held at the site. This gave people the opportunity to share their views and raise concerns. People told us staff were caring and they were happy with how staff supported them. We observed staff interacting with people and saw that people were comfortable and staff knew them well.
Care plans had been reviewed and were personalised. Staff kept daily records which recorded the care and support that had been given. The local authority was involved in people’s reviews which included health assessments. People were able to access employment and plan their own activities. During our inspection four people were supported to go on holiday.
There was not a registered manager in post. A manager had been appointed and was going through the process of registering. The manager had started following our last inspection and had stabilised the service. They were supported by the provider who maintained oversight of this service.
The Secretary of State has asked the Care Quality Commission (CQC) to conduct a thematic review and to make recommendations about the use of restrictive interventions in settings that provide care for people with or who might have mental health problems, learning disabilities and/or autism. Thematic reviews look in-depth at specific issues concerning quality of care across the health and social care sectors. They expand our understanding of both good and poor practice and of the potential drives of improvement.
As part of thematic review, we carried out a survey with the manager at this inspection This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
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 22 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Following the inspection, we imposed conditions on the providers registration. The conditions required the service to report to CQC each month on areas of concern seen at that inspection. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. The service remains rated requires improvement overall. This is the third consecutive inspection where the service has been rated as Requires Improvement.
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. The provider is required to send us information each month following their audits. If we receive any concerning information we may inspect sooner.