This service provides care and support to people living in five ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Not everyone using Dana Home Care receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’ which is help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The service had a registered manager. This 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.
At the last inspection of this service, in January 2016, the service was rated ‘Good’. The service’s rating is now ‘Requires Improvement’, the first time it has received that rating.
The service was not consistently ensuring the proper and safe use of medicines. One person had not received the medicines as prescribed, and records relating to medicines were not always accurate.
The service worked with people whose behaviour could challenge. Staff were trained to use restraint as a last resort. However, there were sometimes inconsistencies between different records of the same instance of restraint or sanction. Reviews had not identified this potential safety risk.
Staff recruitment checks were not sufficiently comprehensive, and signs of unsuitability were not always given due attention. Some staff were employed before these checks were completed. This did not assure that these staff were safe to work with people using the service.
Although some complaints from people using the service were paid due attention, the complaints system was not effectively operated due to inconsistencies with identifying, recording and responding to other complaints.
The service relied too much on our interventions to support continuous learning and improvement. For example, three police incidents and a safeguarding matter were not notified to us, as required by legislation, until we pointed this out to the management team. Improvements to systems of reviewing sanctions and restraints were only made following our interventions.
There were a number of audit systems used at the service. However, we found that issues that were identified from these processes were not always addressed. Additionally, the provider’s governance processes did not identify a number of concerns and service shortfalls we found.
Nonetheless, the service promoted a positive culture that achieved good outcomes for many people. People and healthcare professionals generally fed back positively about the service they received.
The whole service worked in co-operation with other organisations to deliver care and support that, on the whole, improved people’s quality of life. People were treated with kindness, respect and compassion, and were given emotional support when needed. Attention was paid to supporting people’s varied communication needs, to help them be better understood and more trusting of staff.
As far as possible, the service supported people to express their views and be actively involved in making decisions about their care and support. Consent to care was sought in line with legislation and guidance.
People received personalised care that reflected their needs and preferences. Their independence was respected and promoted, though balanced with assessments of safety risks. People were supported to engage in preferred activities, study and employment, both at home and in the community.
People accessed healthcare services, received ongoing healthcare support, and were supported to maintain a balanced diet. For example, some people were losing weight as planned, and being encouraged to eat healthier meals.
The service provided enough staff who worked regularly with people. Staff were supported to gain the skills and knowledge to deliver the care and support people needed.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.