Northamptonshire Domiciliary Care Agency

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people’s needs were not always met.

This service scored 43 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs.

The provider was failing to support staff and provide effective oversight to help them understand how to truly deliver person-centre care in practice. As a consequence, we found this failing had impacted on most of our quality statements during this assessment.

People's care plans did not contain adequate guidance for staff on how to support people appropriately and safely. We found care plans did not always reflect recent changes to people’s care and support needs. For example, when someone’s blood sugars changed from being taken by the service to the doctor’s surgery, this had not been updated in all care plans.

People's records failed to show involvement from them and their relatives in the review of people’s needs, so we could not be assured these had been developed in line with people’s individual preferences and supported the delivery of person-centred care.

During our assessment some staff told us they had struggled to understand the difference between a residential care home and the supported living service they were now working. We found there had been no specific training or guidance to help people develop their understanding of providing a person-centred supported living service in line with best practice guidance, such as, the REACH standards for supported living.

At one home we found monitoring cameras were being used in a person’s bedroom and the communal area and that all the people living there were being continuously monitored by a live video feed. We were told an initial camera had been introduced in response to the needs of a person living with epilepsy. However, following an incident at the home further cameras had been implemented beyond the reason for their initial introduction. This meant that unnecessary restrictions had been placed on all the people living at the home without the required consent and did not align with their care needs.

We were not assured person-centred care had been sufficiently implemented or embedded in care delivery.

We raised our concerns about the monitoring cameras with the provider during our assessment who told us they were not aware these had been introduced and had removed all but the one camera that remained in place for the original purpose.

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity.

Staff did not have specific or enhanced training with regards to the people they supported. For example, we identified shortfalls in the evidence and delivery of training relating to people with a diagnosis of dementia, diabetes and Prader-Willi syndrome.

At two services we were told a lack of local authority funding was impacting people being able to access the activities they wanted to do as part of the planned care. For example, a person living at one home told us once they return from the day service on a Thursday, they didn’t leave the house again until the Monday morning. A staff member told us, “[Staff] were told if we go over the hours they will close us, so we can’t do extra activities.” This concern was raised with the registered manager who told us a local authority review was in the process of being completed, and before the end of our assessment the registered manager was able to share the outcome of the review.

At another service, we were told a person had been waiting for a review for around 12 months, as they wished to reduce the number of days they were going to the day centre to spend time doing different activities. Staff told us the delay was impacting on the person’s well-being as they did not always want to go to the day centre. If the person decided not to go to the day centre, staff told us this was impacting on the other person living at the home as they wouldn’t get their dedicated 1:1 support from staff. We raised our concerns with the registered manager during our assessment who told us a review had been requested. However, we found the lack of oversight by managers in relation to this issue meant there had not been adequate escalation of the impact this was having on the person’s well-being. The provider told us before the end of the assessment they were in dialogue with the local authority in relation to a review.

The provider did not always supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs.

Since 2016 onwards, all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. The standard applies to all people with a disability, impairment, or sensory loss and in some circumstances to their carers.

The provider had some accessible information, for example, the complaints policy, satisfaction questionnaire and support agreement. However, a theme throughout our assessment was there was no assurance people, their relatives or representative had been involved in service delivery, and, in this instance, there was no assurance people had been supported to understand these.

Some people required information to be shared with them using a specialist communication technique called ‘Makaton.’ However, not all staff had received Makaton training, so we were not assured people would always receive information in a format accessible to them.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. Staff did not always involve people in decisions about their care or tell them what had changed as a result.

The provider had a complaints policy in place and a system to record and monitor complaints and compliments. The records we viewed demonstrated there had been 2 official compliments logged about the service in the last 12-months from a family member and a care manager from the local authority. Records also indicated the service had received 3 official complaints in the last 12-months. However, we were not assured from the records shared with us these complaints would be used to drive improvements. A relative told us, “I don’t think they deal with complaints in the proper manner,” and “It has been a challenge getting Mencap to realise the importance of [the issue].”

A satisfaction survey was sent to people in an accessible format in 2025 to obtain feedback about the service. The registered manager told us the survey results would be analysed, and an action plan would be established for any learning. We found completed surveys for 2025 in people’s care files at one home; it was not evident how people had been involved in completing the surveys. However, staff were also not aware if these surveys had been shared with the provider or if they were copies.

The provider did not always make sure that people could access the care, support and treatment when they needed it.

People living with long term conditions did not have robust health care plans, for example, NICE guidance for people with diabetes recommends regular retinopathy (an eye condition that can cause sight loss) screening. Care plans did not provide staff with adequate guidance and there was no information about retinopathy screening in the care plans we viewed in relation to people living with diabetes. Although there was no indication that equity in access was deliberately inequitable, these concerns combined with the provider failing to provide staff with adequate condition-specific training meant we were not assured that people would always have access to the care, support, and treatment they required.

The provider had an on-call policy in place so a member of the management team could always be contacted. We found the implementation of the on-call policy in practice to be inconsistent as staff told us they were not always following the process and calling the person on-call, as their preference was to talk to their own service manager, or the area operations manager. One staff member told us, “I have not found it [the regional on-call] very useful and tend to just use local managers.” We were concerned this approach meant the correct process was not being followed.

Staff and leaders did not listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not tailored in response to this.

We could not be assured that people’s experience and outcomes were being used to treat people as an individual. For example, there was no evidence to show people’s strengths, goals and aspirations were used as a basis on which to provide care and support for people to live independent lives. Documentation for people who lacked capacity did not contain clear decision-making records or evidence of best interest discussions.

Although there was no indication that care was deliberately inequitable, people experienced care that was dependent upon which staff provided their care and how well staff knew them on a personal level. We also found the level of service people were receiving was dependent upon the leader responsible for the individual supported living homes. This meant people’s experience of care were variable and less person-centred.

The provider was aware that care planning and documentation needed improvement and that there had been variable leadership and told us they were taking steps to address this.

People were not always supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life.

The provider did not have a system in place for people to plan for important life changes and future care, so they could have the time and support for informed decisions to be made about their future. Staff did not have all the information they needed to provide care that met people’s needs and preferences at the end of life. For example, a person’s recently completed end of life care plan did not provide any guidance for staff on how the person wanted to be cared for, or where they preferred to be. Their care plan demonstrated the person had been prescribed end of life medicines to help control symptoms, however, there was no guidance for staff to understand what symptoms to look for or when to call for medical assistance for administration of their prescribed medicines.

The provider’s systems to assess, record, or manage people’s future planning had failed to identify there was no adequate provision or process to ensure care records contained adequate information and guidance for staff.