Portland Domiciliary Service

Portland Domiciliary service is a supported living service which was supporting 11 people at the time of the inspection. The service can support up to 12 people. The service comprises of 12 purpose-built bungalows.

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.

People’s experience of using this service and what we found.

Right Support

The service didn’t always make reasonable adjustments for people so they could be fully in discussions about how they received support, including what staff they had to support them. The provider had enough staff to keep people save. However, there was a high use of agency staff and agency staff members were not always consistent.

Staff supported people to make decisions following best practice in decision-making. However, some aspects of peoples support plans, regarding positive behaviour support plans to help people when they were anxious, were not always followed.

The provider didn't always support people to have the maximum possible choice and control to be independent over their own lives. People were encouraged to set targets and in some areas of life for example, gaining more independence. However, this wasn’t consistent and steps to achieve goals were not clear for staff to follow.

We have made a recommendation regarding outcomes for people.

Medicines were managed and administered safely. However, records and systems to monitor medicines, needed to be improved. Staffs’ competency to administer medicines was checked. People were supported with their medicines in a way that promoted their independence and achieved the best possible health outcome.

The provider supported people to be safe in their own homes, with fire safety checks and people had personal evacuation plans. The provider gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People’s bungalows were personalised.

Right care

People had enough staff to meet their needs and keep them safe. However, inductions and checks on agency staff were not always in place. People were not always supported by person centred practices. Failure to induct agency staff properly, meant they didn’t have the right information to support people in a personalised way. People did not always receive consistent care from a staff team who knew them well.

People were encouraged to take positive risks. Risk assessments were in place for people. The provider acted to protect people from abuse. Staff knew how to report any concerns to the appropriate places. Staff had training on how to recognise and report abuse.

Right culture

People and those important to them, were not always involved in planning their support. The provider didn’t always enable people where appropriate to work with staff to develop the service. The service was treated as a whole at times and not as individuals living in their own bungalows.

We have made a recommendation regarding engaging people in planning the service.

People didn’t always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were not always supported by staff who understood best practice in relation to the wide range of strengths or sensitivities people with a learning disability and/or autistic people may have. Staff teams were not always consistent therefore didn’t always know people well enough to be supporting their aspirations.

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

Rating at the last inspection and update

The last rating for the service was good, published on 12 July 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the length of time since the previous inspection. 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. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Portland Domiciliary service on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to managing accidents and incidents , records, staffing, and manager oversight at this inspection.

Follow up

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

Portland Domiciliary Service is a domiciliary care agency. It provides personal care to people living in their own houses and flats on one central site. It provides a service to older adults and younger disabled adults. This service provides care and support to people living in 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 care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.' Registering the Right Support CQC policy.

On the day of our inspection there were 10 people using the service.

This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in place. A registered manager is a person who has registered with CQC to manage the service. Like 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.

We last inspected the service in June 2016 and rated the service as ‘Good’. At this inspection we found the service remained ‘Good’.

People told us they felt safe being supported by Portland Domiciliary Service. There were sufficient numbers of staff on duty to keep people safe. There was an effective recruitment and selection procedure in place and relevant vetting checks were carried out. Staff were suitably trained and received regular supervisions and appraisals.

Accidents and incidents were appropriately recorded and risk assessments were in place. Safeguarding procedures had been correctly followed and staff had been trained in safeguarding vulnerable adults.

Health and safety checks were carried out to ensure people were supported to live in a safe environment.

Appropriate arrangements were in place to support people with the safe administration and storage of medicines.

People were supported to have maximum choice and control of their lives, and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were supported with their dietary needs and care records contained evidence of visits to and from external healthcare specialists.

People told us they were supported by kind and caring staff members. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they started using the service and support plans were written in a person-centred way. Person-centred means ensuring the person is at the centre of any support plans and their individual wishes, needs and choices are taken into account.

People were protected from social isolation. People were supported to access activities on site and in the community and also undertake voluntary work.

The provider had an effective complaints procedure in place, and people told us they knew how to complain if they wished to.

The provider had an effective quality assurance process in place. People who used the service and staff were regularly consulted about the quality of the service via meetings and surveys.

We last inspected this service in February 2013. At that time the service was meeting the regulatory requirements.

Portland provides personal care to people living in their own bungalows. The bungalows are situated on the site of Willington Care Village in Crook and are managed by the registered provider. There are ten bungalows, nine of which are occupied by people who receive care from Portland.

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.

We found there were enough staff on duty to meet people’s needs and the registered manager had contingency plans in place should a member of staff report the need to take sick leave.

Staff had been trained to administer people’s medicines safely. We checked people’s medicine administration records and found there were no gaps in people receiving their medicines.

Any risks to people had been assessed by the service and actions put in place to reduce the risks to people. For example where a person was at risk of falls actions had been taken to ensure their risk of falling was minimised.

Staff had been trained in safeguarding people and were confident in reporting their concerns to the registered manager.

We saw all new staff to the service received an induction, were allocated training and then progressed to complete an NVQ in social care. Staff told us they felt supported by the training they had received.

The registered manager and the staff understood the need for people’s mental capacity to be assessed and the need to involve family members and other professions in decisions which affected people. We found the service met the requirements of the Mental Capacity Act.

We found the registered provider had sought people’s consent to have their care delivered by Portland. If people had not been able to give their consent the registered provider had sought consent from their next of kin.

Staff ensured people had enough to eat and drink and had sought advice from medical professionals where people had a poor appetite.

Staff knew what people liked and disliked and understood the needs of the people for whom they provided care. People told us they felt looked after by staff.

The service supported people’s well-being. We found the registered manager understood the need for consistency of care to maintain people’s well-being. We observed staff had good relationships with the people for whom they provided care.

The service had listened to people’s relatives as natural advocates when they had raised concerns or wanted to change the care of their relative.

People’s care needs were described in a person centred way. This meant their plans reflected their individual and specific needs.

The service contacted people’s GP’s when they required attention. Other professional involvement was sought for example from people’s care managers as and when issues arose. The service therefore did not work with people in isolation but involved other professionals as required.

The registered manager had taken people’s complaints seriously, investigated each complaint and provided an outcome of their investigation to the complainant.

Staff and people who used the service made only positive comments about the registered manager to us. We found the registered manager knew people who used the service very well.

The registered provider had in place arrangements for quality managers to visit the homes and carry out audits of the service. The audits resulted in the quality manager advising the registered manager on what actions needed to be taken to improve the service.

The registered manager also carried out quality audits and quality surveys to monitor the service which resulted in actions being taken to ensure the service continually improved.

The service had in place local community links and people were supported to access local community services.

We found the service maintained accurate and up to date care records

We found consent to provide care and treatment was sought from people who used the service.

We saw people were actively engaged in their care plans and their independence was promoted. One person said, 'I do the vacuuming', Two people kept pets and were supported to care for them.

We saw safeguarding people was important to the provider. Staff were trained in safeguarding and regular checks were made to ensure people were safe.

The provider ensured people were protected by undertaking the necessary recruitment checks and recruiting staff of good character.

We found the provider assessed and monitored the quality of the service provision, The provider took action to improve the service when required.