Archived: Wolds & Coast Domiciliary Agency

Wolds & Coast Domiciliary Care Agency is a domiciliary care service providing personal care for people who are living with dementia, mental health conditions, physical disability, sensory impairment, older people, younger adults and people with a learning disability and/or autism in their own home. At the time of our inspection 11 people received support from the service.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

Risks to people continued to not be effectively managed. Health conditions continued to not be sufficiently risked assessed.

Medicines continued to not be managed safely. This included the management of homely remedies and some people were not receiving their medicines as prescribed.

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. At time’s people’s choice was restricted due to staffing levels. Capacity assessments had not always been recorded.

Right Care

There was not always sufficient staff on duty. People did not always receive person centred care due to the staffing levels.

Staff had not always had training in supporting people with a learning disability to ensure they were supporting people appropriately.

People had good relationships with the staff. People were supported to maintain relationships with their relatives.

Right Culture:

Staff felt supported by the registered manager but did not always feel supported by the provider. Although the registered manager recognised improvements where required, they had not always had the time and resources to make these.

People, their relatives and staff were supported to give their views in meetings and a satisfaction survey was in the process of been carried out to gather people’s feedback.

The provider's quality monitoring processes were not robust and had not always identified concerns and improvements in the service identified during the inspection.

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 11 December 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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider seek advice from a reputable source regarding auditing and action planning. At this inspection we found the provider had failed to make the required improvement and the provider was now in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook this focused inspection to check they 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 which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, medicines, staffing and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made recommendation regarding person centred care.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Wolds and Coast Domiciliary Agency is a domiciliary care service providing personal care for people who are living with dementia, mental health conditions, physical disability, sensory impairment, older people, younger adults and people with a learning disability and/or autism in their own home. At the time of our inspection 11 people received support from the service.

This service provides care and support to people living in two ‘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.

People’s experience of using this service

Risks to people were not always managed and medicines practices were note safe. Records were not up to date and checks in place to monitor the quality of care being provided had not identified or addressed the concerns found. The registered manager was absent from the service but the nominated individual for the provider and the manager were responsive to concerns we found and had identified some areas for improvement before our visit. We made a recommendation about the use of action plans and audits to support the changes required.

Robust recruitment processes were not always followed. The provider had already identified this, and action had been taken.

People were supported with activities and interests to suit them and to aid their independence. Staff knew people’s likes and dislikes well.

People were supported with their communication needs and staff demonstrated effective skills in communication. Staff had received training and support to enable them to carry out their role. 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 told us the management team were approachable. The provider had systems in place to safeguard people from abuse and staff demonstrated an awareness of safety and how to minimise risks.

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.

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 05 June 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to the safe administration of medicines and the management of risk at this inspection.

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.

At the last inspection the service was rated Good. At this inspection we found that the service remained Good.

There was a person registered with the Care Quality Commission at the time of the inspection. We were told they were retiring but another person held a manager role and had been trained by the outgoing registered manager. A registered manager is a person who has registered with the Care Quality Commission 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.

Care was planned in partnership with people and they received the care and support they needed to meet their individual needs. The managers and staff were committed to working in a person-centred way and treated people with kind-heartedness and consideration. People, including those who had difficulties communicating or who could become upset, responded positively to the way in which staff approached them. Staff were professional but kind in their approach.

People were protected from abuse because staff could identify the different types of abuse and knew what actions to take to report abuse. It was clear from our observations that people felt safe around the staff.

Improvements were identified through meetings, reviews and surveys. As well as consulting with people there were systems in place to monitor the quality and safety of the service and bring about any improvements that were needed. The home worked in partnership with other organisations to make sure they were providing high quality care.

The service had a clear management structure. Managers worked closely with staff, frequently observing and providing care. People were confident in the leadership of the service. They were encouraged to raise any areas of concern, which were taken seriously and the appropriate action was taken.

Staff demonstrated good communication skills when engaging with people. The staff were familiar with the needs of people. There was plenty of communal space available to people, including outside space.

Risks to people were monitored and people were encouraged to maintain a safe level of independence. Staff supported people in a positive way and were able to recognise when people may require additional support. We saw that people were cared for and supported by qualified and competent staff who were regularly supervised. Staff told us they felt extremely well supported by managers and the registered provider through training and meetings where their views were listened to.

The service was organised to meet people's individual needs. They were supported by staff that were kind and treated them with dignity and respect. Without exception, people we spoke with were complementary and positive about the staff that supported them.

People were supported to buy, prepare and cook their own food.

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.

The premises were safely maintained by the housing provider but checks of the environment were carried out by staff. Staff were recruited safely and during this inspection we saw there was sufficient staff available to provide support to people.

People's consent was obtained before care and support was provided. Where people did not have capacity to consent to care or treatment best interest decisions were made that involved the relevant people involved in the person's care.

Care plans provided clear guidance to support staff to ensure people's needs were safely met. People we spoke with confirmed they were satisfied with their support.

People were supported to take their prescribed medication in accordance with their care plan.

Staff received regular supervision and training to ensure they had the support necessary to enable them to undertake their role appropriately.

The provider had effective systems in place to check on the quality and safety of the service people received.

People told us that they felt safe in their home. They told us that they could speak to staff if they had any worries or concerns and that they felt staff would help them if they could. One person said that they trusted all of the staff at the home and said, "I am really happy living here". People said that they attended tenant's meetings and that they could raise any issues at these meetings.

We observed good rapport between people who used the service and staff and it was clear that staff had a good understanding of each person's individual level of independence and need for support. People were encouraged to undertake household chores and to take part in activities within the local community, and spent one to one time with their key worker. People enjoyed telling us about their holidays and their active social lives.