15 September 2016
During a routine inspection
People in Action Domiciliary Care – South Warwickshire, provides care to younger adults with a learning disability or with mental health difficulties, in their own homes. Some people live with family members, whilst others live in homes they share with other people supported by the provider. At the time of our inspection, the provider was supporting 23 people.
The service had a registered manager. 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. Whilst we spoke with the registered manager, and established they had oversight of the service, a ‘service manager’ was in post and oversaw the day to day running of the service.
People told us they felt safe and comfortable with the staff who supported them. Most relatives were also confident people were safe. Staff received training in how to safeguard people from abuse, and were supported by the provider who acted on concerns raised and ensured staff followed safeguarding policies and procedures. Risks to people’s safety were mostly identified, minimised and focussed towards individual needs so people could be supported in the least restrictive way possible and build their independence. However, some risk assessments were not up to date and had not been completed where risk had been identified.
People were supported with their medicines by staff who were trained and assessed as competent to give medicines safely. People told us their medicines were given in a timely way and as prescribed.
There were enough staff to keep people safe, but recruitment was underway to ensure there was a full staff team able to meet people’s individual needs. The provider conducted pre-employment checks prior to staff starting work, to ensure their suitability to support people who lived independently. Staff told us they had not been able to work until these checks had been completed.
People told us staff asked for consent before providing them with support. People were mostly able to make their own decisions and staff respected their right to do so. Staff and the service manager had a reasonable understanding of the Mental Capacity Act 2005, and the provider had ensured applications to deprive people of their liberty under the Deprivation of Liberty Safeguards, had been made as required.
People had access to health professionals when needed, and care records showed support provided was in line with what had been recommended.
People told us staff were kind and caring and treated them with dignity. Most relatives agreed, although some staff and relatives had concerns about the way some staff spoke with people. We found the provider took this seriously and was taking steps to deal with this. People were supported to make choices about their day to day lives. People’s care records were written in a way which helped staff to deliver personalised care and gave staff information about people’s communication, their likes, dislikes and preferences.
Relatives told us, and records confirmed, that people were not always supported in a responsive way, or according to their preferences and needs. Frequent staff changes along with reduced staffing levels, led to people’s support being changed from what was planned, in order to free staff up to cover gaps elsewhere in the service. People and most relatives felt able to raise any concerns with the service manager. They felt these would be listened to and responded to effectively and in a timely way.
Staff told us the service manager was approachable and responsive, but that they did not always feel well supported by senior staff who they felt were less available and responsive following recent organisational changes. There were systems in place to monitor the quality of the support provided, but these had not always identified the issues we found, and actions plans were not sufficiently robust to enable the service to continually improve.