Archived: Domiciliary Care Service

Updated 4 July 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 registered 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 scheduled inspection was announced. We gave the service 7 days notice of the inspection site visits because it was possible that some of the people using the service might not have been able to consent to a home visit from an inspector, which meant that we had to provide time for any ‘best interests’ decisions to be made about this.

The inspection site visit started on 23 January and ended on 25 January. It included visits to two of the supported living settings, accompanied by the registered manager. We visited the office location on 25 January to see the registered manager and to review care records and policies and procedures.

The inspection team included one adult social care inspector and two experts by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. Both experts by experience had expertise in the area of learning disabilities.

Before our inspection, we reviewed all the information we held about the service. We used information the registered provider sent us in the Provider Information Return (PIR). This is information we require registered 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.

We reviewed notifications that the registered provider had submitted to us, as required by law, to tell us about certain incidents within the service. We also obtained feedback from the local authority which commission the service.

We visited and met seven people who used the service who were living in three of the shared houses and six people who lived in their own flats. We observed staff supporting people around their homes. We spoke in some depth with five people who used the service and observed care and support provided to eight people who did not communicate verbally. We also spoke with nine people’s relatives on the telephone to gain their views of the service.

We spoke with nine members of support teams, including two senior staff and the registered manager. We reviewed documentation relating to people who used the service, the staff and the management of the service both at their homes and at the registered provider’s office. This included three people’s care and support records, including their daily records, and their assessments and support plans. We saw the systems used to manage and administer people’s medication. We looked at the personnel records for three staff members, which included recruitment, training and support records. We saw records of complaints and safeguarding concerns and of meetings with people who used the service and their relatives, as well as staff meeting minutes. We also looked at the registered provider’s quality assurance systems to check if they were effective and identified areas for improvement.

Updated 4 July 2018

The Domiciliary Care Service provides care and support to people living with learning disabilities in three ‘supported living’ setting, so that they can live in their own home as independently as possible. 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 the inspection the service was providing support packages to 30 people, who lived in one of three supported living settings. Some people lived in shared houses and some people lived in their own flats.

At the last inspection, the service was rated Good. You can read the report from our last inspections, by selecting the 'all reports' link for ‘Domiciliary Care Service’ on our website at www.cqc.org.uk

This inspection took place on 23 and 25 January 2018 and was announced. We gave the service seven days notice of the inspection site visits because it was possible that some of the people using the service might not have been able to consent to a home visit from an inspector, which meant that we had to provide time for any ‘best interests’ decisions to be made about this.

At this inspection we found the service Requires improvement. There was further work to do to make sure people were better supported to follow their interests and take part in activities that they liked, that were socially and culturally relevant and appropriate to them. This included having more access to the wider community.

In addition to the record of formal complaints, there was work to do to ensure that the more informal concerns people’s relatives raised and the action taken to address them were recorded, and managers made aware. Engagement with and listening to people’s relatives was an area for improvement. The absence of visible managers on a day to day basis in one supported living setting had led to a period when there was a lack of cohesion and there was work for the registered manager to do to address the issues arising as a result of this.

There was a registered manager in post. 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. The registered manager had recently returned to work after a six month absence and it was evident that her presence had been missed.

People who used the service were positive in their feedback and most of the relatives we spoke with said that on the whole their loved one’s day to day care needs were met. However, some relatives told us the service was going through a retendering process, which meant that a new provider was soon likely to be taking over the running of the service. There were enough staff available to ensure people were safe, although several staff had left and this had necessitated the use of bank and agency workers, who had taken time to get to know people.

We found that care and support was planned and delivered in a way that made sure people were safe. Systems were in place to safeguard people from abuse and the staff we spoke with knew how to recognise and report abuse. Risks associated with people’s needs and lifestyles were identified and plans were in place to minimise the risks. Medicines were managed safely and administered as prescribed.

We found that overall; staff were trained and had the skills they required to carry out their role. People received a healthy diet which they had been involved in choosing. People were supported to live healthy lifestyles and had access to relevant healthcare professionals as required. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People were treated with kindness and compassion. When we visited people in the supported living settings we saw staff interacting with them in a caring and positive way and it was clear that the people who used the service had developed good relationships with the staff. We saw that staff respected people and ensured their dignity was maintained.

Some people’s relatives expressed concern about whether the number of support hours people received were enough to ensure people’s needs were met and their interests were maintained. They said their family members did not have the opportunities they should for engaging in meaningful activities and most people had not had a holiday for a long time. We saw that staff were creative in making sure that people had at least some access to the community and were able to be involved in activities of their choice. There were differing opinions about the personal care provided to people, with some relatives expressing concern, while other relatives spoke of people being very well supported in this area.

The service had a complaints procedure and this was available in an easy to read format. The Trust had put a great deal of time and effort into involving people who used the service and engaging them in creating easy read guides for people about what they should expect from the service and many other aspects of their lives.

There were also differing opinions about the management of the service. Some relatives felt the Trust did not listen to them. Other relatives felt the staff and managers were doing their best in a difficult situation. Audits took place to ensure the registered provider’s policies and procedures were being adhered to. People who used the service were given opportunities to voice their opinions and views and be involved in how the service was run.

Further information is in the detailed findings below.