Background to this inspection
Updated
23 March 2024
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 Health and Social Care Act 2008.
Inspection team
The inspection team consisted of 2 inspectors and an Expert 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.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
This service also 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.
Registered Manager
This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.
At the time of our inspection there was not a registered manager in post. A new manager had been recently appointed for the service.
Notice of inspection
The inspection was unannounced
The inspection activity started on 28 September 2023 and ended on 16 October 2023. We visited the office location on 28 September 2023.
What we did before the inspection
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 reviewed the information we held about the service. This included information received from the local authority following their unannounced visit on 4 September 2023. We used all of this information to plan our inspection.
During the inspection
We spoke with the head of finance who was acting up in the absence of the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider, on the day of the inspection we also spoke with the service lead. We reviewed documents and records that related to people’s care and the management of the service. We reviewed 8 care plans, which included risk assessments and 6 staff files, which included pre-employment checks. We looked at other documents such as training, medicines and quality monitoring records.
After the inspection we spoke with the nominated individual, 2 people, family members of 5 people who use the service and 5 members of staff.
Updated
23 March 2024
We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and 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 supporting people with a learning disability and autistic people and providers must have regard to it.
About the service
Disablement Association of Barking and Dagenham is registered as a domiciliary care agency based in the London Borough of Barking & Dagenham.
The service provides personal care to adults in their own homes and also in a supported living setting. People who were supported in a supported living setting had their own flats and a communal lounge. At the time of the inspection the service provided support to older people, people with a learning disability and autistic 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 the inspection, the service was supporting 8 people with personal care.
People’s experience of the service and what we found:
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.
Right Support:
The provider did not always assess the risks people were exposed to. This meant there were no plans to manage these risks and to help keep people safe. Staff received safeguarding training but were not always knowledgeable about the action to take if they witnessed or came across allegations or suspicions of abuse or neglect. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were safely recruited and received training and an induction. Staff told us they were supported by the provider and received supervision to discuss their performance.
Right Care:
People did not always receive kind and compassionate care. Some relatives of people using the service raised concerns about people not being safe. The concerns included staff shouting at people and handling people rough when supporting them with personal care. There were concerns of people being woken up early in the morning to be showered, which was not always according to their preferences. The provider did not always ensure sufficient numbers of suitable staff were deployed to care for and support people using the service. People did not always receive personalised care which met their needs. Staff received training in a range of areas to help equip them with the skills and knowledge required to meet the needs of the people using the service. However, some staff did not always implement best practice from their learning.
Right culture:
People were not empowered to make decisions and achieve their aspirations. They did not always receive good quality care and support because some staff did not understand, or did not want to deliver a personalised service which reflected best practice for people with learning disabilities and autistic people. Staff told us they had good relationships with people, however, the support they provided focused on basic tasks and not on promoting individuality and independence. There was a risk of a closed culture because staff did not always act in an open and transparent way and did not always accept the view of others, including people who used the service, which challenged the way they wanted to work.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Why we inspected
The inspection was prompted in part due to concerns received about unsafe care , care plans, staffing and safeguarding concerns. , A decision was made for us to inspect and examine those risks.
Enforcement and recommendations
We have identified breaches in relation to person-centred care, consent to care, safeguarding people from the risk of abuse, safe care and treatment, good governance, dignity and respect and staffing at this inspection.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
We have made a recommendation for the provider to carry out medicines competency assessments for the staff who support people with their medicines.
Follow Up
We will work alongside the provider and local authority to monitor progress with making improvements at the service.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.