Lancashire Domiciliary Care Service

Lancashire Domiciliary Care Service, provides care and support to people with learning disabilities and autism in 52 supported living tenancies. There were also a small number of people in their own homes receiving support that were not part of a supported living model. At the time of the inspection there were 161 people receiving support, mostly in the Chorley, Leyland, Preston and surrounding areas, and within four shared tenancies houses and one apartment block on site at Lisieux Hall.

People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living.

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 supported by staff who knew how to keep them safe and report concerns of abuse. Risk assessments had been completed to highlight risks to people’s safety and how these risks can be addressed. Staff knew people and the risks to their safety. People were provided with their medicines in a safe way. There were effective systems in place to reduce the risks associated with COVID-19.

People and their relatives were positive about the care and supported provided. Some people while satisfied with the overall support were less happy with the impact of the high turnover of support staff and managers. This had led to issues with communications and some staff reporting a lack of support and guidance.

The provider had recruited a new manager In November 2020 who in a short space of time had either addressed these issues, or had plans in place to tackle them. A new management structure had been developed and a number of posts created to strengthen and improve oversight to ensure the quality of support given to people and to the staff teams.

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 (RSRCRC) 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.

Based on our review of safe and well-led this service was able to demonstrate how they were currently meeting the underpinning principles of Right support, right care, right culture. People were involved in the planning of their care and accessed support that met their individual interests and hobbies. People’s independence was encouraged and we saw people preparing their own meals and going out independently where able. The managers at the service and staff all described their priority as being to deliver person centred care, that met people’s individual needs.

Whilst Lancashire Domiciliary Care Service only provided personal care to people living in supported living accommodation, the provider was actively looking to expand the supported living accommodation model within the grounds of Lisieux Hall. We had concerns the provider was actively promoting a model of accommodation that could replicate a campus style model. RSRCRC guidance refers to this as an outdated model that could limit people’s opportunities to ordinary community living. We will discuss this with the provider outside of this inspection.

Rating at last inspection

The last rating for this service was good (published 12 July 2019).

Why we inspected

We received concerns in relation to keeping people safe, staff turn-over and how the service was being managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lancashire Domiciliary Care Service 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.

Lancashire Domiciliary Care Service, provides care and support to people with learning disabilities and autism in approximately 50 supported living tenancies. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at infection prevention and control for people who received personal care.

We found the following examples of good practice.

Visitors to tenancies were provided with clear information on how to minimise the risks of infection. Hand cleaning facilities and personal protective equipment (PPE) was available for visitors.

Easy read versions of government guidance in relation to social distancing, hand hygiene and use of PPE was available.

Managers regularly checked with each tenancy how much stock of PPE they had access to. Individual tenancies could order PPE from the providers central supply. Records showed stocks of PPE exceeded current government guidance.

People had been supported to have contact with their families via social media platforms and had been supported to access activities with others via zoom meetings.

Staff received training on IPC procedures and the use of PPE. There were identified areas for staff to don and doff PPE in the tenancies. Cleaning routines and checklists for staff had been developed to minimise the risk of infection.

Individual IPC risk assessments had been completed for all tenants and staff to identify people at increased risk during the Covid 19 pandemic. Appropriate risk management plans had been developed to minimise these risks.

The provider had a contingency plan in place to respond to any future outbreaks.

Lancashire Domiciliary Care Service, provides care and support to people with learning disabilities and autism in approximately 50 'supported living' settings, so that they can live in their own home 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.

The service has 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. 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.

People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them. There were 171 people supported in 50 separate properties. The properties ranged in size from single person flats to a house shared by five people.

People's experience of using this service:

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. The service ensured all incidents were investigated and reported to the local authority safeguarding team. Systems were in place to promote learning and improvement from any incidents to avoid them happening. People were supported to manage the risks in their daily lives. Positive risk-taking strategies maximised people's opportunities to engage in activities. Staff had been recruited safely. Medicines were properly managed and staff competencies were regularly checked.

People's needs had been thoroughly assessed with input from families and professionals. Care plans were detailed. Staff felt they provided enough information to understand what support the person needed. Staff had received regular training and supervision to support them to meet people's needs. A comprehensive induction programme ensured new staff had a good understanding of their role and the values of the organisation. People were supported to maintain their health and wellbeing, through access to a range of health services. The service was compliant with the Mental Capacity Act and associated Deprivation of Liberty Safeguards. People's mental capacity to make specific decisions had been assessed and appropriate authorisation sought when required.

People were supported to understand and manage personal relationships. The service promoted people's choices. Training and information was sourced from an organisation which specialised in personal relationships for people with learning disabilities. This had very positive outcomes for some people, who had been supported to develop respectful relationships. The service supported people to express their wishes and choices. Using total communication methods had improved people's involvement in decisions. The outcomes for some people had been very good in terms of supporting people to manage their feelings and responses when they felt distressed, which had reduced the risks of harm to themselves and others. The provider had an advocacy service which promoted self-advocacy and people's involvement at all levels of the organisation.

People received person-centred care which was responsive to their needs. Care and support plans had been regularly reviewed to reflect any changes in the person’s needs and wishes. People had been referred for further input from professionals when required. Staff were carefully matched to work with people which promoted better outcomes for the person. People were encouraged to raise any concerns they had. Information about how to do this was available in a variety of formats. We saw the service had responded to concerns fully.

There was a registered manager in post. 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.

The management team were committed to providing high-quality, person-centred care. They sought to embed the values of the organisation throughout their practice. Staff spoke highly of the management team, the values they set and their approachability. Staff were proud to work for the service. Roles and responsibilities were clear. Regular checks ensured care was provided correctly and records were accurately maintained. People, their families and staff were actively engaged through meetings, events and surveys. Their views were considered and responded to.

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

Rating at the last inspection:

The last rating for this service was Good. (Published November 2016)

Why we inspected:

This was a planned inspection based on the previous rating

Follow up:

We will continue to review information we receive about the service until we return to visit as part of our re-inspection programme. If any concerning information is received, we may inspect sooner.

Lancashire Domiciliary Care Services is run by Brothers of Charity and is part of a wider service, which also provides day care, supported employment and residential and nursing care to people with learning disabilities in the Chorley and South Ribble areas. Lancashire Domiciliary Care Services is registered to provide personal care. Support is provided both to individuals living in their own home and to people living in small group settings. At the time of our inspection there were 150 people using the service.

The service has a 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.

People were involved and consulted with about their needs and wishes. Care records provided good information to direct staff in the support people wanted and needed. Where risks had been identified, plans had been put in place to help protect people. Information was provided in an ‘easy read’ format so that people could understand what was written about them. Records were stored securely ensuring confidentiality was maintained.

Staff understood their responsibilities in ensuring people were protected from the risk of abuse. The service had acted accordingly when issues needed to be raised and investigated so that appropriate action was taken and people were kept safe.

We found staff understood the principles of the Mental Capacity Act. Where people lacked the mental capacity to make decisions for themselves appropriate steps were taken to ensure their rights were protected.

We found the system for managing medicines was safe. Staff worked closely with healthcare agencies so that people received the care and treatment they needed. Information was shared with other services, where necessary, so that people continued to receive safe and effective care.

Sufficient numbers of staff were available to meet the individual needs of people so that their social, emotional and physical needs were met. Recruitment procedures were thorough so that only suitable applicants were appointed.

Staff received on-going training, development and support. This helped to ensure staff had the knowledge and skills needed to meet the specific needs of people who used the service.

During our inspection we saw staff treating people with respect and dignity. People and their relatives were complimentary about their experiences and the support staff provided. We saw interactions between staff and the people who used the service were warm, friendly and relaxed.

People were encouraged and supported, where necessary, to take part in social, educational and employment opportunities based on their individual wishes and preferences. This helped to promote people’s independence and community presence.

People were encouraged to choose healthy and nutritious food. Where people were at risk, due to a poor diet, appropriate health care advice had been sought.

We saw accommodation provided for people in the shared houses was of a good standard and was clean and well maintained. Checks were made to the premises and servicing of equipment. This helps to ensure the safety and well-being of everybody living, working and visiting the home.

Systems to monitor and review the service provided were in place to check that people received a quality service. People, their relatives and staff spoke positively about the management team in place. People and their relatives told us the managers and staff were approachable and felt confident they would listen and respond if any concerns were raised.

Medicines were being managed well, so that those people needing assistance with their medication were protected from any associated risks. Staff received mandatory training for medication administration and regular checks were made by managers to assess staff competency. Medicines were stored safely.

Staff were competent in carrying out their roles. An effective supervision and appraisal system and training programme was in place for all staff.

Appropriate systems were in place to regularly assess and monitor the quality of services that people receive. Internal and external auditing systems were used.