United Response - Cornwall DCA

Updated 7 June 2023

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 2 inspectors and 1 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

Supported Living: This service provides care and support to people living in ‘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.

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 not a registered manager in post. However, the manager was in the process of registering.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

What we did before the inspection

The provider was not asked to complete a Provider Information Return (PIR) prior to this inspection. A PIR is information providers send us to give some key information about the service, what the service does well and improvements they plan to make. 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 all this information to plan our inspection.

During the inspection

We met with 5 people who used the service and spoke to 6 relatives by phone about their experience of the care provided. We spoke with 17 staff. This included the manager, area manager, care staff, agency staff, administrative staff and 2 staff members from human resources. We reviewed a range of records. This included 3 people’s care records and medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed. We continued to seek clarification from the provider to validate evidence found.

Updated 7 June 2023

About the service

United Response (Cornwall DCA) is a domiciliary care agency which provides personal care to people who have learning disabilities or complex needs. At the time of our inspection, the service was providing care and support to 27 people in 19 different supported living settings. In the accommodation we visited, some people lived in self-contained flats, and others in houses. People had their own bedroom and shared bathroom, as well as shared communal areas.

In 'supported living' settings, people's care and housing are provided under separate contractual agreements. The Care Quality Commission (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

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:

Due to a shortage of staff available to some people, they were not always able to make choices or take part in meaningful activities which were part of their planned care and support.

People were supported by staff who were trained in medicines management. However, records were not always completed accurately.

People who experienced periods of distress had proactive plans in place which ensured restrictive practices were only used by staff if there was no alternative.

Systems were in place to report and learn from any incidents where restrictive practices were used.

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 did not support this practice.

Right Care:

There were not always enough staff at each service to meet people’s needs. Some staff had not promptly received the training they needed to keep themselves and the people they supported safe.

People received kind and compassionate care from staff. People were supported by staff who understood how to recognise and raise concerns.

People were able to communicate with staff because staff who supported them understood their individual communication needs.

Individualised risk assessments were undertaken. Where appropriate positive risk taking was encouraged.

Right Culture:

Oversight, audits and quality checks had not always been completed when required due to a lack of staff.

Staff morale had been affected by low staffing levels and recent changes to the structure of the service.

People’s relatives provided positive feedback about the service.

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 29 January 2020).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. Please see the safe and well led key question sections of the full report.

Enforcement and Recommendations

We have identified a breach in relation to staffing. Please see the action we have told the provider to take at the end of this report. We have also made recommendations in relation to the Mental Capacity Act 2005 (MCA) and how changes to the service are monitored and reviewed.

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.