Domiciliary Care Agency East Area

Updated 28 September 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 two inspectors.

Service and service type

This service provides care and support to people living in 7 ‘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.

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. A manager was in post who was in the process of applying to become the registered manager.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because we wanted to be sure there would be people at home to speak with us and that the provider or manager would be in the office to support the inspection.

What we did before the inspection

We reviewed information we had received about the service. We sought feedback from a number of local authorities and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. 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 visited 4 of the 6 supported living settings where people were receiving support with personal care; Willoughby Services, Helena Services, The Stables and Kings Ripton Services. During our visits, we spoke with 3 people supported by the service, to gain their feedback about the support provided, and we observed staff supporting some people. Some people were not able to give us verbal feedback, we observed their body language and interactions with staff to gain feedback on their wellbeing. During our inspection we also spoke with the manager, 4 service managers [responsible for individual supporting living settings], the regional manager, the operations support manager and 2 support staff. As part of our inspection, we also spoke on the telephone with 6 relatives and 7 staff members.

We reviewed a range of records, including people’s care records and medicines records. We reviewed staff training records and 3 staff recruitment files. We also looked at a variety of records related to the management of the service, including policies and audits.

Updated 28 September 2023

About the service

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.

Domiciliary Care Agency East Area is a supported living service which provides personal care to younger adults, including people with a learning disability and autistic people. 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. At the time of the inspection, 18 people received support with personal care, in 7 supported living settings, made up of flats and shared houses.

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

Right Support

People did not always receive high quality care that resulted in good outcomes for them.

People were not always protected from the risks associated with poor infection prevention and control. Risks to their health and safety were not always managed well.

People did not always receive support that maximised their choice and control.

There were not always enough staff available to support people to do what was important to them.

People were not always supported by staff to pursue their interests and take part in activities.

People had a choice about their living environment and were able to personalise their rooms.

Staff communicated with people in ways that met their needs.

Staff supported people with their medicines safely. Some minor improvements were needed to ensure medicines processes reflected national guidance.

Staff enabled people to access specialist health and social care support in the community.

Right Care:

People did not always receive appropriate support, as the service did not always have enough appropriately skilled staff to meet people’s needs and keep them safe.

The level of person-centred care that people received was not consistent across all of the supported living settings. People did not always receive care that reflected their individual needs and aspirations, was focused on their quality of life, and followed best practice.

People could not always take part in activities and pursue interests that were tailored to them.

People liked the staff who supported them, and most relatives told us staff knew their family member’s needs and preferences.

People’s care, treatment and support plans reflected their range of needs.

People could communicate with staff and understand information given to them because staff understood their individual communication needs.

People were supported by staff who had been recruited safely. Staff had training on how to recognise and report abuse and they knew how to apply it.

Right Culture:

People did not always receive good quality care and support.

The service had had experienced staffing difficulties and people were not always supported to receive consistent care from staff who knew them well.

The service did not always work with people, those important to them and staff to develop the service.

The service did not always have a culture of improvement and inclusivity. They did not always respond to complaints appropriately.

The service did not always monitor and evaluate the quality of support provided to people.

People and those important to them were involved in planning their care. They were happy with the management of the service.

There had been a number of changes in management over the previous year or so, which had resulted in inconsistency in the level and quality of support being provided across the service. Governance arrangements were not always effective. Checks of quality and safety were not always being completed as they should have been, and where improvements were needed, these were not always being completed in a timely way.

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

Rating at last inspection

The last rating for this service was requires improvement (published 22 June 2022).

Why we inspected

We had received concerns from Lincolnshire County Council, following their visits to 2 of the supported living settings: Roman House and Willoughby Services. The concerns related to safety, cleanliness, staffing arrangements, staff training and recruitment, communication, medicines management and staff culture. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. Roman House was closed by the provider on 5 May 2023, so this setting was not included in our inspection.

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, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to staffing levels and training, the management of risks to people’s health and safety and governance arrangements at this inspection.

We have made recommendations regarding the management of complaints, support with activities and seeking and acting on the views of people supported by the service, relatives and staff.

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

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.