Domiciliary Services

Domiciliary Services is a care agency providing personal care and support to people living in their own homes. People lived in a supported living service with shared facilities with between two and five people who share their home. At the time of our inspection 15 people were using the service. Not everyone who used the service received personal care. In this service, the Care Quality Commission can only inspect the service received by people who get support with personal care. This includes help with tasks related to personal hygiene and eating. Where people receive such support, we also consider any wider social care provided.

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

People gave different views about the quality of care they received. People and their relatives were complimentary about the care workers who supported them. Some relatives commented that their family members individual care needs were not always met.

People had their medicines as prescribed. However the medicines administration records were of a poor quality and not completed accurately.

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.

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 the underpinning principles of Right support, right care, right culture.

Right support: Model of care and setting does not maximise people’s choice, control and Independence. People were not always able to go out to do things they enjoyed which impacted on their independence.

Right care: Care is not always person-centred and does not always promotes people’s dignity, privacy and human rights. People and their relatives were not involved in care planning and records were not accessible to read for some people.

Right culture: Ethos, values, attitudes and behaviours of leaders and care staff ensure people using services lead confident, inclusive and empowered lives. The systems in place did not always promote an environment that promoted people’s choice and independence.

The monitoring systems in place were not robust because these did not find and address the concerns we found with the quality of medicines and care records.

People had care assessments and support plans in place, however we found people’s records were not always updated on the new computerised system and people’s care files contained the previous provider’s care documents.

There were mixed views of the staffing levels at the service. While the staff rotas planned for sufficient staff there were times when staff were not available and/or deployed to support people to enjoy the things they liked to do.

Staff were regularly tested for COVID-19 and had access to sufficient supplies of personal protective equipment [PPE] to reduce the risks of infection.

Staff understood the provider's safeguarding procedures, staff told us they had completed training on abuse and knew how to report concerns.

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

Rating at last inspection:

The last rating for this service was good (6 April 2018).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

Enforcement and recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to person-centred care, consent, safe care and treatment, good governance and staffing.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

This comprehensive took place on 27 February 2018 and was announced. The inspection site visit started and ended on 27 February 2018. Telephone calls to people using the service and their relatives were carried out on 27 and 28 February 2018.

We gave the service 72 hours’ notice of the inspection visit because the location provides a domiciliary care service. We needed to be sure that they would be in.

Two inspectors and two experts by experience undertook the inspection. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to the inspection, we reviewed the information we held about the service including notifications. Statutory notifications include information about important events, which the provider is required to send us by law. We reviewed the Provider Information Return (PIR) form sent to us. A PIR is a document that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We used this information to plan the inspection.

During our inspection, we spoke with 11 people using the service and six of their relatives. We spoke with two members of care staff, a deputy head of service, a human resources manager, two service managers, and a chief executive officer. The registered manager was not available on the day of the inspection due to adverse weather.

We looked at 10 people’s care records, including their risk assessments and five medicine administration records. We reviewed information about the management of the service including safeguarding reports, incident records and policies and procedures. We looked at 15 staff records that included recruitment, induction, training, supervisions and appraisals.

After the inspection, we received feedback from two health and social care professionals.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We saw the service had infection control procedures which included guidance on hand washing and infection control audits. Staff were aware of the policy and understood their roles in relation to infection control.

We saw the service carried out Disclosure and Barring Service (DBS) checks on all staff who worked in the service to ensure they were suitable to work in the care sector.

People were supported by staff who had the knowledge and skills to deal with foreseeable emergencies. They had received first aid training which was regularly updated.

People were protected from the risk of harm because the provider had ensured staff knew how to recognise and report concerns about abuse or neglect.

The registered manager was able to explain how the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS) related to their service.

Is the service effective?

People's social, health and support needs were assessed with them, and they were involved in reviewing their care plans. People told us the service met their identified needs. One person we spoke with said, 'I look at my care plan.' People were given information by staff which enabled them to make decisions about their care and support.

Is the service caring?

People were supported by kind and attentive staff. Staff were able to explain how they supported people to maintain their dignity and deliver services in a caring way. Care plans included details of how people liked to be supported. People told us the staff were 'caring' and 'friendly'. One person said, 'All the staff are very nice to me.'

Is the service responsive?

People's needs were assessed before they were signed up to the service. We saw checks were made to ensure people had not changed their minds about what they liked to do. People told us staff would make changes to the service they provided at their request. One person said 'I am happy with Plus, they do what I want them to do.' Staff regularly asked people's view of the service and responded to what people told them.

Is the service well-led?

The registered manager was clear about the aims and objectives of the service. Quality assurance processes were in place to check what people thought about the service. We saw the service had sent feedback forms to people who used the service and their relatives.

People using the service told us staff treated them with respect and kindness, and they were well cared for. One said 'I get to go out. I have my own room and a key to it. There are lots of good things to do."

We reviewed the care documents for six of the people using the service. The records contained up to date care, or support plans. The plans were written in conjunction with the person, and were based on individual needs. One of the people using the service said, "Everything is OK. There is nothing I don't like. Staff treat me well." Another person told us, "So far everything is OK. Staff are OK and the food is alright."

Staff we talked with demonstrated they understood signs of abuse and knew how to raise concerns of abuse. They also received annual safeguarding training. People using the service did not raise any concerns. One person said, "I feel safe here."

Staff told us they received regular training, supervision and support. They said they were enabled to gain further qualifications appropriate to their work.

The provider had effective systems in place to monitor the quality of the service being provided.

We found that care was reviewed on a regular basis, and that people using the service and their relatives were involved in these reviews.

People were protected from abuse as staff had undergone safeguarding training.

Care workers told us that the agency was supportive. They said that they had regular supervision and annual appraisals.

We found that the agency had a number of systems in place to review care plans and risk assessments. However, it did not have systems in place to carry out spot checks to monitor the quality of all parts of the service.