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Archived: Domiciliary Care Service Requires improvement

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Reports


Inspection carried out on 23 January 2018

During a routine inspection

The Domiciliary Care Service provides care and support to people living with learning disabilities in three ‘supported living’ setting, 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. At the time of the inspection the service was providing support packages to 30 people, who lived in one of three supported living settings. Some people lived in shared houses and some people lived in their own flats.

At the last inspection, the service was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Domiciliary Care Service’ on our website at www.cqc.org.uk

This inspection took place on 23 and 25 January 2018 and was announced. We gave the service seven days notice of the inspection site visits because it was possible that some of the people using the service might not have been able to consent to a home visit from an inspector, which meant that we had to provide time for any ‘best interests’ decisions to be made about this.

At this inspection we found the service Requires improvement. There was further work to do to make sure people were better supported to follow their interests and take part in activities that they liked, that were socially and culturally relevant and appropriate to them. This included having more access to the wider community.

In addition to the record of formal complaints, there was work to do to ensure that the more informal concerns people’s relatives raised and the action taken to address them were recorded, and managers made aware. Engagement with and listening to people’s relatives was an area for improvement. The absence of visible managers on a day to day basis in one supported living setting had led to a period when there was a lack of cohesion and there was work for the registered manager to do to address the issues arising as a result of this.

There was 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. The registered manager had recently returned to work after a six month absence and it was evident that her presence had been missed.

People who used the service were positive in their feedback and most of the relatives we spoke with said that on the whole their loved one’s day to day care needs were met. However, some relatives told us the service was going through a retendering process, which meant that a new provider was soon likely to be taking over the running of the service. There were enough staff available to ensure people were safe, although several staff had left and this had necessitated the use of bank and agency workers, who had taken time to get to know people.

We found that care and support was planned and delivered in a way that made sure people were safe. Systems were in place to safeguard people from abuse and the staff we spoke with knew how to recognise and report abuse. Risks associated with people’s needs and lifestyles were identified and plans were in place to minimise the risks. Medicines were managed safely and administered as prescribed.

We found that overall; staff were trained and had the skills they required to carry out their role. People received a healthy diet which they had been involved in choosing. People were supported to live healthy lifestyles and had access to relevant healthcare professionals as required. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People were treated with kindness and compassion.

Inspection carried out on 15, 16 and 17 September 2015

During a routine inspection

The inspection took place on 15, 16 and 17 September 2015 and was announced. The provider was given short notice of the visit to the office, in line with our current methodology for inspecting domiciliary care agencies. This was the first inspection of the service under the Health and Social Care Act 2008.

The Domiciliary Care Service provides personal care to people living in their own homes At the time of the inspection the service was providing support packages to 31 people, who lived in one of four supported living schemes. Some people lived in shared houses and some people lived in their own flats. Most were 24 hour support packages.

The service had a registered manager in post at the time of our inspection. 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.

Before the inspection we received information from a governor of Rotherham Doncaster and South Humber NHS Foundation Trust. The role of NHS Trust governors is to hold the non-executive directors to account for the performance of the board of directors and to represent the interests of NHS foundation trust members and of the public. The information was in relation to the service provided to people in one of the four supported living schemes. These included the level of staff support hours provided, the support staff training in administration of medication people’s safety in relation to any inappropriate behaviour presented by their peers, and the use of slings, for people who needed staff support to move using hoists. The Trust governor also wanted to be sure that particular incidents had been addressed properly and learned from to prevent recurrences.

When we visited people in the supported living schemes we saw staff interacting with people in a caring way and it was clear that the people who used the service had developed good relationships with the staff.

During the inspection we found that care and support was planned and delivered in a way that made sure people were safe. There were no current concerns in relation to the numbers or flexibility of the staff support for people overall and all the staff we spoke with were clear that there were enough staff to keep people safe and to meet people’s needs.

We found that support staff were adequately trained to administer medication to people safely. We found any errors were investigated thoroughly, learned from, and action was taken to prevent recurrences. Medicines were well managed generally, with room for improvement regarding monitoring and more personalised storage for some people.

We found that people who used the service were kept safe and any risks were assessed and appropriate risk management plans in place, to help support staff to manage and minimise risks. This included any behaviour people might present, which might challenge the service.

Staff had received training in safeguarding people from abuse and all safeguarding concerns were reported to the appropriate professionals, including the local authority safeguarding team and were able to explain their role in safeguarding people.

We spoke with the staff supporting people and with healthcare professionals about the use of slings. They told us that people were not at increased risk of harm from the slings used.

There was enough skilled and experienced staff on duty to meet people’s needs. We saw there was a recruitment system in place that helped the employer make safe recruitment decisions when employing new staff. New staff had received a structured induction and essential training at the beginning of their employment. This had been followed by regular updates and specialist training to develop their knowledge and skills.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were in place to protect people who may not have the capacity to make decisions for themselves. The Mental Capacity Act 2005 (MCA) sets out what must be done to make sure that the human rights of people who may lack mental capacity to make decisions are protected, including balancing autonomy and protection in relation to consent or refusal of care or treatment.

The management team demonstrated a good awareness of the Deprivation of Liberty Safeguards and their role in protecting people’s rights and recording decisions made in their best interests.

There was good, clear guidance for staff about what people liked to eat and drink and how they needed to be supported, and people were involved in choosing what they ate. People’s comments, and our observations, indicated they were happy with the meals provided. We saw specialist dietary needs had been assessed and catered for and people received a well-balanced diet.

People were supported to maintain good health, have access to healthcare services and received on going healthcare support. People had received support from healthcare professionals when required.

People’s needs were assessed and care and support was planned and delivered in line with their individual support plan. People’s support plans clearly identified the areas in which they needed support. People’s relatives said that the staff worked hard to provide people with a good lifestyle.

The service had a feedback and complaints management system in place and this was seen as part of continuous improvement. People knew how to raise concerns and we saw evidence that any concerns raised had been dealt with effectively.

We saw that regular quality and safety audits had taken place to make sure policies and procedures were followed.

We saw that the management team had done some work to listen to and involve all stakeholders, and to learn, improve, and personalise the service to people. However, we identified engagement with some people’s relatives as an area which required improvement, as there was further work to do on this.