Background to this inspection
Updated
11 January 2022
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
This inspection was carried out by one inspector and one Expert by Experience who made telephone calls to people and relatives of people using the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in three ‘supported living’ settings, so that they can live 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.
Inspection activity started on 11 November 2021 and ended on 23 November 2021. We visited the office location on 11 November 2021, and we spoke with people, relatives and staff on 15, 17 and 22 November 2021. Feedback of the inspection process was provided to the registered manager on 23 November 2021.
What we did before the inspection
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We reviewed information we had received about the service and formal notifications that the service had sent to the CQC. Notifications are information that registered persons are required to tell us about by law that may affect people's health and wellbeing. We used all of this information to plan our inspection.
During the inspection
We spoke with the registered manager. We reviewed a range of records including two people's support plans and three people's medicines records. We looked at two staff files in relation to recruitment and staff supervision.
After the inspection
We spoke to three people who used the service and three relatives about their experience of the care provided. We looked at one further support plan, two staff files in relation to recruitment and staff supervision, training data, quality assurance records and policies and procedures. We received feedback about the service from a health and social care professional. We continued to seek clarification from the provider to validate evidence found.
Updated
11 January 2022
About the service
Dimensions London & Shires Domiciliary Care Office is a domiciliary care service that provides personal care to adults with a learning disability, autism and complex needs living within a supported living setting. At the time of the inspection the service was supporting three people with 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’s experience of using this service and what we found
People and relatives spoke positively of the service and told us people felt safe with the staff that supported them. However, despite positive feedback we found issues and concerns around the management of medicines, documentation of people’s health risks, mental capacity assessments and deprivation of liberty safeguards (DoLS) and management oversight of the service.
The provider had systems in place to monitor the quality and safety of the service, however they did not identify the issues we found during the inspection.
The provider had systems in place to assess risks to people before undertaking their care and support. However, we found people’s health risks were not always fully documented within people's support plans.
Minor issues were found with the management of people’s medicines. We recommended the provider reviews its procedures for managing medicines in line with national guidance.
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. We recommended the provider reviews its procedures to ensure up to date records of mental capacity assessments and DoLS are maintained in line with Mental Capacity Act 2005 (MCA).
Staff were aware of signs of abuse and how to report them, they felt confident management would respond to any concerns.
People were supported by a consistent team of staff. Recruitment processes ensured only those staff assessed as safe to work with vulnerable adults were employed.
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 the underpinning principles of Right support, right care, right culture. The model of care and setting maximised people's choice, control and independence. Care was person-centred and promoted people's dignity, privacy and human rights. The ethos, values, attitudes and behaviours of leaders and care staff ensured people using services led confident, inclusive and empowered lives.
People were supported by staff who were skilled and trained to meet their support needs. Staff told us they were well supported through supervision, team meetings and appraisals.
People were supported to maintain a balanced and healthy diet. The service supported people to access relevant health care services where required.
Peoples support plans documented people’s needs, preferences and agreement with how they wanted to be supported by the service. People told us they were supported by kind and friendly staff who respected their privacy and dignity.
People were involved in planning and reviewing their care and support. People were supported by a staff team who knew them well and provided support in line with their preferences and choices. People and relatives told us they felt able to raise any concerns with staff or management.
The provider sought the views of people who used the service. People and relatives felt the service was well managed.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
This was a planned inspection. This service was registered with us on 16/09/2020 and this is the first inspection.
At this inspection we found a breach of regulation related to the governance of the service.
You can see what action we have asked the provider to take at the end of this full report.
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.