An Darach Care - Cambridgeshire

Updated 18 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

The inspection was carried out by 3 inspectors (1 of whom specialised in medicines), a specialist advisor (an external professional with a specialism in learning disabilities and autism) and an Expert by Experience. 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

This service provides care and support to people living in 4 ‘supported living’ settings, based on 2 sites, so 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.

Registered Manager

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.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 27 June 2023 and ended on 15 August 2023. We visited the location’s office on 27 June 2023. We visited people in their homes on the 29 June 2023 and 04 Jul 2023.

What we did before the 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 reviewed support plans and associated records for 9 people. We reviewed medicine administration and associated records for 12 people. We spoke with 4 people who used the service and observed staff delivering support to people in 4 houses. We spoke with 15 staff including the registered manager, service manager, deputy managers, senior support staff, support staff, quality business partner, service development practitioner, head of adults’ service and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

After the inspection we received further documentation electronically, such as governance audits, recruitment files, supervisions, and minutes of meetings. We spoke with 7 relatives, a social worker and 2 social care professionals from the local authority. We continued to liaise with the local authority about our concerns following the inspection.

Updated 18 January 2024

An Darach Care - Cambridgeshire is a domiciliary care agency providing personal care and support to younger adults with a learning disability. At the time of our inspection the service was supporting 18 adults in 4 supported living houses and 2 single occupancy annexes. The service can support up to 20 people in total. The registered manager works from a separate office located on the same site as 1 of the houses close to Peterborough.

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.

Right Support:

Care was not always provided in a dignified manner which had the potential to compromise people’s human rights. Staff were trained in restrictive practices, and we found people's records mostly, not all, had guidance in place for staff to follow when using control and restraint. 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.

Right Care:

Care was not always provided in a person-centred way which promoted people's dignity, independence or human rights. There were not always staff with suitable skills deployed to meet the needs of people. There were some gaps in staff training, and we were not assured staff had the skills and knowledge to fill the requirements of their role. Medicines were not always safely managed, and medicine records were not always completed accurately.

Right Culture:

The service lacked effective oversight and leadership. The provider's systems for monitoring and improving the quality of the service had not been effective. Learning from events was not always shared with the staff team. This placed people at potential risk of harm.

The failings outlined in this report demonstrated the provider had failed to ensure people received a well-managed service which was safe and compassionate placing people at risk of potential harm.

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 14 July 2021).

Why we inspected

The inspection was prompted in part by notification of an incident following an allegation of abuse. This incident is subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident. However, the information shared with CQC about the incident indicated potential concerns about the safeguarding procedures and the culture within the service. This inspection examined those risks.

As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for An Darach Care - Cambridgeshire on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to safe care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

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