United Response - Newcastle DCA

United Response – Newcastle DCA is a supported living service. At the time of the inspection they were providing care and support to 25 people spread over 10 supported living premises. The service provides support to people with learning or physical disabilities or autistic spectrum disorder.

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

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.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. However, some improvements were required.

Right support:

People were supported by staff who focused on people's strengths and promoted what they could do. People could make choices and plan activities they preferred.

Medicines were managed safely. However, some improvements were needed in the records for medicines including handwritten records and when required medicines.

People were encouraged to be part of the community. Staff had a good understanding of people’s individual needs and encouraged them to reach their goals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There was enough staff to support people in a person-centred way. Some agency staff had been used at times. However, the provider had a robust safe recruitment drive in place to fill vacant posts.

Right care:

Staff understood how to protect people from abuse and what they needed to do to report this. Staff followed safe infection prevention practice in people's homes.

Right culture:

People were supported by staff who understood best practice in relation to the wide range of strengths and needs people with a learning disability and/or autistic people may have. This meant people received compassionate and empowering support that was tailored to their needs.

The provider needed to improve record keeping across a number of areas and was going to review quality assurance systems to support this going forward.

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

Rating at last inspection and update

The last rating for this service was good (published 15 January 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. The inspection was also prompted in part due to concerns received about medicines, staffing and training and the care people received. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-Led.

For the key questions of Caring and Responsive which were not inspected, we used the rating awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection. We have made three recommendations in connection with medicines, infection prevention and control and training records.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for United Response - Newcastle DCA on our website at www.cqc.org.uk.

Follow up

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

People’s experience of using this service: United Response – Newcastle DCA 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.

People’s rights were respected. People were supported to live the lives that they wanted to. Staff helped people find activities which they would enjoy and to pursue their hobbies. Staff understood the importance of people’s relationships and helped them to maintain and build friendships including romantic ones. People’s differences were accepted and celebrated. People were supported to do as much as they could for themselves. Staff understood the way people communicated and made sure information was given in a way which people understood.

People were supported to make choices. Staff understood the law where people did not have capacity to make decisions. Proper processes had been followed when decisions had been made on people’s behalf. People had been supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People and their relatives told us staff were friendly and kind. Staff were well trained and knowledgeable about their roles and the care people needed. People looked relaxed in the company of staff. Relatives told us the service was safe and that people were well cared for.

Systems and processes were in place, followed and well monitored to keep the service safe. Medicines were well managed. Risks were minimised.

Staff carried out lots of checks to make sure that the service was delivering a good service. Some people who used the service were involved in these checks so that people’s views on care were included.

The provider shared research and good practice between their services. They identified trends and new ways of working. They continuously looked to improve the care people received.

Rating at last inspection: Good (Report published in May 2016).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

We last inspected Newcastle Domiciliary Care Agency (DCA) in August 2014. At that inspection we found the service was meeting all of the legal requirements in force at the time.

Newcastle DCA is part of the United Response group. It is registered to provide personal care to adults with learning disabilities within Newcastle, Durham, North Tyneside and South Tyneside. People are supported by staff to live individually in their own homes or in small groups, referred to as independent supported living schemes. Different levels of support are provided over the 24 hour period dependent upon people’s requirements. Many of the people are tenants of their home and pay rent for their accommodation which is leased from housing associations.

A registered manager was in place. A registered manager 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.

People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. Staff were aware of the whistle blowing procedure which was in place to report concerns and poor practice. When new staff were appointed thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Due to their health conditions and complex needs not all of the people were able to share their views about the service they received. Some people could tell us they felt safe. People appeared contented and relaxed with the staff who supported them.

Staff knew the people they were supporting well and there were enough staff on duty to provide individual care to people. Care was provided with patience and kindness and people’s privacy and dignity were respected. People were supported to become more independent, whatever their level of need. Care plans detailed how people wished to be supported and people were involved in making decisions about their care. Records gave detailed instructions to staff to help people learn new skills and become more independent.

People were assisted by staff to plan their menu, shop for the ingredients and cook their own food. Other people received meals that had been cooked by staff. People were supported to be part of the local community. They were provided with a range of opportunities to follow their interests and hobbies and were encouraged to try new activities. They were supported to holiday in this country or abroad and enjoyed outings to the town, coast and countryside.

Records showed people were supported to maintain some control in their lives. They were given information in a format that helped them to understand and encourage their involvement in every day decision making. A complaints procedure was available and written in a way to help people understand if they did not read.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed. They received their medicines in a safe and timely way.

Staff said the registered manager and management team were supportive and approachable. Communication was effective, ensuring people, their relatives and other relevant agencies were kept up to date about any changes in people’s care and support needs and the running of the service.

People had the opportunity to give their views about the service. There was consultation with people and family members and their views were used to improve the service. The provider undertook a range of audits to check on the quality of care provided.

. Is the service safe?

. Is the service effective?

. Is the service caring?

. Is the service responsive?

. Is the service well-led?

This is the summary of what we found.

Is the service safe?

An assessment of people's care and support needs was carried out before people started to use the service. This was to ensure staff had the skills in order to meet the person's support requirements.

Risk assessments were in place to help protect people and keep them safe but at the same time promote their independence.

Is the service effective?

We observed staff were enthusiastic and were keen to help people develop and become more independent in aspects of daily living. Staff were very knowledgeable about people's care and support needs and through consistent working helped to calm and reassure people with some complex care and support needs. They encouraged the involvement of people by offering them choices in ways that were appropriate to the person.

We saw staff had received some training to help them understand some of the different care and support needs of people they worked with.

Is the service caring?

We observed staff were helpful and offered people information and support about their care. Records showed staff kept people's relatives up to date with what was happening with their relative's care.

People who used the service were introduced to new experiences and activities to help them develop and provide them with stimulation and interests.

Is the service responsive?

Information was collected by the service with regard to the person's ability and level of independence before they started to use the service. Various assessments were completed by the manager of the service with the person and/or their family to help make sure staff could meet their needs. Regular reviews were carried out with the person who used the service and their representative to make sure the person's care and support needs had not changed. This helped ensure staff supplied the correct amount of care and support.

Referrals for specialist advice were made when staff needed guidance to ensure the health needs of people were met.

People's individual needs were taken into account and they, or their representative if they were not able, were involved in all decision making with regard to their care. They were kept informed and given information to help them understand the care and choices available to them.

Regular meetings took place with staff to discuss the running of the service and to ensure the service was responsive in meeting the changing needs of people.

Is the service well-led?

Recent management changes had helped to ensure the individual houses were managed by staff who promoted the ethos of individual care rather than institutional care. The emphasis was now upon people living individually, although they shared accommodation, and being involved in decision making about their daily living requirements. This meant there was now a focus from management on the provision of individual care and support to people who use the service.

Staff spoken with commented they felt supported by the manager. They said they were provided with training opportunities to help them have more understanding of people's care and support needs.

As a result of the information received we only visited the service identified to us.

We saw people were safe and protected from abuse.

We saw the home had effective systems in place to manage medicines.

We saw people were safe and protected from abuse. Staff were suitably qualified and experienced to care for people.

There were effective systems in place to monitor the service and to record and monitor complaints. Complaints were taken seriously and responded to appropriately.

Records were available and accurate. They were stored securely and were fit for purpose.

People who used the service or their representatives were positive about the care and support provided. Comments included 'They are brilliant. They are really helpful' and 'They provide a good service'.

The person we spoke with told us they were happy with the way they were treated, their comments included "It's alright here. We do things that I want to do, and the staff are polite." And, "The staff here look after me, I'm helped with everything I need."

Both of the relatives we spoke with told us that they felt people were well cared for and treated with dignity and respect. One relative said, "The staff are lovely to everyone. They know people really well as they've cared for them for such a long time."

We found that people had not been given up to date details about what they could expect from the service. They were supported in promoting their independence but were not always included in the planning of their care.

Care had been planned and delivered in a way that ensured people's safety and welfare, and people's individual needs had been taken into account. However we found shortfalls with staff training and care records which meant people were at risk of unsafe or inappropriate care.