The announced inspection of Mencap York Domiciliary Care took place across several dates in December 2016 and January 2017. We visited the agency offices on 13 and 20 December. We visited some of the supported living schemes on 14, 15 and 20 December. Interviews with relatives of people that used the service took place on 13, 16 and 19 December and further interviews with relatives and other stakeholders took place on 3 January 2017. Mencap York Domiciliary Care provides personal care and support to people with a learning disability and/or Autism spectrum living in and around York. At the time of our inspection, the service supported 50 adults, many living in twelve supported living schemes. People were tenants of housing association properties and Mencap York Domiciliary Care provided personal care to people within their home. The housing providers were responsible for the buildings and their maintenance. Mencap York Domiciliary Care ran a small ‘community service’, which provided domiciliary care and support to people living elsewhere in the community.
The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last nine months. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 on 10 November and 10 December 2015 the service did not meet all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider was in breach of four regulations. These related to Regulation 12: Safe care and treatment, Regulation 18: Staffing, Regulation 10: Dignity and respect and Regulation 17: Good governance.
This was because the registered provider had not managed risk safely, ensured staffing levels were adequate to meet people's needs, monitored staff training, respected privacy and dignity and identified concerns, which meant that service delivery was inconsistent.
At the last inspection we made three recommendations, because there were shortfalls with management of medicines, providing person centred care and managing complaints.
At this inspection the registered provider had made sufficient changes to demonstrate compliance with the regulations.
The registered provider had ensured risks to people that used the service were appropriately assessed and managed. Risks assessments were detailed, covered areas of risk and were regularly reviewed. They cross-referenced with the information held in people’s support and health action plans, which also noted the risks people might face.
Staffing numbers were sufficient in all of the supported living schemes we visited. Everyone we spoke with felt staffing levels were adequate and that vacancies were covered by other support workers when necessary. Rosters were adequately covered to meet the needs of people that used the service.
The registered provider ensured support worker training needs and updates were monitored. The service had a high proportion of employees and relief workers whose training was up to date. The training matrix (record) was well managed and colour coding enabled quick and easy identification of training gaps and when training updates were needed. Dates of completed training were clearly identified. Support worker training had improved and was being managed appropriately.
We found that people’s privacy and dignity were respected.
The registered manager had implemented further audits and widened the range of safety checks to include people’s environments. Quality assurance and monitoring systems were much improved and the service was becoming more consistent across the supported living schemes.
The service had addressed the recommendations we made. Medicines were managed safely. People that used the service experienced a person-centred approach to their care and support needs. Where people lacked capacity their support plans were develop, for example, to include a way of summoning support. This was because specialist equipment was arranged for people to use which informed support workers when they needed to attend them.
People and their relatives told us low-level complaints and niggles were addressed more appropriately and satisfactorily, but there was still room for further improvement. All complaints were centrally collated and the organisation was analysing trends so that greater effort could be made to resolve issues more effectively.
People were protected from the risk of harm because the registered provider had systems in place to detect, monitor and report potential or actual safeguarding concerns. Support workers were appropriately trained in safeguarding adults from abuse and understood their responsibilities in respect of managing potential and actual safeguarding concerns.
The premises at each supported living scheme were safely maintained and there was evidence in the form of maintenance certificates, contracts and records to show this. Recruitment policies, procedures and practices were carefully followed to ensure support workers were suitable to care for and support vulnerable people.
People were cared for and supported by workers that were regularly supervised and appraised regarding their personal performance. However, the registered provider was still embedding the new supervision system and had encountered some issues with staff understanding and use of the new format documentation.
People’s mental capacity was appropriately assessed and their rights were protected. Employees of the service had knowledge and understanding of their roles and responsibilities in respect of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They understood the importance of people being supported to make decisions for themselves.
The registered manager was knowledgeable on how the service worked with other health and social care professionals and family members to ensure decisions were made in people’s best interests where they lacked capacity to make their own decisions.
People received adequate nutrition and hydration to maintain good levels of health and wellbeing. People received compassionate care from kind support workers that were knowledgeable about people’s needs and preferences.
People and their relatives were supplied with information they needed with regard to their care and support when necessary. People were involved in all aspects of their care and were always asked for their consent before support workers undertook care and support tasks.
People had the opportunity to engage in pastimes and activities if they wished to. People were encouraged to maintain good family connections and support networks.
The service was not always well-led, because although people had the benefit of a positive and open management style, there were clear 'visions and values' for Mencap employees to follow and quality assurance and monitoring was carried out, there were minor concerns identified with record keeping.
Recording systems used in the service protected people's privacy and confidentiality and they were securely held. However, we made a recommendation to ensure all support workers completed records regarding people’s information and for the running of the service, clearly, consistently and carefully.