Surrey Children’s Domiciliary Care Service provides support to children with a range of disabilities who have been assessed by a social care team as requiring a personal care service within the family home. Staff support children with disabilities ranging from physical, learning disabilities, multiple disabilities, autism and challenging behaviours. The support children received was for tasks such as accessing leisure activities support in the home and to offer their family respite. There were 50 children who received support with their personal care (the regulated activity) at the time of the inspection.
The service was run by a registered manager. The registered manager was off sick on the day 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 and associated Regulations about how the service is run. The service had an interim manager (acting up) in post; the person was originally a Domiciliary Care Co-ordinator. The day to day management of the service is completed by the Domiciliary Care Co-ordinators.
The service was not always safe. Staff did not always have written information about risks to children and how to manage these. Risks were identified but a management plan was not always in place. For children who had behaviours that challenge, staff did not have guidance in place to ensure that they kept themselves, others and the child safe. When incidents and accidents occurred, the registered manager had not always followed up on the actions.
The service was not always well led. There were not robust systems in place to monitor, review and improve the quality of care for children and their families. The service did not have a policy on the storage of personal records and some were stored away from the registered office.
The service was responsive. The service completed a care plan and risk assessment on the initial meeting with the child and family. However we recommend that an improvement could be made with regards to the documentation and complete of assessments on pre-admission and on going as required.
Children’s medicines were administered and stored safely. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. There were guidelines in place to tell staff how to administer emergency and as required (PRN) medicines.
Children were protected from avoidable harm. Staff received training in safeguarding children and were able to demonstrate that they knew the procedures to follow should they have any concerns.
There were systems in place to ensure that staff employed were recruited safely. There were enough staff to meet the needs of people.
The Mental Capacity Act 2005 is not applicable to children below 16. For those children aged 16-17 the manager had ensured that the requirements of the MCA had been followed. Family members had consent on the child’s behalf to the care provided.
Children were supported to eat healthy, balanced diets in line with their dietary requirements and their choice. For children who needed extra support with feeding or used a percutaneous endoscopic gastrostomy (PEG) for their nutritional and fluid needs, staff had training.
Children were supported to maintain their health and well-being. People had regular access to health and social care professionals.
Staff were trained and had sufficient skills and knowledge to support children effectively. There was a training programme in place and training to meet children’s needs. Staff received regular supervision and had an annual appraisal.
Positive and caring relationships had been established with children and their families. Consistent staff supported the children.
Children, their families’ and other professionals were involved in planning children’s care. Children’s choices and views were respected by staff. The child’s privacy and dignity was respected.
Children received a personalised service. Staff knew the child’s preferences and wishes and they were adhered to. However children’s needs were not always assessed. Child had care plans in place; however they were not always updated or detailed.
The service listened to children, staff and families views. The management promoted an open and child and family centred culture.
Staff told us they felt supported by the manager and Domiciliary Care Co-ordinators. Families told us they felt that the management was approachable and responsive.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.