07, 10 and 11 July 2014
During a routine inspection
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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.
The inspection was announced; we told the provider two days before that we would be coming. This was to ensure the registered manager was available when we visited the agency’s office and so we could arrange to visit some people in their own homes to hear about their experiences of the service. This was the first inspection since the service was registered at this location.
Domiciliary Care East Devon is a domiciliary care service for adults, the provider is Robert Owen Communities, a Devon and Cornwall based organisation that supports people with learning disabilities. It provides support for 30 people with personal care needs in the Honiton, Exmouth and Exeter areas of Devon. This includes people with learning disabilities, mental health problems, sensory and physical disabilities. The service ranges from a few support hours several times a week, to 24 hour support for some people in supported living settings. A supported living service is one where people live in their own home and receive care and support in order to promote their independence. People have tenancy agreements with a landlord and a separate agreement to receive their care and support from the domiciliary care agency. As the housing and care arrangements are entirely separate, people can choose to change their care provider without losing their home.
We visited two supported living settings, and people who lived there had their own rooms and shared other parts of the house. We also visited a person with personal care needs who lived independently that staff supported several times a week.
The service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.
People were at the heart of the service, which was organised to suit their individual needs and aspirations. People’s achievements were celebrated and their views were sought and acted on. People were supported by staff that were compassionate and treated them with dignity and respect. Staff were trained to use a range of communication tools suitable to enable the people they supported to express their needs and wishes.
People were active members of their local community and led busy and fulfilling lives. There was evidence of positive outcomes for people, and that people had progressed over time, gained new skills and increased their independence. People were enabled through positive risk taking, to challenge themselves to achieve. Staff were supported to challenge practice and to experiment and try different approaches with people.
There was strong leadership which put people first, set high expectations for staff and led by example. The service had an open culture, a clear vision and values, which were put into practice. Staff were proud to work for the service and felt valued for their work. A positive culture was demonstrated by the attitudes of staff and management when we talked with them about how they supported people. Many of the staff we met had worked in the service for a long time, knew people well and had developed deep and meaningful relationships with each person they supported.
People benefitted from a service that was committed to continuous learning and improvement. Staff were enabled to become skilled practitioners through a system of induction, training, and continual professional development. The registered manager promoted evidence based practice and encouraged staff to reflect on their practice through regular supervision and appraisal, team meetings and mentorship. Practice took account of local and national guidance about effective care.
Staff were encouraged to raise concerns and report incidents. Incidents were used as opportunities to review what worked well for each person and what needed to be changed. Staff were confident and knew how to make sure people, who did not have the mental capacity to make decisions for themselves, had their legal rights protected and worked with others in their best interest.
The service worked in partnership with other organisations in creative and innovative ways to improve people’s independence and enable them to lead busy and fulfilling lives. This included working with a variety of organisations to gain opportunities for people to get work experience and gain employment.
The provider had robust quality monitoring systems to monitor the quality of care. Continuous improvement plans were in place which identified the staff responsible, set deadlines and were regularly monitored and reviewed.