An Darach Care - Cambridgeshire

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:

Care was not always provided in a dignified manner which had the potential to compromise people’s human rights. Staff were trained in restrictive practices, and we found people's records mostly, not all, had guidance in place for staff to follow when using control and restraint. 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:

Care was not always provided in a person-centred way which promoted people's dignity, independence or human rights. There were not always staff with suitable skills deployed to meet the needs of people. There were some gaps in staff training, and we were not assured staff had the skills and knowledge to fill the requirements of their role. Medicines were not always safely managed, and medicine records were not always completed accurately.

Right Culture:

The service lacked effective oversight and leadership. The provider's systems for monitoring and improving the quality of the service had not been effective. Learning from events was not always shared with the staff team. This placed people at potential risk of harm.

The failings outlined in this report demonstrated the provider had failed to ensure people received a well-managed service which was safe and compassionate placing people at risk of potential harm.

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 good (published 14 July 2021).

Why we inspected

The inspection was prompted in part by notification of an incident following an allegation of abuse. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the safeguarding procedures and the culture within the service. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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

Enforcement

We have identified 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

An Darach Care - Cambridgeshire is a domiciliary care agency providing personal care and support to 19 younger adults living in five supported living houses at the time of the inspection. Four of the supported living houses are situated close to Peterborough, Cambridgeshire with the fifth house in Suffolk. The five houses can support up to 25 people in total. The registered manager works from a separate office located at one of the houses close to Peterborough.

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 autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. People were at the centre of their support and decisions made about their care. Staff and the registered manager promoted people's independence. They focused on supporting people to live their lives without restriction.

People were usually safe using the service because staff were trained and knew what they were doing, although not all possible abuse had been properly reported. Staff assessed and reduced risks as much as possible, and equipment was checked to make sure it was safe to use. There were enough staff to provide support safely. The provider obtained satisfactory recruitment checks before new staff started work.

People received their medicines and staff knew how these should be given. Medicine records were completed accurately and with enough detail. Staff supported people to have enough to eat and drink. They used protective equipment, such as gloves and aprons to prevent the spread of infection. Staff followed advice from health care professionals and made sure they asked people's consent before caring for them.

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.

People liked the staff that cared for them. Staff were kind and caring, they involved people in their care and support, and made sure people's privacy was respected. Staff worked well together, they understood the provider's aim to deliver high quality care, which helped people to continue to live as independently as possible.

Staff kept care records up to date and included national guidance if relevant. However, there was little to no information about people’s end of life wishes.

We have made a recommendation to talk with people about their end of life wishes.

The provider had a complaints procedure in place and people knew who to contact if they were not happy. Staff completed systems to monitor how well the service was running. The registered manager made changes where issues had occurred, so that the risk of a similar incidents occurring again was reduced. People were asked for their view of the service and action was taken to change any areas they were not happy with.

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

Rating at last inspection

This service was registered with us on 12 December 2019 and this is the first inspection.

The last rating for the service under the previous provider was good, published on 12 September 2018.

Why we inspected

This was a planned inspection based on the registration date.

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.