Archived: United Response B&NES DCA

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.

The service people received was called ‘supported living’. This meant people received personal care from the provider in their own homes for which they had a separate tenancy agreement with a housing provider.

The inspection was announced. The provider was given 48 hours' notice because we wanted to make sure the registered manager and staff would be available to speak with us. The inspection was carried out by one adult social care inspector.

There was a registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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 in November 2015 we found, a breach of the Health and Social Care Act 2008 (Registration) Regulations 2009. This was because the registered manager and provider had not always submitted notifications of incidents to CQC as required by law. At this inspection we saw the provider had taken the action they had identified in their action plan. As a result improvements had been made and the service was no longer in breach of this regulation.

During this inspection we did not find any breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 or the Health and Social Care Act 2008 (Registration) Regulations 2009

At the last inspection, the service was rated Good overall.

At this inspection we found the service remained Good.

Why the service is rated good:

People received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm. People were supported to take risks, promote their independence and follow their interests. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed.

The service was effective in meeting people’s needs. Staff received regular supervision and the training needed to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected.

People received a service that was appropriately caring and maintained a clear focus on promoting independence. They were cared for and supported by staff who knew them well. Staff treated people with dignity and respect. People’s views were actively sought and they were involved in making decisions about their care and support. People were supported to maintain relationships with family and friends.

The service was responsive to people’s needs. People received person centred care and support. They were offered a range of activities both at the service and in the local community. People were encouraged to make their views known and the service responded by making changes.

People benefitted from a service that was well led. The vision, values and culture of the service were clearly communicated to and understood by staff. A comprehensive quality assurance system was in place. This system was based upon regular, scheduled audits which identified any action required to make improvements. This meant the quality of service people received was monitored on a regular basis and where shortfalls were identified they were acted upon.