Royal Mencap Society - Norfolk Domiciliary Care Agency

Updated 20 August 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

One inspector carried out the site visit, met with the manager and talked to relatives. Another inspector made phone calls to staff.

Service and service type

This service provides care and support to people living in the community, either in their own flats or houses or in supported living services. 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 service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period notice of the inspection because we wanted to arrange to visit several services and needed consent from people in order for us to visit.

What we did before inspection

We reviewed information we had received from the provider since the last inspection. This included notifications of significant incidents which the provider is required to send us by law. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We spoke with eight relatives prior to our visits. We took this into account when we inspected the service and made the judgements in this report.

We used all this information to plan our inspection.

What we did at the inspection

During the inspection we visited two supported living schemes over two separate days and met five people using the service.

We spoke with five staff and a further four staff after the inspection. We met with the registered manager over the two days when conducting site visits and met with her separately to go through care plans and other records. We also communicated with two professionals.

Updated 20 August 2022

Royal Mencap Society – Norfolk Domiciliary Care Agency is a care agency providing personal care to people living in the community. People received support in their own properties or in shared supported living services which provide support for small groups of people. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our inspection 24 people were receiving a regulated activity.

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

During this inspection we received good feedback from staff and relatives who expressed confidence in the service and felt that people were being supported to have a good quality of life.

The service had been under tremendous strain particularly considering the impact of the COVID-19 pandemic. Despite this, staff and the management team had pulled together to ensure people’s commissioned hours were provided. Staff reported occasionally working with less staff than they needed but said this had minimal impact on people’s support needs.

Record keeping was not up to date and audits to assess the quality and safety of the service as a whole were not as regular or sufficiently robust. There had been a reduction in management hours. This was due to service managers and support workers with additional responsibilities working shifts and not being able to always complete their other administrative tasks. Some documentation particularly in relation to people’s mental capacity and how staff should act in their best interest if deemed not to have full capacity was not clearly documented.

People’s records had been transferred on to a new digital platform but not all records had been scanned in which made it difficult to case track both people and staff records. The new systems were being embedded but we found no one using the service had been given access to their records or being asked to regularly contribute to a review of their needs.

Staff had access to regular digital training mostly online as face to face training had not been safe to deliver during the pandemic. There were suitable arrangements in place to support new staff, but we found spot checks were not happening and supervision of staff varied in quality and frequency across the different sites. Staff expressed concerns about developmental opportunities as supervisions were not used to set objectives and review staffs training needs. The registered manager explained a new staff development tool was being introduced. We have made a recommendation about staff training.

There was insufficient oversight of staff practice in relation to their infection control practices. feedback was not regularly sought about how to improve the quality of the service.

Records did not demonstrate how people were supported to make appropriate choices in line with their preferred communication preferences. People's ability to understand decisions had not been fully considered in line with their needs. The service had not fully considered people’s needs and preferences in relation to the care and treatment as they aged. We have made a recommendation about this.

Staff understood their needs and interests. People had varied opportunities to go out and do things they enjoyed. Staff valued people and ensured they maintained contact with friends and family.

Rating at last inspection

The service changed its registration 09/10/2020. This was their first inspection since a change in registration.

The last rating for the service under the previous location was good, published on 30 July 2019.

Why we inspected

This was a planned comprehensive inspection.

Follow up

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

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