HCS Domiciliary Care Ltd

Updated 7 December 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 8 and 9 October 2018 and was announced. We gave the service 48 hours’ notice of the inspection visit because the location provides support to people in their own home within a supported living service. We needed to ensure that the registered manager would be available to support with the inspection process and that people had consented to us visiting their home.

One inspector carried out this inspection with the support of two experts by experience who spoke with people during the inspection and made telephone calls and spoke with 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.

Before the inspection, we checked for any notifications made to us by the provider and the information we held on our database about the service and provider. Statutory notifications are pieces of information about important events which took place at the service, such as safeguarding incidents, which the provider is required to send to us by law.

During the inspection we spoke with four people and 12 relatives. Many people supported by the service were unable to verbalise to us their feedback and comments about the care and support that they received from the service and the support workers. For that reason we noted and observed interactions between people and their support staff to form a judgement about how people were supported.

We spoke with the nominated individual, registered manager, one service manager, the quality and training manager and five support workers. We looked at six people’s care plans and the recruitment and training records for six support workers, eight people’s medicines records and records relating to the management of the service such as audits, policies and procedures.

During the inspection we spoke with four people and 12 relatives. We observed interactions between people and their support staff. We also spoke with the nominated individual, registered manager, one service manager, the quality and training manager and five support workers. We looked at six people’s care plans and the recruitment and training records for six support workers, eight people’s medicines records and records relating to the management of the service such as audits, policies and procedures.

Updated 7 December 2018

This inspection took place on 8 and 9 October 2018 and was announced. We gave the provider 48 hours' notice of this inspection to ensure that the registered manager would be available to support us with this process.

In November 2017, the provider changed its name and legal entity from HCS (Enfield) Limited to HCS Domiciliary Care Limited. This is the service’s first comprehensive inspection under the new provider name. Under the previous provider registration, the service had been inspected in December 2015 and had been rated ‘Good’.

This service is a domiciliary care agency. It provides personal care to people with physical and learning disabilities and mental health issues. The service provides care and support to people living in three ‘supported living’ settings, so that they can live in their own home as independently as possible. Each person has their own room and bathroom facilities and share communal lounges, kitchen and laundry facilities. 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 this inspection there were 30 people using the service.

A registered manager was in post at the time of this 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.’

Throughout the inspection we observed positive interactions between people and staff which promoted person centred care, choice, respect and dignity. Care staff were clearly aware of the needs of the people they supported and how these were to be met. People who could communicate with us told us that they were happy with the care and support that they received.

As part of the inspection we visited all three schemes and whilst two were seen to be well-managed, at the third scheme we identified some concerns around the lack of management oversight which had failed to identify care plans not being reviewed in a timely manner, lack of awareness of a DoLS (Deprivation of Liberty Safeguards) authorisation and poor decoration and condition of the scheme.

The provider and registered manager had a number of checks and audits in place to monitor the quality of care and support that people received so that appropriate improvements and learning could be recognised. However, not all of these checks were recorded.

The providers safeguarding policy clearly defined the different types of abuse people may experience and the steps to be taken to report any identified concerns. Support workers demonstrated the steps they would take to report any concerns to keep people safe and protected from abuse.

Information within care plans included people’s identified risks associated with their health, care and support needs. Risk assessments listed people’s identified risks and the steps to be taken to reduce or mitigate people’s known risks to ensure their safety.

People needs and choices were assessed before a package of care was agreed so that the service could confirm that people’s needs could be effectively met.

The providers medicines policy and management processes for the administration of medicines ensured that people received their medicines safely and as prescribed.

Recruitment processes were robustly followed to ensure that only support workers assessed as safe to work with vulnerable adults were employed.

Support workers told us and records confirmed that they were appropriately supported in their role through induction, regular training, supervision and annual appraisals. However, the provider did not always provide training which addressed the specialist nature of the service provided to people with learning disabilities.

Where people were able to give consent to the care and support that they received, this had been clearly documented with the person’s care plan. Support workers understood the key principles of the Mental Capacity Act 2005 (MCA) and how these were to be applied when supporting people daily.

Care plans were detailed and person-centred and gave a comprehensive account of the person and how they wanted to be supported with activities relating to their daily care and support. We observed that people were supported to maintain their independence and were encouraged to access the community and engage in a variety of activities of their choice.

People were supported to access a variety of healthcare services where required in order to maintain good health and a healthy lifestyle.

People and their relatives knew the registered manager and the individual service managers located at each supported living scheme. Relatives told us that they felt able to approach the managers and that they were receptive to their concerns, which were appropriately addressed.

People and their relatives were informally asked for their comments and feedback on the quality of care and support that they received. The service was yet to carry out an annual satisfaction survey since being registered.