Northamptonshire Domiciliary Care Agency

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect

This service scored 45 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity.

People told us they liked living in their home and spoke positively about the staff team. One person told us, “I like the staff. I am a new person now, since I moved in here, I like it.” Another person told us, “It’s lovely here, it’s the best.” We received mixed feedback from relatives. Relatives generally felt staff were kind, caring and compassionate. Relatives told us, “I can see staff look after [relative] well,” “Yes, I think the carers are caring," “I think the care [relative] has is good and staff are kind,” and “I cannot praise staff enough they are like a family and have birthday parties and barbecues”. However, relatives also told us, “I think some staff are caring, they seem to be the ones that have been there for a long time, but some are not.”

We observed the staff cared about the people they were supporting and people generally expressed satisfaction with the service they received. However, we also observed that people’s dignity was not always maintained when people were accessing their bathroom and on two occasions, we had to interject to protect people’s dignity.

At two homes we observed inappropriate language being used by the staff while communicating with the people they were supporting. For example, in one home a staff member called a person they were supporting a “silly bugger” and although they corrected themselves, they went onto say this to the same person on several occasions. In another home, staff were referring to people’s continence aids as “pampers”. We raised this with the registered manager who told us the person called the continence aid a “pampers” themself, however, this was not described in the care plan and the manager acknowledged this didn’t mean staff should be referring to them in this way.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics.

We received mixed feedback from relatives about people’s individual needs being met by the service. Relatives told us, “I think staff understand [relative],” Yes, they understand [relative] needs,” However, relatives told us, “Sometimes the care is misplaced.” and, “Some of the staff don’t really understand autism”. Another relative told us their relative’s medical equipment often needed cleaning when family visited and checked on this.

People’s care records lacked detail about people’s cultural backgrounds, interests, or how they preferred to receive support. Staff did not use people’s communication aids to effectively engage with them. For example, we observed now and next boards in people’s homes not being used by staff as part of people’s daily care and support.

People had unnecessary restrictions in place that meant people were not being treated as individuals and did not have access to things that were important to them. For example, at one home a person who liked to regularly wear a Christmas jumper throughout the year had these locked away to prevent them from wearing them. We raised our concerns with the provider during our assessment who told us they would arrange for a restrictive practice audit to be carried out by an internal support function.

The provider did not always promote people’s independence, so people did not always know their rights and have choice and control over their own care, treatment and wellbeing.

People told us staff helped them plan and take part in social activities that were important to them, including trips to the seaside, cinema, bowling, walks, pub meals and going to the day centre.

People did not have choice and control over all decisions being made about them. For example, at one home a person’s hygiene products were being locked away to stop them using a whole bottle.

We were not assured that people living at the homes had a genuine tenancy as the provider was not actively supporting people to understand their rights in relation to their tenancy agreement or developing the understanding of the staff team in relation to this model of care. For example, at one home staff were regularly spending time in people’s home while the people living there were not present. We raised our concerns with the registered manager during our assessment who told us they were not aware staff were staying in the home while people were not there, and they would address this immediately.

Records showed a lack of involvement from people and their relatives in the assessment and review of needs. There was no assurance people were asked their preferences in relation to the staff the provider recruited, and people were not routinely involved in the recruitment and selection process. This meant opportunities for people to have choice and control over their care and support were not maximised.

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress.

It was evidenced during our assessment that staff knew the people they were supporting well and were able to anticipate their needs. However, we found there was a lack of positive behaviour support, including the completion of functional behavioural assessments and positive behaviour support plans. This meant we were not assured people who were anxious or distressed were always being supported effectively by staff.

At one home, we observed a staff member emptying a person’s catheter bag in the communal lounge. While the staff member was anticipating the needs of the person we were concerned this intervention was carried out without seeking the views and wishes of the individual. This meant the person’s privacy and dignity was impacted, as well as their ability to exercise choice and control over their care as no consent was sought or obtained before carrying out the care task.

The provider did not care about and promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care.

We received mixed feedback during our assessment about the support available for staff. One staff member told us, “I’ve never been asked about my well-being by a manager.” Another staff member told us, “I want to feel appreciated.”

There was no evidence of supervision or appraisals that focussed on the well-being or development of the staff working in the service. We found training, competencies, and onsite supervision at the individual supported living service was not effective.

Not all homes held regular team meetings. The provider did not ensure staff received training to meet people’s specific needs and there was a reliance on staff’s knowledge of the people they were supporting rather than empowering them through training, development and supervision.

At one home staff told us about a blind in the staff sleep-in room that had been broken for around 3 years and was being held up during the day with pegs. The staff told us they had purchased a new blind a long time ago and had been waiting for the provider to arrange for someone to put this up.

There was a lack of effective systems, processes, and oversight in the service, to ensure staff always had effective guidance, to deliver person-centre care, and promote the wellbeing of the staff.