Portland Domiciliary Service

Updated 27 January 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

Two inspectors, a medicines inspector and 1 Expert by Experience carried out 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.

Service and service type

Portland Domiciliary service provides care and support to people living in 11 ‘supported living’ settings, 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.

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. The service had a manager registered with the Care Quality Commission.

Notice of inspection

This inspection was unannounced on day 1 and 2. Announced on day 3.

What we did before inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. 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 used all this information to plan our inspection.

During the inspection

We visited people at home in their bungalows and spoke with 6 people who used the service who were able to speak with us and 7 relatives about their experience of the care provided. We also spoke with 6 support workers and 4 members of management staff including the registered manager and operations manager.

We reviewed a range of records. This included 3 people’s care and medication records. We looked at 3 new starters staff files in relation to recruitment. A variety of records relating to the management of the service, including risk assessments, incident reports, action plans and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We also looked at quality assurance records.

Updated 27 January 2024

About the service

Portland Domiciliary service is a supported living service which was supporting 11 people at the time of the inspection. The service can support up to 12 people. The service comprises of 12 purpose-built bungalows.

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.

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

Right Support

The service didn’t always make reasonable adjustments for people so they could be fully in discussions about how they received support, including what staff they had to support them. The provider had enough staff to keep people save. However, there was a high use of agency staff and agency staff members were not always consistent.

Staff supported people to make decisions following best practice in decision-making. However, some aspects of peoples support plans, regarding positive behaviour support plans to help people when they were anxious, were not always followed.

The provider didn't always support people to have the maximum possible choice and control to be independent over their own lives. People were encouraged to set targets and in some areas of life for example, gaining more independence. However, this wasn’t consistent and steps to achieve goals were not clear for staff to follow.

We have made a recommendation regarding outcomes for people.

Medicines were managed and administered safely. However, records and systems to monitor medicines, needed to be improved. Staffs’ competency to administer medicines was checked. People were supported with their medicines in a way that promoted their independence and achieved the best possible health outcome.

The provider supported people to be safe in their own homes, with fire safety checks and people had personal evacuation plans. The provider gave people care and support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People’s bungalows were personalised.

Right care

People had enough staff to meet their needs and keep them safe. However, inductions and checks on agency staff were not always in place. People were not always supported by person centred practices. Failure to induct agency staff properly, meant they didn’t have the right information to support people in a personalised way. People did not always receive consistent care from a staff team who knew them well.

People were encouraged to take positive risks. Risk assessments were in place for people. The provider acted to protect people from abuse. Staff knew how to report any concerns to the appropriate places. Staff had training on how to recognise and report abuse.

Right culture

People and those important to them, were not always involved in planning their support. The provider didn’t always enable people where appropriate to work with staff to develop the service. The service was treated as a whole at times and not as individuals living in their own bungalows.

We have made a recommendation regarding engaging people in planning the service.

People didn’t always lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff. People were not always supported by staff who understood best practice in relation to the wide range of strengths or sensitivities people with a learning disability and/or autistic people may have. Staff teams were not always consistent therefore didn’t always know people well enough to be supporting their aspirations.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection and update

The last rating for the service was good, published on 12 July 2018.

Why we inspected

This inspection was prompted by a review of the information we held about this service and due to the length of time since the previous inspection. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Portland Domiciliary service on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to managing accidents and incidents , records, staffing, and manager oversight at this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.