15 June 2023
During an inspection looking at part of 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.