Background to this inspection
Updated
8 November 2019
The inspection
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 Care Act 2014.
Inspection team
The inspection was carried out by one inspector.
Service and service type
This service provides care and support to people living in three ‘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.
Two established managers were in post and were registering with the Care Quality Commission. This means that they and the provider will be legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave a short period notice of the inspection. This was because we needed to be sure that the provider or a manager would be in the office to support the inspection, and also to make arrangements to gain feedback from people.
Inspection activity started on 8 October 2019 and ended on 10 October 2019. We visited the office location on 8 and 9 October 2019.
What we did before the inspection
Before the inspection we reviewed information we had received about the service since the last inspection. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with three people who used the service about their experience of the care provided. We spoke with ten members of staff including the area and service managers, practice leads and support workers.
We reviewed a range of records. This included five people’s care records and two people’s medicines records. We looked at six staff files in relation to recruitment processes, training and staff supervision. A variety of records relating to the management of the service were reviewed. This included policies and procedures, quality assurance and health and safety documents.
After the inspection
We had contact with four relatives to find out more about their experiences. We also received feedback from three professionals who had regular contact with the service. Their comments have been incorporated into this report.
Updated
8 November 2019
About the service
United Response Bath and North East Somerset DCA is a domiciliary care agency which provides personal care to people who have learning disabilities or complex needs. At the time of our inspection, the service was providing care and support to 18 people in three different supported living settings.
In the accommodation we visited, some people lived in self-contained flats, and in other houses, people had their own bedroom and shared bathroom, as well as shared communal areas.
In ‘supported living’ settings, people's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support.
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 had 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 received planned and co-ordinated person-centred support that was appropriate and inclusive for them.
People’s experience of using this service and what we found
People were supported by enough staff and regular agency staff were used when needed. Staff were safely recruited. Staff were supported by managers and received training. Some staff had not had supervision as frequently as the provider required, but managers were aware of this and had a plan in place to address the concern.
People's medicines were administered and managed safely, although temperature checks required more consistent monitoring. Staff received training and the provider regularly checked staff’s competency in the management of medicines.
People were safe and protected from avoidable harm or abuse. Staff were trained in safeguarding and were supported by effective policies. Risks to people’s safety were assessed and regularly reviewed.
People’s needs and preferences were assessed before they started to receive support from the service and were regularly reviewed. Support plans gave guidance to staff about what people could do for themselves and how best to provide support.
People were supported to eat and drink enough to meet their individual needs and preferences. People had access to routine and specialist healthcare services.
Staff were clear about their responsibilities, and consistent managers were in post. Systems were in place to monitor and review quality and performance, and actions were taken when shortfalls were identified.
We received largely positive feedback about United Response Bath and North East Somerset DCA. Relatives told us their loved ones seemed happy being supported by the organisation. The staff we saw were caring and treated people with dignity and respect.
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.
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 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 drivers of improvement.
As part of the thematic review, we carried out a survey with a manager during this inspection. This considered whether the service used any restrictive intervention practices (restraint, seclusion and segregation) when supporting people.
The service used positive behaviour support principles to support people in the least restrictive way. Restraint was used only when necessary, and staff had received training in current practice and principles. Review processes, including a debrief, after the use of restraint were in place.
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 good (published 30 May 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.