Archived: United Response - Derby City DCA 2

Updated 9 August 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This comprehensive inspection took place on 2 July 2018 and was announced. The provider was given two working days’ notice because the location provides a domiciliary care service and we needed to be sure that someone would be available at the office. We also needed to arrange to speak with people who used the service as part of this inspection. The inspection team consisted of one inspector.

We used information the provider sent us in the Provider Information Return. This is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make.

The inspection was also informed by other information we had received from and about the service. This included statutory notifications. A notification is information about important events, which the provider is required to send us by law. We also received feedback from the local authority who commission services from the provider.

We visited four people in their own homes, one person could give us their views on the support they received. The other three people, due to their needs were unable to talk with us about the support they received. To enable us to understand the experiences of these people, we observed the support provided to them and how the staff interacted with them.

During the inspection, we spoke with the area manager, a peripatetic manager, acting service manager, a team manager, and three care staff. Following the inspection, we spoke on the telephone with one person’s relative.

We looked at two people’s care records to check that the care they received matched the information in their records. We reviewed two staff files to see how staff were recruited. We looked at the systems the provider had in place to ensure the quality of the service was continuously monitored and reviewed to drive improvement.

We asked the area manager to email copies of their audits so that we could see how the provider monitored the service to drive improvements. These were sent to us within the required timeframe.

Updated 9 August 2018

United Response Derby City DCA 2 is a domiciliary care agency that provides personal care to adults with a learning disability living in their own houses and flats. Some people lived in a large building that was divided into one-bedroom flats. One of these flats was used as a communal flat with an office and communal lounge and kitchen area. This communal flat was accessible to people that lived in the flats and to staff. Three other people lived in a house together. Not everyone that lived in the flats received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. People’s care and housing are provided under separate contractual agreements. CQC does not regulate the premises that people lived in; this inspection looked at people’s personal care and support.

The 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. The aim of the guidance is to assist services in enabling people with learning disabilities and autism using the service to live as ordinary a life as any citizen.

We inspected this service on 2 July 2018. This inspection was announced. This meant the provider and staff knew we would be visiting the service’s office before we arrived. There were nine people in receipt of personal care support at the time of this inspection visit.

There had been no registered manager in post since 25 January 2018. 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. A person was in post to oversee the management of the service but they were absent from work at the time of the inspection and another person was providing management support.

This is the first inspection since the service registered on the 14 July 2015. The service moved their office base in May 2017. At this inspection we found that some improvements were needed regarding the support provided to people that lived in the flats and these were being addressed by the provider and the provider was reviewing people’s care packages with funding partners.

For people that lived together in a shared house no concerns were identified at this inspection.

The provider had informed us of the last registered manager’s absence but we had not received a notification informing us that the registered manager was no longer in post. This is a legal requirement. The area manager told us they had sent a notification to us, but they were unable to provide evidence of this. The registered manager had not cancelled their registration with us when they resigned from their position.

The provider had identified issues regarding the support in place for people in the flats. They had identified that the culture in the service that supported people in the flats required improvement to ensure it achieved good outcomes for people. They had taken the appropriate action and were working with commissioners to address these concerns and ensure people received the support they needed. Information regarding these improvements is detailed in this summary.

Sufficient numbers of care staff had been deployed to complete care calls in the right way; however, the provider had identified that some staff were not always following this practice for people that were supported in the flats. This meant that some people were not receiving their support at the agreed time, which meant that the support provided was not always responsive to their needs. The provider was addressing this at the time of this inspection.

The provider had also identified that some staff who were supporting a person that used Makaton had not received training and this was being organised. Makaton is used to support hearing people with learning or communication difficulties using signs and symbols.

Processes were in place to safeguard people from situations in which they may experience abuse. We saw the provider took the appropriate action when concerns were identified. Risks to people’s safety was assessed, monitored and managed so they were supported to stay safe while their freedom was respected.

People were supported to take their medicines in a safe way. Background checks had been completed before new care staff had been appointed. People were protected by the arrangements to prevent and control infection and lessons had been learnt when things had gone wrong.

People received the assistance they needed to eat and drink enough to maintain a balanced diet. People were supported to live healthier lives and access healthcare services and on-going healthcare support.

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. The importance of gaining people’s consent to the support they received was understood by the staff team. Staff knew about people’s individual capacity to make decisions and supported them to make their own decisions. Where people were unable to make certain decisions, the staff ensured that best interest decisions were made in accordance with legislation.

People were supported to express their views and were involved in making decisions about their care as far as possible. This included access to lay advocates if necessary. Confidential information was kept securely and only accessible to authorised persons.

People’s concerns and complaints were listened and responded to, to improve the quality of care. Care staff were supported to speak out if they had any concerns about people not being treated in the right way. In addition, the provider was actively working in partnership with other agencies to ensure people’s needs were effectively met. People and their relatives were provided with opportunities to express their views of the service to enable the provider to drive improvement.

The provider’s systems to monitor and review the quality of care people received had identified where improvements were needed and actions were being taken to address these.