Swanton Community Care

Swanton Community Care is a domiciliary care agency providing personal care and support to people with mental health needs, physical disability, autism or learning disability who live in their own homes. At the time of the inspection, they were providing a service to 26 people, 19 of whom were receiving support with a regulated activity.

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’s experience of using this service and what we found

People were happy with their care and support. People told us that they had good relationships with staff and felt included in the planning and reviews of their care and support.

The provider had successfully improved quality assurance systems and was focussed on engaging with people who use the service for feedback. The registered manager had supported people to achieve positive outcomes and had a clear vision for the development of the service. This was supported by staff, senior managers and local authority commissioners.

Care plans were developed in a person centred way and led by the person involved. Staff had confidence in the quality of the care plans and risk assessments. This helped them fully understand people’s needs and respond appropriately.

Staff told us the registered manager was supportive and encouraged them to contribute ideas for service improvement.

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.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

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 19 June 2019). 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions Safe and Well-Led. No areas of concern were identified in the other key questions. We therefore did not inspect them.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Swanton Community Care on our website at www.cqc.org.uk.

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.

People’s experience of using this service: People were not always confident staff had the skills to support them with their medicines. Staff were trained in the safe administration of medicines and had their competency assessed, though we found problems with medicine records, stock checks and storage.

Quality assurance processes were in place but had been unable to maintain a high-quality service due to recently being implemented. The newly registered manager was passionate about providing a good service, had made positive changes in a short space of time and encouraged an open and honest culture.

Staffing levels were appropriate to meet people’s needs, but people felt staffing levels could be improved. People were included in staff recruitment and the provider’s processes helped ensure only suitable staff were employed. The provider’s induction and ongoing training helped ensure staff had the skills and knowledge to meet people’s needs.

People had choice and control over who provided their care and when. People spoke positively of their relationships with staff and were supported to take part in activities that interested them. Staff respected people as individuals, had a positive approach to equality and diversity and promoted people’s independence.

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 supported this practice. Staff were trained in mental capacity legislation and understood their responsibilities. They gained consent before providing care and supported people to make their own decisions and choices.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

People’s dietary requirements were met, and referrals were made to healthcare services in a timely way. Care plans were updated which enabled staff to provide person-centred care and follow professional advice.

We identified two breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. The registered persons had failed to ensure the safe management of medicines and had not suitably assessed, monitored and improved safety whilst providing the regulated activity of personal care.

Details of the action we have asked the provider to take can be found at the end of this report.

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

Rating at last inspection: At the last inspection, on 9 August 2016, the service was rated Good (report published 5 October 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

The service is required to have a registered manager by a condition of registration. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. 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. The registered manager had recently left the service and recruitment was underway. There were measures in place for a locality manager to oversee the service and a service co-ordinator managed the day to day operation.

We undertook this inspection on the 9 August 2016. We gave the service 24 hours’ notice as we wanted to be sure there was someone available at the main office to speak with us.

Is the service safe?

We found staff were recruited safely and there were sufficient staff employed to meet people’s care needs. Some people who used the service were assessed as requiring one to one support and staff confirmed they always had this support. We found staff had received training in how to safeguard people from the risk of harm and abuse. They were knowledgeable about what constituted abuse and what to do should they become aware it had happened. Staff completed risk assessments for specific areas to help identify risk and also to help reduce it without overly controlling people’s lives. We found people received their medicines as prescribed. Staff had received training and managed medicines safely.

Is the service effective?

We found staff supported people who used the service to meet their health care needs and to access health care professionals when required. They supported people to make appointments and accompanied them to the doctors or dentist. People’s nutritional needs were met. Staff supported people to shop and prepare their meals. They provided advice to people when required about healthy eating. Staff supported people to make their own decisions and choices about aspects of their lives. Some people lacked capacity and when this occurred, staff knew what action to take and how to apply legislation to ensure decisions were made in their best interest. Staff involved relevant people when best interest decisions were made. We found staff had access to a range of training which was considered essential to their roles and which was specific to the needs of people who used the service. The training, support and appraisal system helped staff to feel confident when supporting people. The building where the service was located had an entrance suitable for people who used wheelchairs or who had mobility difficulties.

Is the service caring?

We observed staff supported people in a kind and patient way. They had developed positive relationships with the people who used the service and knew their needs well. We observed staff respected people’s privacy and dignity and helped them to develop independent living skills. Staff helped people to keep in contact with their friends and family. Information and explanations were provided to people, some of which was in an easy read format. We saw staff held people’s personal records securely and maintained confidentiality.

Is the service responsive?

We found people who used the service had an assessment of their needs and care plans were developed which guided staff in how to support them so care was not overlooked. Staff were responsive to people’s changing needs and kept documentation up to date. There was information in assessments and care plans about people’s preferences for care, what was important to them and how best to support them. This helped staff to deliver care that was centred on the person. Staff supported people to participate in activities of their choice and to feel part of the community by accessing local facilities. There was a complaints policy and procedure in easy read and people spoken to felt able to complain knowing it would be addressed.

Is the service well-led?

The registered provider had failed to submit notifications to the CQC about some incidents which affected the health and welfare of people who used the service. This is a requirement of registration with the CQC. We use this important information to assess how the provider manages incidents to help prevent re-occurrence of them. This helps improve the safety of the service for people who receive care and support. We have written to the registered provider on this occasion reminding them of the need to send in notifications in line with our regulations. We found the culture of the organisation was open, transparent, inclusive and focussed on putting people who used service first; people felt able to raise concerns and staff felt listened to. There was a quality assurance system which made checks on a range of areas and ensured that any shortfalls were identified and addressed.