Domiciliary Care Service

Updated 9 April 2021

The inspection

This was a targeted inspection to check on the specific concern we had about infection control. We will assess all of the key question at the next comprehensive inspection of the service.

Inspection team

This inspection was undertaken by two inspectors.

Service and service type

This service provides care and support to people living in 22 ‘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. The service also provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they 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

This inspection was announced. We gave the service 5 days' notice of the inspection site visit because the service is vast and spreads across the county of Hertfordshire. We needed to give the registered manager time to make arrangements to facilitate the inspection.

We visited the office location on 02 March 2021 and three ‘supported living’ settings on 04, 11 and 18 February 2021. We contacted people and staff from two further settings between 15 February 2021 and 02 March 2021.

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. The provider was not asked to complete a provider information return prior to this inspection. 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 spoke with one person who used the service and four relatives about their experience of the care provided. We spoke with 12 members of staff including the registered manager, two setting managers, senior care workers, care workers and an administrator. During our visits we were shown around the communal areas of each building and observed infection prevention and control practice.

After the inspection

We continued to seek clarification from the settings managers to validate evidence found. We reviewed the providers infection prevention and control policy, infection control audits and other documentation related to the management of COVID-19 risks.

Updated 9 April 2021

About the service: Domiciliary Care Service is operated by Hertfordshire County Council (HCC) from main offices within Farnham House, Stevenage. At the time of our inspection 358 people received care and support from teams of staff who were responsible for particular sites and geographical areas.

Not everyone using Domiciliary Care Service receives the regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them

People’s experience of using this service:

People and their relatives were confident that people were safe and well protected from the potential risks of abuse and avoidable harm. Staff received training about how to safeguard people from harm and were knowledgeable about the risks and potential signs of abuse. Where potential risks to people’s health, well-being or safety were identified, staff were knowledgeable about these risks and knew how to respond safely.

Staff received fire awareness training. Practice evacuations took place to help ensure staff and people knew how to make their way to ‘safe zones’ as quickly as possible. Fire safety equipment was made available including evacuation chairs and slides. Staff had received infection control training, the houses we visited as part of this inspection were clean. Incidents and accidents were recorded, investigated and reviewed by the management team. This helped to ensure steps were taken to identify, monitor and reduce risks.

Safe and effective recruitment practices helped ensure staff were of good character and sufficiently experienced, skilled and qualified to meet the complex needs of people who used the service. People, their relatives and staff confirmed there were enough experienced, qualified staff to meet people’s individual support needs. Regular bank and agency staff covered for staff shortages and unforeseen absences such as sickness. People’s medicines were stored, managed and disposed of safely. Staff were trained and supported people to take their medicines at the right time in accordance with the prescriber's instructions and had their competencies checked by senior colleagues.

People's needs and preferences were assessed and the care provided was based on this assessment. Staff received training and refresher updates in a wide range of subjects relevant to their roles and specific to the needs of the people supported. Newly recruited staff completed an induction programme and did not work unsupervised until assessed as competent to provide care and support in practice. Staff said they felt valued, listened to and were well supported by their management team.

Staff were knowledgeable about people’s nutritional needs, and supported them to eat a healthy balanced diet wherever possible. Staff had good relationships with external professionals who told us they were confident that people received good support from the service. People had access to a wide range of health and social care professionals relevant to their needs. Staff sought people’s consent to the care and support they received, together with that of their relatives where appropriate.

People were positive about the quality of care provided by the staff and managers who supported them. People’s relatives complimented the staff team for the care and support they provided. Staff had developed positive and caring relationships with people and were knowledgeable about their individual needs, personal circumstances and factors that affected their moods and behaviours.

People were fully involved in the planning and reviews of their care and support. Each person had a ‘key worker’ assigned to them who was responsible for ensuring they received the support required to meet their individual needs. People were supported to access advocacy services to obtain independent advice and guidance relevant to their needs where needed. Staff respected people’s privacy and promoted their dignity. Confidentiality was well maintained, and information held about people’s health, support needs and medical histories was kept secure.

People received personalised care and support. Detailed information and guidance had been developed to help staff provide consistent care and support in a person-centred way. People enjoyed a varied and active social life with the encouragement, support and involvement of staff. Staff and management learnt from people’s experiences, concerns and complaints in a positive and responsive way. People and their relatives knew how to make a complaint and said the management team responded to any concerns raised in a prompt and positive way. People were encouraged to give regular feedback about the service they received.

The service supported people who do not wish to move to a clinical setting as they approached end of life. Staff received specific training in this area and hospices were also involved with people’s end of life care and provided advice and guidance as needed.

People and their relatives were positive about how the service was managed. The management team undertook checks and audits in a wide range of key areas to help ensure a safe service was maintained. The management team were clear about the provider’s values and the purpose of the services provided. Staff also understood these values.

Staff told us that managers were effective in their roles, approachable and gave them clear and consistent leadership. People’s relatives told us that managers were good at keeping them informed about developments and changes to the care and support their family members received where appropriate.

The registered managers and site managers were knowledgeable about the people who received support, their needs, personal circumstances and the relationships that were important to them. They ensured that staff had the tools, resources and training necessary to meet the varied needs of all the people they supported. The provider routinely distributed feedback forms to people, staff members, relatives of people who used the service and health professionals to gain their opinions on the service provided.

Rating at last inspection: The service achieved a Good rating at the last inspection in August 2016.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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