Domiciliary Care Cheshire

Domiciliary Care Cheshire is a supported living service which is registered to provide personal care for people with learning disabilities and autism who live in their own homes or flats within the local community. The service was providing support to 45 people and personal care to approximately 17 people at the time of the inspection across 6 supported living settings.

People supported either lived in their own home or self-contained apartments some of which had staff facilities within communal areas. 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

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Restrictions on people’s care and support were not always appropriate or monitored clearly. There was a lack of oversight on the use of restriction at times. The provider took steps to rectify this during the inspection.

Staff received a range of training to enable them to provide safe and effective support, but at times staff training was out of date. Staff knew the people they supported well, including their likes, dislikes, needs and preferred choices. Staff were recruited safely and had a good understanding of safeguarding and whistleblowing procedures. People were supported to attend health appointments in the local community and were engaged in a range of activities.

Where people had specific health needs, these were risk assessed and staff understood people’s needs well. Where appropriate, people had positive behaviour support plans to guide staff on how to support them safely and effectively.

Right Care

Records relating to people’s recorded care needs were at times missing or incomplete. Relatives told us people received enough food and fluid to maintain a health lifestyle, but this was not always recorded clearly. Staff supported people to undertake healthy eating and regular exercise.

Relatives praised the staff approach to providing care and support, and felt their loved ones were being supported well. People received care and support tailored to their wants, needs and preferences. People were able to exercise choice over how they spent their time.

Staff treated people with dignity and respect, and supported them to develop living skills and achieve meaningful outcomes in the areas of independence, community access and taking control of their own care. People told us they were happy with being supported by their staff, and they had developed good relationships with them.

Right Culture

The management team undertook audits of the care delivered, but this had not always identified issues with the use of restrictions and staff recording care delivery. The provider had worked to instil a positive culture at their locations. Staff told us they were confident in raising concerns should they need to, and praised the management team who were described as “brilliant” and “responsive.” Staff and relatives told us morale had improved since the last inspection and staff and people were engaged in expressing their views around the delivery of care.

There was a range of professionals involved in people’s care. Some professionals felt the management team needed to be more forthcoming with requests for information. People’s care records evidenced the involvement of a wide range of health and social care professionals so people could receive effective and responsive care via good partnership working.

Leaders at the service led by example and staff, people and their relatives said there had been a positive improvements in culture and openness. Staff told us they felt supported, valued and listened to by the management team, and people and their relatives were confident in raising concerns should they need to.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 June 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

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 the provider remained in breach of regulations.

At our last inspection we recommended that the provider worked with partner agencies to review people's accommodation needs and to ensure compatibility within services was being considered. At this inspection we found this recommendation had been met.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, restrictions placed on people and staffing. A decision was made for us to inspect and examine those risks.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Domiciliary Care Cheshire on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe care and treatment and good governance at this inspection.

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

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.

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

Domiciliary Care Cheshire is a supported living service which is registered to provide personal care for people with learning disabilities and autism who live in their own homes within the local community in Wirral and Cheshire. Support in everyday activities can be provided, which helps people to live as independently as possible. The service was providing support to 46 and personal care to approximately 23 people at the time of the inspection across 6 supported living settings.

People supported either lived in their own home or self-contained apartments some of which had staff facilities within communal areas. 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.

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.

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

Right Support:

Risks to people's safety were not consistently assessed and mitigated. Risk assessments did not always reflect people’s most up-to-date needs or give clear guidance to staff about how to mitigate the risk.

Positive behaviour support plans were not always in place and those in place did not always give sufficient guidance for staff to follow.

People had not always chosen or been placed in the most appropriate accommodation to meet their assessed needs. This meant some people could not always access communal areas within their homes. We have made a recommendation about this.

Most people were supported by some regular staff who knew them well and had the necessary skills and knowledge to meet their individual needs. Staff training updates were not consistently evidenced. Some people were not receiving support from regular staff and were unable to participate in all activities of their choice.

Personal emergency evacuation plans were in place however, required review to ensure people’s safe evacuation in the event of an emergency.

Trained and competent staff supported people to manage their medicines. Medicine care plans held sufficient information to support staff to meet people's individual needs. There were medication reviews to help ensure the service operated in line with the best practise principles of STOMP (Stopping over medication of people with a learning disability, autism or both with psychotropic medicines).

Most people told us they were supported to participate in activities of their choice. Some people described the many activities they participated in including theatre visits, café outings and shopping.

People were supported with their communication. Staff understood and supported people with their individual communication styles. Information was made available in accessible formats, such as, easy read and pictorial.

Most people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

Systems in place to protect people from the risk of abuse were in place however, had not been consistently applied across all services. Staff understood how to protect people from poor care and abuse. They described actions they would take to keep people safe. However, some concerns raised had not been acted upon in a timely manner.

People who were able to tell us described receiving kind and compassionate care by staff who knew them well. Staff respected people’s privacy and dignity.

Staff had access to appropriate personal protective equipment [PPE] and safe infection prevention and control processes were in place.

People’s care, treatment and support plans did not consistently reflect their individual needs. Some people and their relatives had been involved in the development of their care plans. Reviews of people’s care plans were not consistently undertaken with their involvement.

Some people consistently took part in activities and pursued interests of their choice. Some of the services gave people opportunities to try new activities that enhanced their lives. Comments from people included, "I am enjoying the quiz and buffet today with my friends" and "I have lots of fun with my staff and I am always busy."

Right Culture:

The provider did not always follow good practice guidance in relation to the supported living model.

The provider and registered manager did not always empower people to be fully involved in the development of their care or the service they lived in.

People, their relatives and appropriate health and social care professionals had not fully participated in the review of people’s care plans and the support they received.

The management team undertook regular audits to look at ways of developing and improving the service. Where concerns had been identified they had not been addressed in a timely manner.

Staff feedback about the management of the service was variable. Some staff told us they felt well supported whereas others said they had felt abandoned by the senior management team.

Rating at last inspection

The last rating for this service was good (Published 31 July 2019).

Why we inspected

The inspection was prompted in part due to concerns received about one of the supported living services in relation to the management of risk. A decision was made for us to inspect and examine those risks.

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

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Domiciliary Care Cheshire on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safeguarding people from abuse, risk management, positive behavioural support and governance systems at this inspection.

We made a recommendation in relation to the provider working with partner agencies to review people’s accommodation needs and to ensure compatibility within services was being considered.

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

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.

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

People supported either lived in their own homes and one address included people living in their own self-contained apartments within a larger building. 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.

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. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

Not all people were able to give a direct account of the support they received. People were comfortable and relaxed with the staff team, they approached staff to make their needs known. People who were able to communicate verbally, did not comment directly on the support they received but it was clear they had formed positive and trusting relationships with the staff team. Relatives and professionals connected with the service were positive about how the service met people’s needs.

People received safe and effective care from staff who were caring and focused on upholding the rights of the people. Care plans were person centred and covered all aspects of people’s lives, needs, preferences and daily routines. People’s needs had been fully assessed prior to the service providing support.

Staff had a detailed knowledge of the people they supported and had developed positive relationships with them. Staff received training relevant to the needs of the people they supported, ensuring the support was effective. Sufficient staff were employed and this was regularly reviewed. Staff were supported through regular supervision and team meetings.

Risks that people faced in the support they received and from their wider living environment were recognised and mitigated. People were protected from abuse through staff training and robust policies and procedures. Medicines were safely managed.

People were supported by staff who were very familiar with their needs. People were encouraged to use appropriate methods of communication so they could make their needs known. Care plans sought to maximise people’s independence in their lives. People were supported to pursue their chosen activities both within their homes and in the wider community. People who used the service received support that was well organised and subject to checks, to ensure the quality of the support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes 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.

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

This service was registered with us on 17 May 2018 and this is the first inspection.

Why we inspected

This was a planned inspection based on the newly registered status of the service.

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.