St Anne's Community Services - York DCA

Updated 8 December 2023

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

Inspection team

The inspection was carried out by an inspector and a medicines specialist advisor.

Service and service type

The service operated a domiciliary care agency, providing personal care to people living in their own houses.

The service also operated a supported living setting, providing support to people in their home 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service short notice of our visit to the office. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

We gave several days’ notice of our visit to the supported living setting because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 26 October 2023 and ended on 8 November 2023. We visited the location’s office on 26 October 2023 and the supported living setting on 31 October 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used information gathered as part of monitoring activity that took place on 13 September 2023 to help plan the inspection and inform our judgements. We used all this information to plan our inspection.

During the inspection

We spoke with 3 relatives about their experience of the care provided. We spent time with and observed 1 person who used the service. We spoke with 11 members of staff including the registered manager, deputy manager, area manager, and 8 care workers. We also spoke with the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 2 people's care records and medicine records. We reviewed a variety of documents relating to the management of the service, including policies and procedures, staff recruitment records, training and quality assurance documentation.

On 2 November 2023 we served a letter under Regulation 17(3) of the Health and Social Care Act (Regulated Activities) Regulations 2014, requesting a detailed improvement plan, addressing the high risk areas we identified on inspection. The provider submitted an action plan on 3 November 2023.

Updated 8 December 2023

About the service

St Anne’s Community Services – York DCA provides personal care to people living in their own homes and supported living settings. The service provides support to people with a learning disability and autistic people. At the time of the inspection, 35 people were using the service.

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, 4 people were receiving personal care.

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 were not safely assessed, monitored, and managed. There was insufficient guidance in place to support staff to keep people, themselves and others safe. People’s medicines were not safely managed. Medicines were not always in stock and records were not always in place, or clear and up to date. Incidents and potential safeguarding concerns were not always dealt with appropriately. People were not always supported by staff who were safely recruited. People were not always well supported with their communication needs. We received positive feedback about the care and support provided from the domiciliary care agency side of the service.

The service did not have copies of relevant Mental Capacity Act (MCA) documentation and therefore we could not be assured that people were being supported in the least restrictive way possible and in their best interests. People were not supported to have maximum choice and control of their lives. Systems in the service did not support best practice in this area and we have made a recommendation about this.

Right Care:

There were not always enough staff to provide person-centred care within the supported living setting. Activities and outings were limited, and some staff told us this was due to staffing levels. Assessments of people’s needs were not always up to date and did not always reflect the person as a whole. Support plans did not promote strategies to enhance people’s independence and did not contain clear pathways to future goals and aspirations. People’s sensory needs had not been explored fully. People’s nutritional needs were not always clearly communicated to staff. People’s social needs were not met, and people were not provided with appropriate stimulation.

Right Culture:

The provider had not created a culture in which people were able to develop and flourish. Support delivered was not person-centred and did not empower people to lead their best lives and increase their independence. Quality assurance systems and processes were ineffective. Systems were not in place to support continual improvement of the service. Relatives told us they felt comfortable in raising concerns, and staff and relatives spoke positively about the registered manager. The provider responded to feedback and an action plan was 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 2 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and record keeping. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. Due to concerns identified on inspection, the scope of the inspection was expanded to include the key questions of effective and responsive.

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

The overall rating for the service has changed from good to inadequate based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Anne’s Community Services – York DCA on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person-centred care, staffing and good governance.

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

We have made a recommendation about ensuring compliance with the Mental Capacity Act (MCA).

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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.