Archived: United Response - Cornish Close DCA

Cornish Close Domiciliary Care Agency was last inspected in November 2013 when it was found to be meeting all of the five standards reviewed.

Cornish Close Domiciliary Care Agency is registered to provide personal care and support to people with physical and learning disabilities along with associated mental health needs. People receiving the service live in one of the five bungalows in the grounds of a larger unit.

We were aware that the provider was in the process of changing the registered manager and an application had been made to this effect. The service had been without a registered manager for over a year. We had not been notified of this until May 2016. 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 provider had put interim measures in place in the absence of the registered manager.

Some people we spoke with had limited verbal communication. However, everyone clearly indicated they felt safe, were happy with the service and liked the staff.

Staff had received training in safeguarding vulnerable adults and could clearly describe the action they would take if they suspected any abuse had taken place. There was a safeguarding booklet in an easy-read format, available for people using the service. The booklet signposted people to organisations implementing equal rights for people with learning disabilities.

We saw that a number of incidents had occurred in the service during the last year. A number of medicines errors and a financial error had been reported to the local authority as safeguarding concerns but these had not been notified to the CQC. These incidents and some poor practices indicated that the service were not always safe.

Staff received training in the administration of medicines and recorded this on pre printed documentation supplied by the pharmacist.

The bungalows were clean and tidy and free from odour. There were effective health and safety checks in place. Staff had access to personal protective equipment (PPE) such as gloves and aprons and used them when undertaking personal care tasks and administering medicines.

The service had a safe system in place for the recruitment of new staff. There was a reliance on using agency staff at the service; however, the provider tried to use the same people for consistency. The company also had their own pool of bank staff to cover for regular staff absences.

An induction programme was in place for new staff to complete required training courses and shadow existing staff. Staff confirmed that they had completed training courses relevant to their role and felt confident in their role

People’s care records and risk assessments contained personalised information about their needs. The support plans we looked at included risk assessments, which identified any risks associated with people's care and had been devised to help support people to be as independent as possible.

If people’s needs changed a system was in place to liaise with the person, their family and other professionals to update care plans and risk assessments. Where required people’s health and medical needs were met, with access to GPs and other health professionals.

We found that the service was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards. Staff could describe to us how their practices met the requirements of the MCA as they always sought people’s consent before they provided care and support. They followed instructions and guidance issued by health professionals and acted in the best interests of the person.

During our inspection we saw that staff were kind and caring. People were given time to do things at their own pace and offered encouragement from staff. We saw that staff knew the people they were supporting well.

People and their relatives were involved in the assessment and review of their care. Staff supported people to access the community and participate in activities that were important to them. Outside spaces had been developed by staff in front of people’s bungalows.

Staff told us that the upper management structure wasn’t clear given the absence of a long term registered manager and the further pending changes in management, but they felt supported by individual team managers of the bungalows. Team meetings were held and staff were able to raise any issues or concerns.

A system was in place for responding to complaints. We were told by relatives and staff that team managers were approachable and would listen to their concerns.

There was evidence of some audits and competencies of staff being undertaken at the service but we identified that overall, the systems in place to assess, monitor and improve the quality and safety of the service were not sufficiently robust.

During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we have told the provider to take at the back of the full version of the report.

Relatives said they were very happy with the care provided and had no concerns about their relatives safety and welfare. One person said, 'My relative hasn't been this happy for years. The staff are very good and I am always kept informed about what's going on. The staff take my relative out and about shopping and on day trips out. I am very happy with everything.' Another person told us, 'The staff are really good and know my relative very well. I drop in at different times of the day and the unit always has a lovely homely atmosphere.'

People had been involved in the development of their plan of care and support as much as possible. If a person was unable to make decisions for themselves, staff would consult with relevant health care professionals and/or independent advocates involved in the person's care. This ensured decisions made on their behalf were within the person's best interest.

People's physical care needs were met. Staff consulted with health care professionals for advice and guidance when necessary.

People's social and emotional care needs were also met by way of a range of social activities being provided.

Staff were trained on how to protect people from abuse and harm. None of the staff we spoke with had any concerns about the safety and welfare of the people they supported or the care practices of their colleagues.

Good staff recruitment and selection procedures were in place and appropriate security checks had been completed before staff were employed. This meant suitable staff were employed to carry out their role.

A complaint procedure was available to the people who used the service and their relatives so they knew what to do if they were unhappy with the standard of care they received.

'I like living at Cornish Close.'

'The staff are nice.'

'The staff are good, they help me with things in my room.'

'I am happy with the care I get. My care plan gets reviewed regularly and I am always involved in what's going on.'

'The staff are very good, they are very kind and I have never been treated badly.'

Relatives of the people who used the service said they were very happy with the way their relative was looked after and they had no concerns to raise about their safety and welfare. Their comments included:

'The staff are very kind, I am very happy with the way my son is being looked after. The staff treat him as a person and a friend.'

'My daughter's care is regularly reviewed. I am always invited to the review meeting so I am kept informed about how things are.'

'I have never heard any of the staff speak badly to anyone, they are all very kind.'

'I have never had cause to complain about anything but I would just speak with the senior staff if I wanted to talk about anything that was worrying me.'