Archived: Dorset Learning Disability Service - Domiciliary Care

Updated 12 August 2021

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

This inspection was completed by one inspector.

Service and service type

This service provides care and support to people living in a ‘supported living’ setting, so that they can live 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.

The service did not have a manager registered with the Care Quality Commission. A manager had been appointed and was in the process of applying to become registered. The registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

This inspection was announced. This was because the service is small and people are often out and we wanted to be sure there would be people at home to speak with us. We wanted to check that the people supported by the service gave permission to us visiting their home.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We also reviewed information we had received about the service and from the provider since our last inspection.

During the inspection-

We spent time with people who used the service and observed the support they received. We spoke with four members of staff, the manager and the provider’s service manager who had been overseeing the service.

We reviewed a range of records. This included two people’s care records and records relating to the management of the service such as team meeting minutes, audits and service development plans.

After the inspection.

We spoke with or received feedback from relatives of three of the people receiving support and three social care professional who worked with people who lived in the home. We sought to clarify some information related to one person’s prescribed medicines and this information was made available quickly and an error was addressed. This error had not had any impact on the person.

Updated 12 August 2021

About the service

Dorset Learning Disability Service - Domiciliary Care is a care at home service that currently supports five people with learning disabilities and autism who live in shared supported living. The people living in the home share communal areas and have their own bedrooms.

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

People sought out and received support that was relaxed and natural. Care and respect was evident between people living and staff working in the home.

People were supported by staff who cared about them and were committed to supporting them to live fulfilled lives. Staff were sometimes cautious about how changes in individual’s support plans might impact on both the individuals and the dynamic of group living. They felt able to express any concerns they had.

Whilst the staff team had remained consistent, there had been a sustained period of management change. This had led to some lack of clarity around a shared vision both within the organisation and externally with professionals and relatives. The provider and manager were aware of this and had plans in place to improve understanding. Staff felt supported by their new manager and each other.

The systems in place to monitor the quality and safety of the service were mostly robust and action plans were in place to improve the quality and safety of the support people received.

The manager was aware of tensions between some views held by the team and external professionals. Professionals expressed frustrations about the responsiveness of the team. The manager was working to improve relationships for the benefit of people living in the home.

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 statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. There was work ongoing to address this.

Right support:

• The layout of the home largely supported people to live independently and make decisions about their lives. There was work scheduled for an independent professional to support the tenants of the property to make agreements about how they used the shared spaces. Care and support plans did not focus on supporting people’s tenancies. Managers told us they would address this.

Right care:

• The care provided was person-centred and promoted people’s dignity, privacy and upheld their human rights.

Right culture:

• The values, attitudes and resultant behaviours of senior staff and the staff supporting people ensured people living in the home were leading more empowered lives within their communities. There was work required to ensure support reflected the legal framework of supported living. Managers told us this work would be carried out. We have made a recommendation about this.

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

The last rating of the service was Good (published November 2018).

Why we inspected

We undertook this targeted inspection to follow up on changes that the provider told us they were making across the Leonard Cheshire Disability Dorset Learning Disability Service. The inspection was prompted in part due to concerns received about culture and working in partnership. A decision was made for us to undertake a targeted inspection to examine those risks.

During the inspection we received feedback that identified concerns about whether people were receiving personalised care that is responsive to their needs. We widened the scope of the inspection to become a focused inspection which included the key questions of responsive and well-led. We found people mostly received personalised care and the provider was working to further personalise the support people received.

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.