Royal Mencap Society - Domiciliary Care Services - North London

Updated 15 July 2022

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 Care Act 2014.

Inspection team

This inspection was carried out by two inspectors. One inspector spoke to relatives of people using the service on the telephone. The other inspector visited the office and three of the supported living services as well as speaking to people using the service, staff and relatives on the telephone.

Service and service type

This service provides care and support to people living in eight ‘supported living’ settings so that they can live as independently as possible. The accommodation is rented and is the occupant’s own home. 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.

The service had a manager registered with the Care Quality Commission. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave the service notice of the inspection. This was because we wanted to be sure the registered manager would be available at the office and to arrange to visit people in their homes.

Inspection activity started on 18 May 2022 and ended on 31 May 2022. We visited the office location on 18 May and three of the supported living houses on 24 May. On other days we reviewed records, spoke with relatives, people using the service and staff in telephone and video calls.

What we did before the inspection

We reviewed information we held about the service including notifications, safeguarding incidents and contacts with the service over the last year. The provider completed a provider information return in 2019. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all this information to plan our inspection.

During the inspection

We met nine people who used the service. We spent time observing staff interacting with these people and supporting them. We spoke with four other people about their experience of the care provided. We spoke with the relatives of 17 people who used the service.

We spoke with 17 members of staff, including the registered manager, regional manager, three service managers, two assistant service managers and ten support workers. We sought feedback from the local authority and professionals who work with the service.

We reviewed a range of records. This included five people’s risk assessments, support plans, care records, eating and drinking records, medicines records, three staff recruitment files, quality assurance records and staff training records. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found.

Updated 15 July 2022

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.

About the service

Royal Mencap Society - Domiciliary Care Services - North London is a supported living service providing personal care to people with a learning disability and autistic people. This service provides care and support to twenty-seven people living in eight '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. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

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

Right support:

There were some risks for people with dysphagia (swallowing difficulties) as staff were not consistently following expert guidelines on supporting some people with eating and drinking. When we raised this concern the provider responded by requesting new assessments for the people concerned to ensure they were supported safely.

The service worked well with health and care professionals to meet people's care needs. Medicines were generally managed safely but we identified a few areas for improvement.

The care two people needed at night time was not written clearly so there was a risk they may have unmet needs during the night.

People were given choice and control in a supported way. Staff supported people to follow their individual interests and to develop their independence. The service provided a clear and positive ethos to guide staff in how to support people to maximise their choices and independence. Staff supported people with accessing the health services they needed to achieve the best health outcomes.

People had support to follow their own chosen lifestyles and daily routines. Staff supported them with their personal care needs and their independence.

Staff were trained to meet the needs of the people they were supporting. We observed staff interacting with people. People were comfortable around staff and staff were aware of people’s individual personalities and preferences. People were treated with respect and dignity and supported to be involved in meaningful activities.

Right care:

There were some safety concerns where two people had not been protected from the risk of avoidable harm. In both cases people had been at risk of harm from a person they lived with.

People’s relatives were satisfied that people received good care and were happy with how the service supported people to lead fulfilling lives. 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 a strong commitment to delivering person-centred care and in practice people led individual lifestyles where staff respected their individuality and rights to dignity and privacy. Staff had good knowledge of people’s individual communication needs and treated people with kindness and respect while providing care.

Right culture:

Staff formed relationships with people they supported and encouraged them to make decisions for themselves. The provider had implemented new initiatives to improve the culture within services. This had not yet been implemented in this service but staff were preparing for it. Systems were in place to promote continuous improvement. People’s families were involved in their care and support and people benefitted from a stable staff team who were committed to providing them with the best care.

The provider had a quality assurance system in place to check that the service was running safely and meeting people’s needs. The registered manager was committed to continuous learning, aware of improvements needing to be made and had planned to ensure these improvements were made. There was an open culture in the service where staff enjoyed working and relatives generally felt involved.

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

Rating at last inspection

The last rating for this service was good (published 17/07/2018).

Why we inspected

The inspection was prompted in part by notification of a specific incident. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of risk and safeguarding people from abuse. This inspection examined those risks.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led key question sections of this full report.

The provider has taken some action to mitigate the risks.

Enforcement and recommendations

We have identified breaches in relation to keeping people safe, safeguarding people from risk of abuse and the management of the service at this inspection.

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

We have made a recommendation about regular monitoring of people’s weight to help monitor their health.

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.