Nottingham Mencap Short Breaks Service

Right at Home (Derby) Ltd is a domiciliary care agency. It provides personal care to people living in their own homes. The Care Quality Commission (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, 57 people were using the service 35 of those were receiving a personal care service.

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

Staff told us they were very proud to work for the service and felt extremely well supported in their roles. The management team had dedicated a lot of time and resources to staff training and development.

People told us they enjoyed their independence whilst also getting the support they needed to live independently and be part of their local community.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us the service was safe. Staff knew how to recognise and report any concerns about people's safety and welfare. Strong recruitment procedures helped to protect people against the risk of being supported by unsuitable staff. Risks to people safety and welfare were identified and managed.

The leadership of the service was good. People were positive about the service and told us they would have no hesitation in recommending it. The service had a good quality assurance and monitoring systems to ensure people received safe care and treatment. These systems meant the management team were able to identify any shortfalls in the service and act quickly to rectify them.

The provider worked in partnership with other agencies to make sure people received the right care and support.

Staff had access to sufficient supplies of Personal Protective Equipment (PPE) and received regular updates from the provider on the management of risks related to COVID-19.

Rating at the last Inspection

This service was registered with us on 27 May 2020 and this was the first inspection.

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

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Nottingham Mencap Short Break Services is a domiciliary home care service providing care to children and adults with personal care needs. The children and adults they care for have a learning disability and/or communication needs. They care for children and adults for an agreed time period within their own homes and out in the community. The service provides short breaks from caring responsibilities for relatives and carers. They were providing a service to three people at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care within their own home. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the guidance CQC follows to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture. People were supported to make their own decisions where able maximising their independence. People received care that promoted their dignity, was person-centred and respected their human rights. The ethos and values of the provider and the behaviour of care staff and management resulted in people leading confident and inclusive lives.

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

The risks to people’s safety were assessed and recorded. However, we did find that some risks such as how to evacuate a person in case of a fire were not individualised to that person’s needs. Guidance was in place for staff to support people that presented behaviours that may challenge; however, formal training had not been provided for staff.

We have made a recommendation about this in the full report.

People were protected from the risk of abuse. Separate safeguarding polices were in place for children and adults and staff had completed safeguarding training for both. We did note the policies did not include the external reporting process to other authorities should a reportable incident arise. A process was in place to ensure accidents and incidents were investigated and reported. There was not currently a process in place to ensure the CQC were notified of reportable incidents. The provider is acting to address this. Records showed there were not currently any incidents to report.

Improvements were needed in some aspects of the overall governance of this service. The complaints policy and whistleblowing procedures did not include guidance for how to report concerns externally. The registered manager and nominated individual had limited knowledge of CQC regulations and processes and were not fully aware of the requirements to report notifiable incidents to the CQC. They both have assured us they will improve their knowledge and understanding of these processes in order to ensure people continued to receive safe care.

We have made a recommendation about this in the full report.

Robust infection control procedures were in place. This included how to reduce the risk of the spread of COVID-19. People did not currently require assistance with their medicines.

People, relatives and staff spoke highly of the registered manager. They praised their caring approach and felt confident they or their relatives received the highest possible quality of care. This view was reflected during the inspection. Both the registered manager and the nominated individual spoke with passion about improving the lives of the people they and their staff cared for.

People and staff felt well supported during the height of the COVID-19 pandemic. Staff wellbeing was actively supported and monitored. All felt able to discuss any issues with the registered manager and were confident they would be acted on.

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

Rating at last inspection and update

This is the first inspection of this service since 25 July 2013. The service ceased providing the regulated activity of personal care following this inspection and therefore was not inspected. We were informed by the provider in October 2019 that they had recommenced providing the regulated activity of personal care.

Why we inspected

We inspected this service due to the provider recommencing the provision of the regulated activity of personal care. We have found evidence that the provider needs to make improvements. Please see the ‘Is the service Safe?’ and ‘Is the service Well-led?’ sections of this full report. We found no evidence during this inspection that people were at risk of harm from these concerns.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We were only able to speak briefly to one person using the service due to people's limited communication abilities. We gained the views of people using the service by speaking with their relatives, the staff and looking at records.

The person we spoke with answered our question positively when we asked if they were happy with the support they received from staff. The two relatives we spoke with gave positive feedback about the service. One relative said, 'They [the agency] are very good, I don't know what I would do without them.'

We saw there were effective procedures in place to ensure staff were recruited safely.

We saw there were systems in place to make sure people and/or their relatives could have a say in how the service was run. There were also systems in place to ensure people could raise concerns if they wished to.

People were encouraged to make choices for themselves. For example people were asked what was important to them and how they would like their care delivered. Relatives told us people were supported to choose what they would like to do during support sessions and staff would facilitate this. People were involved in planning the way staff would support and care for them.

We spoke with three relatives of people using the service during our visit and received positive comments about the care provided. People said, 'staff do everything you ask for' and 'the service is very good. It allows me to have a break and I know my relative looks forward to the sessions.'

We found staff were given training to enable them to do their job safely and they were given regular feedback by the management team on how well they were working.