Archived: Heart of England Mencap DCA Central

About the service

Heart of England Mencap is registered as a domiciliary care service which provides personal care to people in their own homes and within supported living accommodation. At the time of our inspection there were twenty-two people 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.

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

Right support:

• Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

• People were supported by staff to pursue their interests.

• Staff supported people to achieve their aspirations and goals.

• The service made reasonable adjustments for people so they could be fully in discussions about how they received support, including support to travel wherever they needed to go.

• Staff supported people to take part in activities and pursue their interests in their local area and to interact online with people who had shared interests.

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

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

Right care:

• People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs.

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

• 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 supported them consistently and understood their individual communication needs.

• People who had individual ways of communicating, using body language, sounds, Makaton (a form of sign language), pictures and symbols and could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

• People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

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

• People could take part in activities and pursue interests that were tailored to them. The service gave people opportunities to try new activities that enhanced and enriched their lives.

• Staff and people cooperated to assess risks people might face. Where appropriate, staff encouraged and enabled people to take positive risks.

Right culture:

• People received good quality care, support and treatment because trained staff and specialists could meet their needs and wishes.

• 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. This meant people received compassionate and empowering care that was tailored to their needs.

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

• Staff placed people’s wishes, needs and rights at the heart of everything they did.

• Staff evaluated the quality of support provided to people, involving the person, their families and other professionals as appropriate.

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

• People’s quality of life was enhanced by the service’s culture of improvement and inclusivity.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 25 June 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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

Why we inspected

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

This inspection was prompted by a review of the information we held about this service. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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:

Staff understood how to keep people safe and how to report any concerns they may have. However, under previous management, safeguarding concerns had not always been acted on in a timely way.

Staff had been trained in administering medication, however a lack of oversight meant we could not be assured people were receiving medication as prescribed.

People’s capacity to make important decisions had not been assessed where required.

Risks to people had been identified but it was not always clear how risks had been assessed and action was not always taken to mitigate risk in a timely way.

Despite this, staff knew about risks associated with people’s health and understood how to minimise these as they knew people well.

There were enough staff to meet people’s physical and emotional needs.

Staff were recruited safely, and processes checked the background of potential new staff.

Accidents had been recorded and any immediate action had been taken to reduce the risk of the event happening again. Overall analysis was complete to identify patterns and trends.

Staff understood how to prevent the spread of infection.

People’s needs were assessed before being supported by the service.

Staff received an extensive induction and had access to the training and guidance they needed to complete their role well.

People were offered choices. For example, in the meals and drinks they were offered.

Staff respected people’s rights to privacy and dignity.

Every person and relative we spoke to told us staff were caring and kind.

Staff treated people with dignity and respect.

Care plans were personalised and contained the information and guidance staff needed to support people to achieve their goals and aspirations.

Systems were in place to manage and respond to any complaints or concerns raised.

The manager had systems and processes to monitor quality within the home. However, these had not yet been embedded.

The Chief Executive was open and transparent about the difficulties they had faced over the past 12 months and had recently changed the management structure at the service to ensure the quality of service delivery was improved.

The new manager understood their regulatory responsibilities and had informed us of significant events at the service since taking on the management role.

Lessons had been learned when things went wrong.

Rating at last inspection: Good. (The last report was published on 10 August 2016).

Why we inspected: This was a planned inspection to confirm that the service remained Good. The service is now rated ‘Requires Improvement’.

The registered provider was in breach of Regulations 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Enforcement: Action we told provider to take (refer to end of full report).

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

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

Heart of England Mencap DCA Central provides a domiciliary care service and a supported living service, which provides personal care and support to people in their own homes. At the time of our visit, five different teams with their own service manager, supported 86 people. Twenty four of these people received a supported living service. The service was last inspected on 10 December 2013 when we found no breaches of the Health and Social Care Act 2008 and associated Regulations.

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 told us they felt safe using the service and staff understood how to protect people from abuse. There were processes to minimise risks associated with people’s care to keep them safe. This included the completion of risk assessments and checks on staff to ensure their suitability to work with people who used the service.

There were enough suitably trained staff to deliver care and support to people. Staff received an induction and a programme of training to support them in meeting people’s needs effectively. Staff understood the principles of the Mental Capacity Act (MCA) and staff respected people’s decisions and gained people’s consent before they provided personal care.

People told us staff were kind and caring and had the right skills and experience to provide the care and support they required. Care plans contained relevant information for staff to help them provide the care people required. Staff treated people in a way that respected their dignity and promoted their independence.

People were involved in planning how they were cared for and supported. Care was planned to meet people’s individual needs and preferences and care plans were regularly reviewed. Healthcare professionals were positive about the care provided.

People knew how to complain and were able to share their views and opinions about the service they received. Staff felt well supported by the registered manager and were confident they could raise any concerns or issues, knowing they would be listened to and acted on. The registered manager valued staff and promoted their development.

There were processes to monitor the quality of the service provided and understand the experiences of people who used the service. This was through regular communication with people and staff, returned surveys, spot checks on staff and a programme of other checks and audits.

People we spoke with were positive about the care they received. One person who used the service told us, 'Staff are polite. They ask what I'd like to do.'

Staff demonstrated they understood people's personal needs and the individual ways they communicated their needs.

We found that staff treated people with respect and gained people's consent before they supported them.

We found that staff were aware of safeguarding procedures and knew how to keep people safe. People who used the service told us they felt safe.

We spoke with staff and found that they felt supported by their manager and felt able to raise any issues.

We found that there was a system for monitoring the quality of the service, which included customer satisfaction surveys.