The Wilf Ward Family Trust Domiciliary Care Harrogate and Northallerton is a domiciliary care agency. They provide personal care to younger adults and older people. The service specialises in supporting people who may be living with a physical disability, learning disability or autistic spectrum disorder. The service provides care and support to people living in 14 ‘supported living’ settings so that they can live as independently as possible. In supported living, 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.
At the time of our inspection, there were 38 younger adults and older people using the service. People who used the service lived in a mixture of bungalows and ‘houses of multiple occupation’ across Harrogate, Knaresborough, Ripon and Northallerton. Houses of multiple occupation are properties where at least three people in more than one household share toilet, bathroom or kitchen facilities. Some supported living houses included accommodation for staff who were available to provide support throughout the day and night if needed. The personal care service provided in these supported living houses was managed from offices in Ripon.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion.
Inspection site visit activity started on 23 November 2017 and ended on 8 December 2017. This was our first inspection of this service since it was registered at a new location in December 2016. The service was previously inspected when registered at a different location and was rated ‘Good’ in December 2015.
At the time of our inspection, the service had a registered manager. They had been the registered manager since December 2016. 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.
During this inspection we found examples where risk assessments required more specific guidance on how risks should be managed. People were supported to take their prescribed medicines. Protocols for medicines prescribed to be taken only when needed did not consistently contain important information to guide staff on when to administer them.
We made a recommendation about developing record keeping in relation to mental capacity assessments and best interest decisions.
We received positive feedback about the skills and experience of staff and saw courses were planned to update gaps in staff training. Appraisals and supervisions (known as ‘staff development sessions’) had not been consistently completed as frequently as was required under the provider’s policies and procedures.
Whilst audits had been completed and continuous improvements plans were in place, work was on-going to address the issues the provider had identified. At the time of our inspection, further progress was needed to address the variations and inconsistencies we found across the supported living services.
People told us they felt safe using the service. Staff understood their responsibilities to safeguard people from abuse or neglect. Sufficient staff were deployed to meet people’s needs.
People told us staff were kind and caring. We observed staff provided person-centred care and were attentive to people’s needs. Staff supported people to maintain their privacy and dignity. People said staff listened to them and respected their decisions. We observed staff routinely offered people choices and encouraged them to make decisions. Staff promoted people’s independence; people were encouraged to participate in activities of daily living.
Staff provided effective support to ensure people ate and drank enough. People were supported to access healthcare services to promote and maintain their health and well-being.
People were supported to engage in activities of their choosing and to pursue their hobbies and interests. The provider had a procedure in place to gather and respond to feedback about the service, including complaints. People told us they felt able to complain and that management were approachable if they had any issues or concerns.
The registered manager had completed comprehensive training and set up a focus group to develop the care they would provide if people who used the service needed support at the end of their life.