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Inspection carried out on 26 April 2017

During a routine inspection

HF Trust – Devon DCA (Hft) is part of a larger national provider for people with learning disabilities (HF Trust) and is registered to provide personal care to people living in the community. At the time of this inspection the service was supporting 33 people with varying support needs in a total of 13 supported homes. Some people lived alone, requiring minimal support and others lived in shared accommodation with support during the day and overnight.

This inspection was announced and took place on 26 April and 2 May 2017.

The service had a registered manager in post. 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.

We previously undertook a comprehensive inspection of the service in April 2016 when we rated the service as ‘good’ overall with the question of ‘well-led’ rated as requires improvement. In December 2016 we undertook a focused inspection in response to concerns raised with us about people not receiving safe care and treatment and the staffing arrangements within the service. We rated the key question of ‘safe’ as requires improvement. We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the inspection in December 2016 the service sent us a plan describing the actions they had taken to improve.

At this inspection, in April and May 2017, we found improvements had been made to staffing arrangements and how the service was managed. However, while people were receiving safe care and support, some improvements were required to ensure risk management plans accurately reflected the action staff were taking to keep people safe.

Risks to people’s health, safety and welfare had been assessed and the outcome recorded in their care files. Management plans had been developed to identify how to support each person in a way that minimised these risks. However, we found some management plans did not include all the actions staff were taking to keep people safe. For example, one person’s risk management plan did not identify that staff must supervise them at all times when they were in the communal areas. The registered manager gave assurances these plans would be amended immediately.

People received support from staff who had been safely recruited and well trained. Changes had been made to the number of people the service could support. This had resulted in improved staffing arrangements and the service was less reliant upon agency staff. Staff were aware of their responsibilities to protect people from abuse. The service provided people with guidance and information about protecting themselves when in the community.

Some of the people receiving support could become anxious and display behaviours that may put themselves or others at risk. Hft had a team of advisors who supported staff in assessing people’s needs and provided guidance to promote people’s positive behaviour. Staff told us they had completed training in supporting people who may display potentially aggressive behaviour and were familiar with appropriate distraction techniques.

People’s medicines were managed safely and they received their medicines as prescribed by their doctor. Medicines were stored securely and only staff trained and assessed as competent administered medicines. Senior staff undertook weekly audits of medicines in each supported home. This ensured medicines were ordered when needed, given as prescribed and records were properly completed. People were referred to health care services when necessary. These included GP or community nurses as well as more specialist services such as hospital consultants and physiotherapists. Staff monitored people’s health conditions and liaised with healt

Inspection carried out on 6 December 2016

During an inspection to make sure that the improvements required had been made

HF Trust – Devon DCA (Hft) is part of a larger national provider for people with learning disabilities and is registered to provide personal care to people living in the community. At the time of this inspection the service was supporting 35 people with varying support needs in a total of 13 supported homes. Some people lived alone, requiring minimal support and others lived in shared accommodation with support both during the day and overnight.

This unannounced focused inspection took place on 6 December 2016. It was undertaken in response to concerns raised with us about people not receiving safe care and treatment, and the staffing arrangements within the service.

The service was previously inspected in April 2016 when it received an overall rating of good, with the key question of well-led rated as requires improvement in relation to how the service was managed.

Since that inspection there had been changes to the management structure within the service. In April 2016 there were two registered managers in post, each with a responsibility for a geographical area. At the time of this inspection in December 2016, the service had one registered manager with the responsibility for both geographical areas. 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.

At this inspection, we found the high use of agency staff unfamiliar with people’s care needs had led to some people being placed at risk of not receiving safe care. Some people were also reluctant to receive assistance from staff they did not know well and people were not always supported by their preferred gender of staff.

We made a recommendation that the service keeps its staffing arrangements under review.

Although staff had access to people’s care records, these did not always provide an accurate account of each person’s support needs. Daily care and monitoring records were incomplete and it was not always possible to ascertain the care and support provided to people.

The service’s management team had taken steps to improve the consistency within the staff team. They were aware of the need to improve the support and were working closely with the local authority’s quality assurance and improvement team.

We found the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the service to take at the end of this report.

Inspection carried out on 4 April 2016

During a routine inspection

HF Trust – Devon DCA is part of a larger national provider for people with learning disabilities (HF Trust) and is registered to provide personal care to people living in the community. At the time of this inspection the service was supporting 38 people with varying support needs in a total of 14 supported homes. Some people lived alone, requiring minimal support and others lived in shared accommodation with support both during the day and overnight.

This inspection was announced and took place on 4, 6, 7 and 8 April 2016. We gave 48 hours’ notice of the inspection because HF Trust – Devon DCA provided a supported living service for people who are often out during the day. We needed to be sure the registered managers and some of the staff and people receiving support from HF Trust would be available for us to speak with.

There were two registered managers in post, each with the responsibility for a geographical area or cluster. 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.

Prior to and following the inspection we had received concerns about how the service was managed and how the quality of the support provided was reviewed and monitored. Issues related to how medicines were managed; how people were being supported to promote their independence; how staffing was arranged, and the use of, and the quality of the information proved to agency staff.

At this inspection we found the regional manager was aware of these issues and they had been working with their own internal quality assurance team as well as the local authority’s quality and improvement team to address these concerns. The regional manager had developed an action plan and changes had been made to the service’s practices as a result. Audits of how medicines were being managed at each person’s home were now being completed, agency staff had better access to information about people’s support needs and there was greater management presence to support staff.

Those people who were able to share their views with us told us they liked their home and felt safe there. For those people who were unable to express their views verbally, we saw them approaching staff with confidence and accepting appropriate prompts from the staff indicating they felt safe in their presence. Staff recruitment practices were safe and people were involved in staff recruitment and reviewing staff suitability throughout their probation period. A comprehensive training programme ensured staff had the skills and knowledge to meet people’s needs. Risks of abuse to people were minimised because staff had received training in recognising and reporting abuse and they felt confident both registered managers would respond and take appropriate action if they raised concerns.

Not everyone we spoke with was able to tell us about their relationship with the staff who supported them. Those who could told us they liked the staff and the staff were nice. For those people who could not tell us, we saw them spending time with staff, sitting next to them and smiling as they freely approached them. This indicated people had a good relationship with the staff. The staff talked about people with affection and some staff became emotional when talking to us about how much they enjoyed their work. Staff described themselves as “enablers” rather than “carers” as they felt their role was to support people to live as independently as possible and to learn new skills. Throughout our inspection we saw examples of a caring and kind approach from staff who knew the people very well.

Each person had their need for staff support assessed individually by the local authority. The service provided staff support in line with these ass

Inspection carried out on 3 January 2014

During a routine inspection

On the day of our inspection the service was providing support for nine older people in their own homes and 37 people living with learning disability in 14 settings in Chudleigh, Dawlish, Chudleigh Knighton and Kingsteignton.

During our inspection we visited two of these settings. We spoke with seven people who used the service and representatives for two other people who used the service. We also spoke with a senior manager, the registered manager, a health professional and six support workers.

People who use the service told us staff treated them with respect. We saw examples of support workers respecting people’s privacy and dignity.

Care plans reflected the needs of the person they related to. These contained a comprehensive personal profile which included people’s social histories and set out individual needs.

Support workers received regular supervision and appraisal. The service had ensured staff development needs had been identified and addressed.

There was an effective system in place to regularly assess and monitor the quality of the service provided.

Inspection carried out on 3 January 2013

During an inspection to make sure that the improvements required had been made

When this service was last inspected on 29 August 2012 it was based at Rivendell care home and was part of that registration. Rivendell has now closed and the 'personal care' element of the registration has moved to new offices and is now known as HF Trust – Devon DCA.

We visited on this occasion because at our last inspection we found that there were areas where improvements were needed. The issues related specifically to a group of older people the service had recently started to provide care to. People were not always given information about who would be visiting them or for how long they would be staying. Also people's individual preferences and choices about their care were not always recorded in sufficient detail on care plans.

We found that some good progress had been made towards rectifying these matters, but that there was not yet full compliance in these areas.