Lincolnshire Domiciliary Care Branch

Updated 24 September 2019

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 Care Act 2014.

Inspection team

This inspection was carried out by two inspectors.

Service and service type

This service is a domiciliary care agency. It provides personal care to people living in their own homes.

The service did not have a manager registered with the Care Quality Commission. The provider was in the process of registering two managers for the location. Throughout the report I have referred to them as ‘managers. This means that once registered 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

We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection. Because the service supports people in their own homes and people are often out and we wanted to be sure there would be people at home to speak with us.

What we did before the inspection

We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections.

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. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with eight people who used the service about their experience of the care provided. We spoke with ten members of staff two managers and the regional manager. We also spoke with one visiting healthcare professional. We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at four staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.

Updated 24 September 2019

About the service

Lincolnshire Domiciliary Care Branch is a domiciliary care agency. It provides personal care to 104 people living in their own homes. The service is registered to care for children between 13 and 18 years, younger and older adults, people with learning disabilities or autism, mental health and physical disabilities. Not everyone who used the service received personal care. The Care Quality Commission (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.

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 and what we found

We made a recommendation because some positive behaviour support plans and risk assessments were not up to date and did not include important information from other health and social care professionals. The service had been using high levels of agency staff, however permanent staff had been recruited and this was improving. Staff told us staffing levels were enough to meet the needs of people. Systems and processes were in place to ensure people were protected from abuse. Staff received regular safeguarding training and demonstrated they were knowledgeable about how to protect people from abuse.

Staff received regular training and told us the training provided them with the knowledge to do their jobs effectively. People were supported to eat and drink what they had chosen. People living in shared accommodation benefited from good person-centred support to purchase chosen ingredients and cook meals independently of their housemates. Staff worked well with colleagues across the organisation to ensure that people were getting good opportunities to socialise and engage in activities of their choice.

Staff sought consent from people before delivering care. Staff received training regarding the Mental Capacity Act (MCA) and were knowledgeable about the subject. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff knew people well and were kind and compassionate. People told us they liked their support staff and that they were kind to them. Staff knowledge was good around privacy, dignity and independence. People were given the opportunity to express their views regularly and were involved in their own care.

People were receiving care and support which was responsive to their needs, however care plans were not consistent. Some care plans lacked the person-centred detail to ensure important information about 'how' to support people was included. Terminology used in some care plans was negative. Some recent care plans included better detail, but this needed to be embedded. The provider was aware of the need to standardise support planning and was planning to implement a nationally recognised electronic support planning system in the near future.

The management structure had recently changed which improved the support provided to the staff team. There was no registered manager in post at the time of the inspection, however, applications had been submitted for two registered managers at the location. Leadership in the service promoted a culture which was open and inclusive. Staff were consistently complimentary about the support they received from their managers and team leaders. The team worked with a range of health and social care professionals and had built good links in the community.

Governance systems were in place to ensure oversight and scrutiny of practice within the service. Plans were in place to ensure the service developed and improved. The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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

The last rating for this service was Good (published 31 January 2017)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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