We carried out a review of the data available to us about Richmond and Kingston DCA on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Richmond and Kingston DCA, you can give feedback on this service.
About the service
Kingston and Richmond DCA is a domiciliary care and 'supported living' service and registered to provide personal care and support to people who have a learning disability or complex needs in their own homes. 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.
At the time of the inspection there were 26 people receiving personal care in 8 different supported living settings and also in their own homes. We visited people who lived in self-contained flats, adapted houses where people had their own bedroom and sometimes individual or shared bathrooms and as well as shared communal areas.
People’s experience of using this service and what we found
At the last inspection the service provided was not always safe for people to use as their medicines were not always managed safely and there were poor hygiene practices. Support visits did not always occur at the agreed time or last for the agreed duration and learning from incidents and accidents was not always done in a timely way. The service was not always well-led as the quality assurance system was not always used appropriately to assess and monitor the quality of the service and some audits were incomplete. The provider did not always demonstrate a strong focus on capturing learning to improve the service. The analysis of incidents and accidents was not always robust and there was inconsistent oversight of the operations at the various settings.
At this inspection people’s medicines were managed safely, good hygiene practices were in place, support visits took place on time and lasted the agreed duration and accidents and incidents were learnt from. The quality assurance system identified, monitored and addressed service shortfalls, audits were completed and operations at the various settings were appropriately overseen.
The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.
Right Support
People received a service that was safe for them to live and staff to work in. The quality of the service provided was regularly reviewed, and changes made to improve people’s care and support as required. This was in a way that was best suited to people. The service had established working partnerships that promoted people’s participation and reduced their social isolation.
Right Care
Enough, well trained and appropriately recruited staff supported people to live safely, whilst still enjoying their lives. People and staff had risks to them assessed, monitored and reviewed. Complaints, concerns, accidents and incidents and safeguarding issues were appropriately reported, investigated and recorded. People’s medicines were safely administered by trained staff.
Right culture
The service leadership and management were identifiable, transparent and there was a culture that was honest, open, and positive. The provider’s vision and values were clearly defined, and staff understood and followed them. Staff were aware of their responsibilities, accountability and prepared to take responsibility and report any concerns they may have.
Rating at last inspection
The last rating for this service was Requires Improvement (published 29 June 2022) and there was a breach 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.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, and Well-led which contained a requirement. A decision was made for us to inspect and examine the risks associated with these issues.
CQC has introduced focused inspections to follow up on previous breaches and to check specific concerns.
As no concerns were identified in relation to the key questions Effective, Caring and Responsive, we decided not to inspect these questions. Ratings from the previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Richmond and Kingston DCA on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Kingston and Richmond DCA is a domiciliary care and ‘supported living’ service and is registered to provide personal care and support to people who have a learning disability or complex needs in their own homes. 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.
At the time of the inspection there were 26 people receiving personal care in eight different supported living settings on 24 hours a day and also in their own homes. We visited some people who lived in self-contained flats, adapted houses where people had their own bedroom and sometimes individual or shared bathrooms and as well as shared communal areas.
People’s experience of using this service:
People did not always receive consistent good standards of care. We identified a breach of regulations in relation to good governance. We found people were sometimes placed at risk of avoidable harm due to a lack of adequate oversight on the management of the settings. The provider needed to do more to provide an enabling environment towards independent living for people using the service. The provider’s partnership working with other agencies, social and health professionals and external organisations were not always effective. This undermined their ability to deliver care of consistently high standards.
People using the service and their relatives felt safe with the care provided. Comments included, “I do feel safe and I’m happy with my support worker”; “100% have no question about [person’s] safety” and “I do feel [person] is safe in the group house”.
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.
The service was able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right support: Model of care and setting maximises people’s choice, control and Independence; Right care: Care is person-centred and promotes people’s dignity, privacy and human rights; Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives.
Audits were carried out on the quality of care and improvements. However, these did not always identify areas of improvement. Medicines management processes were not always robust which may have put people at risk of avoidable harm. The registered manager did not always provide adequate oversight to the care provided at the service. They relied heavily on managers and senior staff on site to oversee the operations at the service. The provider did not always effectively use the systems in place to monitor and drive improvement in the quality of care.
Staff were trained in infection prevention and control. People required support to ensure they were not at risk of spreading disease and contamination. The provider did not always work effectively with other agencies to ensure people were always supported to maintain good hygiene standards in their settings.
Staff knew how to protect people from harm and understood their responsibilities to report concerns. Staff were recruited safely and received an induction before they started providing care.
People were involved in planning for their care. Care staff had information to support people with their needs and choices. People’s needs were met. Staff received training required for their roles and felt supported in their work. People felt their concerns were acted on in a timely manner. Staff supported people to access health services when required.
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 had developed meaningful caring relationships with staff who provided their care. Staff supported people to undertake activities of their choice. Comments included, “[Staff] do put evening classes on and take them to the cinema in the evening if they choose to go” and “[People] are always doing something”. Most people received care from a consistent team of care staff. People were treated in a manner that promoted their dignity and maintained their confidentiality and privacy.
People, staff and relatives were involved in the running of the service. Their views were considered and used to develop the service.
For more details, please see the full report which is on the CQC website at ww.cqc.org.uk
Rating at last inspection
This service was registered with us on 09/01/2020.
The last rating for the service at the previous premises was good, published on 23 May 2019.
Why we inspected
We inspected this service in line with our inspection methodology.
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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Enforcement and Recommendations
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.
We have identified a breach in relation to good governance at this inspection.
Please see the action we have told the provider to take at the end of this report.