Domiciliary Care Agency East Area

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.

Domiciliary Care Agency East Area is a supported living service which provides personal care to younger adults, including people with a learning disability and autistic people. 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. At the time of the inspection, 18 people received support with personal care, in 7 supported living settings, made up of flats and shared houses.

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

Right Support

People did not always receive high quality care that resulted in good outcomes for them.

People were not always protected from the risks associated with poor infection prevention and control. Risks to their health and safety were not always managed well.

People did not always receive support that maximised their choice and control.

There were not always enough staff available to support people to do what was important to them.

People were not always supported by staff to pursue their interests and take part in activities.

People had a choice about their living environment and were able to personalise their rooms.

Staff communicated with people in ways that met their needs.

Staff supported people with their medicines safely. Some minor improvements were needed to ensure medicines processes reflected national guidance.

Staff enabled people to access specialist health and social care support in the community.

Right Care:

People did not always receive appropriate support, as the service did not always have enough appropriately skilled staff to meet people’s needs and keep them safe.

The level of person-centred care that people received was not consistent across all of the supported living settings. People did not always receive care that reflected their individual needs and aspirations, was focused on their quality of life, and followed best practice.

People could not always take part in activities and pursue interests that were tailored to them.

People liked the staff who supported them, and most relatives told us staff knew their family member’s needs and preferences.

People’s care, treatment and support plans reflected their range of needs.

People could communicate with staff and understand information given to them because staff understood their individual communication needs.

People were supported by staff who had been recruited safely. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture:

People did not always receive good quality care and support.

The service had had experienced staffing difficulties and people were not always supported to receive consistent care from staff who knew them well.

The service did not always work with people, those important to them and staff to develop the service.

The service did not always have a culture of improvement and inclusivity. They did not always respond to complaints appropriately.

The service did not always monitor and evaluate the quality of support provided to people.

People and those important to them were involved in planning their care. They were happy with the management of the service.

There had been a number of changes in management over the previous year or so, which had resulted in inconsistency in the level and quality of support being provided across the service. Governance arrangements were not always effective. Checks of quality and safety were not always being completed as they should have been, and where improvements were needed, these were not always being completed in a timely way.

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

Rating at last inspection

The last rating for this service was requires improvement (published 22 June 2022).

Why we inspected

We had received concerns from Lincolnshire County Council, following their visits to 2 of the supported living settings: Roman House and Willoughby Services. The concerns related to safety, cleanliness, staffing arrangements, staff training and recruitment, communication, medicines management and staff culture. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. Roman House was closed by the provider on 5 May 2023, so this setting was not included in our inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to staffing levels and training, the management of risks to people’s health and safety and governance arrangements at this inspection.

We have made recommendations regarding the management of complaints, support with activities and seeking and acting on the views of people supported by the service, relatives and staff.

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

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.

About the service

Domiciliary Care Agency East Area is registered to provide personal care to people living in their own homes and shared supported living services in Lincolnshire, Cambridgeshire, Suffolk and Essex. At the time of our inspection, 39 people were receiving a personal care service. Shortly after our inspection, the registered provider applied to remove the Essex services from Domiciliary Care Agency East Area and operate them instead from a different registered location.

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

Right Support

The service gave people care and support in generally safe, clean, well equipped, well-furnished and well-maintained premises that met their sensory and physical needs. However, in two local services staff did not always comply with measures designed to reduce the risk of COVID-19 spreading within the service. The registered manager acknowledged these lapses and took action to address them.

Staff focused on people’s strengths and promoted what they could do, promoting the opportunity for people to lead fulfilling and meaningful lives.

People were supported by staff to pursue their interests inside and outside their home, and to achieve their aspirations and goals.

The service worked with people to plan for when they experienced periods of distress to minimise any restrictions of freedoms at those times.

Staff managed risks to minimise restrictions and to ensure people had as much freedom, choice and control over their lives as possible.

Staff received training in the use of restraint and were confident in their ability to deploy this training as a last resort and for the shortest time possible. At the time of our inspection, there was no one using the service for whom the use of restraint had been identified as necessary.

Staff supported people to make decisions following best practice in decision-making. Staff communicated with people in ways that met their needs.

People had a choice about their living environment and were able to personalise their rooms.

Staff supported people to take part in activities and pursue their interests in their local area.

Staff enabled people to access specialist health and social care support in the community.

Staff supported people with their medicines in a way that respected their independence and achieved positive health outcomes.

Staff supported people to play an active role in maintaining their own health and wellbeing.

Right Care

People received kind and compassionate care and responded to their individual needs. However, on two isolated occasions we observed staff did not fully respect people’s privacy and dignity. The registered manager acknowledged this shortfall and took action to address it.

Staff promoted equality and diversity in their support for people. They understood people’s cultural needs and provided culturally appropriate care.

Staff understood how to protect people from poor care and abuse. The service worked with other agencies to do so. Staff had training on how to recognise and report abuse and they generally knew how to apply it.

Despite difficulties caused by the COVID-19 pandemic, the service had enough appropriately skilled staff to meet people’s needs and keep them safe.

People could communicate with staff and understand information given to them because staff had the skills and knowledge to understand people's individual ways of communicating.

People’s support plans reflected almost all their range of needs and this promoted their wellbeing and enjoyment of life. The registered manager agreed to take action to ensure people’s sexual needs and preferences were more fully understood by staff and documented in their support plan.

People received care that supported their needs and aspirations, was focused on their quality of life, and generally followed best practice.

Right Culture

Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate. However, organisational governance systems were not consistently effective in ensuring that care provision was consistently safe across the service and that staff always respected people's dignity and privacy.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and/or autistic people may have.

Staff knew and understood people well and were responsive to their needs and wishes, supporting their aspirations to live a quality life of their choosing.

Staff were committed to putting people’s wishes, needs and rights at the heart of everything they did.

People and those important to them, including advocates, were involved in planning their care.

The service enabled people and those important to them to work with staff to develop the service. Staff valued and acted upon people’s views.

Staff ensured risks of a closed culture were minimised so that people received support based on transparency, respect and inclusivity.

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 13 September 2019).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

We received concerns in relation to people’s safety and well-being and organisational culture. As a result, we undertook a focused inspection to review the key questions of Safe, Caring and Well-Led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Domiciliary Care Agency East Area on our website at www.cqc.org.uk.

The overall rating for the service has changed from Good to Requires Improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Caring and Well-Led sections of this full report.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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

The management team completed regular checks of the quality of the service provided.

The performance of the organisation was monitored to help ensure improvements were sustained and any identified shortfalls were effectively managed in a timely manner.

People received safe and effective support from staff who received appropriate training and support. People were protected from harm because staff received training in how to recognise and report abuse. The service recruited staff and ensured they had appropriate training to ensure people’s needs were met. Medicines were managed safely. Systems were in place to ensure good standards for infection control were in place.

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. People were provided with good day to day support with areas such as health needs, medicines management and meals. Areas of learning were shared with staff to ensure best practice.

People told us staff were kind and caring. People’s care was arranged in response to their identified needs. This was kept under review and updated as and when needed. People were supported to develop life skills and achieve their goals. There were complaint processes in place and people were supported to express any concerns they might have.

People received care and support tailored to their needs and choices. The service was not currently supporting anyone with end of life care but people’s wishes and preferences were sought and documented.

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 22 February 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.

A registered manager was in post. 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.

Staff received training to protect people from harm and they were knowledgeable about reporting any suspected harm.

Risk assessments were in place and actions were taken to reduce these risks. Arrangements were in place to ensure that people were supported and protected with the safe management of medicines.

There were sufficient numbers of staff to meet people’s needs. There were recruitment procedures in place to ensure that only suitable staff were employed. A staff training and development programme was in place and procedures were in place to review the standard of staff members’ work performance.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA). Staff were supported and trained regarding the MCA

People were supported to access a range of healthcare professionals and they were provided with opportunities to increase their levels of independence. Health risk assessments were in place to ensure that people were supported to maintain their health. People had adequate amounts of food and drink to meet their individual preferences and nutritional needs.

People’s privacy and dignity were respected and their care and support was provided in a caring and a patient way

People’s preferred interests had been identified and they were supported to take part in a range of activities that were meaningful to them. A complaints procedure was in place and complaints had been responded to, to the satisfaction of the complainant. People could raise concerns with the staff at any time.

The provider had quality assurance processes and procedures in place to improve, if needed, the quality and safety of people’s support and care. People and their relatives were able to make suggestions in relation to the support and care provided and staff acted on what they were told.

There were strong links with the external community.