HF Trust - Kent DCA

HF Trust Kent DCA is a supported living service registered to provide personal care. The service provides support to people with a learning disability and/or autism living in supported living settings, so that they can live in their own home as independently as possible. At the time of the inspection they were providing support to 69 people who were in receipt of the regulated activity personal care. 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 lived in their own flats and had access to their own facilities such as bathrooms and kitchen. There were a number of different locations across Kent where the service was providing support to people, known as clusters. Each cluster had their own manager, overseen by the registered manager.

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. Risks to people were not always assessed or managed. For example, risks to people with epilepsy, people at risk of falling, risks relating to constipation and choking had not always been assessed and mitigated. Medicines were not always managed safely. There was not enough appropriately skilled staff to meet people’s needs and keep them safe.

Right Care:

Staff told us they understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse however not all incidents were documented to ensure concerns could be raised. People’s care, treatment and support plans didn’t always reflect people’s range of needs or promote their wellbeing and enjoyment of life. People were supported to maintain balanced diet.

Right Culture:

There was a lack of effective oversight of the service. We found inconsistencies within the clusters, where lessons were not learned and shared throughout all the service. There was not a positive culture within all the clusters to ensure people lived empowered lives. Some communication we reviewed about people was not respectful. Staff did not always support people within all clusters to achieve their aspirations and goals. People and their relatives were not always involved in care planning.

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

Rating at last inspection

The last rating for this service was good (published 01 May 2018)

Why we inspected

We undertook this focused inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about safeguarding and allegations of abuse. A decision was made for us to inspect and examine those risks.

We undertook an inspection to review the key questions of safe, effective, and well-led only.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to risks to people, the failure to ensure the principles of the Mental Capacity Act were consistently followed and the oversight and governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

HF Trust - Kent DCA is a domiciliary care service registered to provide personal care. The service provided care and support to 46 people with a learning disability living in ‘supported living’ settings, so that they can live in their own home as independently as possible.

People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The office is based in Lympne, on a large site with 12 flats in one building, one four bedroom house, a bungalow and a residential service. At this inspection we did not inspect the residential service. Some people using the domiciliary care service lived away from the main site in flats and shared housing. Support for people ranged from a few hours each week for the provision of activities, to twenty four hour support for all aspects of personal care and daily living.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities using the service can live as ordinary a life as any citizen.

At the last inspection, the service was rated ‘Good.’ At this inspection we found the evidence continued to support the rating of ‘Good’ and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good

The service was divided into three clusters. Each cluster had a service manager. At the last inspection one service manager was registered with CQC. At this inspection all three service managers were registered with CQC. 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.

Staff understood their responsibilities in keeping people safe and reporting any suspicion of abuse. Staff knew what the reporting procedures were and told us that they were confident their concerns would be listened to. The registered managers knew how and when they should escalate concerns to the local authorities safeguarding. Individual risks to people had been assessed and plans to reduce risk were personalised, clear and comprehensive. Staff and people understood the steps they needed to take to minimise risks whilst maintaining independence. Assessments were undertaken with people before they moved in to the service to make sure their needs could be met. When the service could no longer meet the needs of the service they were supported to move to another service that could meet their needs.

The registered managers involved people in planning their support. People’s needs had been assessed and treatment delivered in line with current legislation. Support plans were person centred and included people's life story. Plans explained what lifestyle choices people had made. People had access to their plans. There was information about people’s relatives and friends and how people wanted to maintain relationships. Support plans told staff what people could do independently and what support they needed. Staff assessed and treated people as individuals. Staff had received training and understood the principles of the Mental Capacity Act 20015 (MCA). People were supported to make their own choices and decisions.

Medicines were managed safely. Staff were aware of the policies and procedures for the management of medicines and had undertaken appropriate training. Regular audits were undertaken to ensure safe procedures were followed and action was taken when errors were made. Staff had been trained in infection prevention control and there was protective equipment to prevent the spread of infection.

Staff encouraged people to be involved in preparing their own meals or to cook for themselves. People were supported to maintain a balanced diet and be active. There was access to health care when people needed it and people were encouraged and supported to monitor and manage their own health conditions.

People told us that were supported to undertake activities and that they had access to activities in the wider community. There was an open and transparent culture. Regular residents meetings took place and people were able to raise the issues that were important to them. People, relatives and staff were asked their views of the service and action was taken to make improvements where necessary.

People and their relatives were positive about the staff who supported them. People told us that they were happy with the service they received. Staff knew people well and were able to respond to people's needs on an individual basis. The service promoted people’s independence by developing people's skills and confidence as well as providing them with access to technology. People told us that their privacy was respected and we observed people being treated with dignity. People’s preferences about how and where they would like to be cared for at the end of life had been discussed and recorded.

There were enough staff to meet people’s needs. Staff were recruited safely, there was a recruitment policy that was followed and pre-employment checks were carried out. People had the opportunity to meet staff before they provided them with support. Staff had received an induction and mandatory training. Staff had regular supervision and completed appraisals. Staff told us they felt supported by the registered manager and that they were approachable. Regular staff meetings were held to aid communication within the team and to provide updates and feedback. There were daily notes and hand over meetings so that staff knew what had happened between their shifts.

Staff told us that they seek guidance from healthcare professionals as required. They told us they would inform the manager if they had any concerns about people's health.

Quality auditing processes were in place to check the safety and quality of the service provided.

The people we spoke to all told us that they were happy with the service provided. People knew the registered managers well and staff told us that they were supportive. There continued to be policies in place which ensured people would be listened to and treated fairly if they complained. People’s concerns were investigated and the provider had taken action to address concerns. Accidents and incidents were recorded in detail by staff with actions taken. The provider monitored incidents and lessons were learnt when things when wrong.

Further information is in the detailed findings below.

HF Trust - Kent DCA is a domiciliary care agency registered to provide personal care. The agency

office is based in Lympne, on a large site with 12 flats in one large building, one four bedroom house, a residential service and day activity services. The service is divided into three clusters, providing support to adults living in shared living accommodations in the Shepway District of Kent. Support can range from a few hours each week based around provision of activities, to twenty four hour support for all aspects of personal care and daily living. At the time of this inspection 40 people were supported by the agency. Each of the shared living clusters had a service manager. One service manager is a registered manager who is registered with CQC.

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 and associated regulations about how the service is run. The two other service managers had applied to be registered with the CQC, at the time of our inspection their applications were being processed. One manager is responsible for 12 flats in one building, these flats comprise of three bedrooms, two bedrooms and one bedroom flats for individuals, each flat has its own bathroom and kitchen facilities. Another manager is responsible for three shared houses and the manager for cluster three is responsible for three shared houses.

People supported and their representatives made positive comments about HF Trust - Kent DCA. People said “I am happy” and “I like it a lot, I like the staff.” People who we were unable to verbally communicate with were able to communicate with their key workers and had a good rapport with them. One relative commented, “We have peace of mind now, It is the best care he has ever had.”

Systems were in place to make sure people received their medicines safely. Staff recruitment procedures were thorough and ensured people’s safety was promoted. Staff were provided with relevant induction and training to make sure they had the right skills and knowledge for their role.

Risks associated with people’s care and support had been assessed. The guidance in place for staff was clear to ensure people remained safe and were supported to be as independent as possible and participate in household tasks and access the community safely. The service had safeguarding procedures in place and staff had received training in these. Staff demonstrated an understanding of what constituted abuse and how to report any concerns in order to keep people safe.

Staff understood their role and what was expected of them. They were happy in their work, motivated and proud to work at the service. Staff were confident in the way the service was managed. The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and the principles of the Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who may not be able to make important decisions themselves.

The support provided was person centred and flexible to suit the needs of the person supported. People were involved in the planning of their care and support. Care plans contained information about people’s wishes and preferences and where appropriate, pictures and photographs to make them more meaningful. They detailed people’s skills in relation to tasks and what help they required from staff, in order that their independence was maintained or developed. People had regular reviews of their care and support where they were able to discuss any concerns or aspirations.

People supported and a relative spoken with said they could speak with staff if they had any worries or concerns and they would be listened to. There were effective systems in place to monitor and improve the quality of the service provided.

Regular checks and audits were undertaken to make sure full and safe procedures were adhered to. People using the service and their relatives had been asked their opinion via surveys, the results of these had been audited to identify any areas for improvement.