United Response - Wiltshire DCA

United Response – Wiltshire DCA is a supported living service, providing personal care to 12 people at the time of the inspection. The service provides support to people with learning disabilities and autistic people, who live in shared homes or on their own. 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.

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.

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

Right Support

Risk assessments were completed to support people to be as independent as possible. Staff demonstrated a good understanding of risk management plans and the actions they needed to take to support people to stay safe.

People were supported to safely take any medicines they were prescribed. The support people needed was regularly reviewed to ensure people were as independent as possible. Staff kept accurate records of the support they provided people to take their medicines.

There were enough staff to meet people’s needs. The provider had taken action to address staff shortages through use of temporary agency staff where needed. Temporary staff had been working at the service on a long term basis to provide consistent support for people.

People were supported to have maximum choice and control of their lives and staff supported in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care

People and their relatives told us they felt safe and received good care. We saw people interacting with staff in a confident and comfortable way. People appeared at ease in the presence of staff.

We observed staff working in ways that were respectful of people and promoted their independence. Staff responded to people’s requests and provided appropriate support.

People were supported to maintain contact with their family and friends.

Right culture

The registered managers had promoted a person-centred approach in the service. This was evidenced through the content of staff meetings, support sessions for staff and the training staff received. Staff said the registered managers were focused on ensuring people received a good service.

The provider had systems to assess and monitor the quality of the service being provided. Effective action had been taken to make improvements where needed.

Staff told us they felt listened to and valued by the registered manager.

People were supported to be active members of their community and participate in local activities.

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

Rating at last inspection

The last rating for this service was good (published 17 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good, based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for United Response – Wiltshire DCA on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

United Response - Wiltshire DCA delivers domiciliary personal care to people with learning disabilities and autism. Personal care was provided to 12 people across six supported living locations..

The service had a registered manager in place. 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.

Medicines were mostly managed safely. We found that temperature checks were not completed or recorded in medicine cabinets. One person received liquid medicines which could not be stored over a certain temperature. We noted that this medicine bottle did not have an open date recorded on it either. On day two the area manager confirmed that this had been addressed. Medicines were securely stored and only given by staff that were trained to give medicines.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. However, people’s records did not always contain an assessment of their capacity. Where decisions had been made in people’s best interests around their care and treatment these were not always being recorded fully.

People, relatives, friends and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training.

Personalised care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included outcomes and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, epilepsy and diabetes.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.

People were supported with shopping, cooking and preparation of meals in their home. The training record showed that staff had attended food hygiene training.

People were supported to access healthcare appointments as and when required and staff followed GP and community learning disability nurses advice when supporting people with on-going care needs.

People and relatives told us that staff were caring. During home visits we observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected needs identified in these. Outcomes were set by people and person centred reviews took place. These evidenced that people were actively supported to work towards their outcome areas and that achievements were recorded. Additional support was highlighted and provided. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people, families, professionals and staff and noted that they contained mostly positive feedback.

There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there was one outstanding complaint which was currently being followed up by the registered manager. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.

Staff had a good understanding of their roles and responsibilities. Information was shared with staff so that they had a good understanding of what was expected from them.

Family, friends and staff felt that the service was well led. The management team and area manager encouraged an open working environment. People and staff alike were valued and worked within an organisation which ensured a positive culture was well established and inclusive. All the management had good relationships with people and delivered support hours to them.

The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.

Quality monitoring visits and audits were completed by the management team. In addition to these Quality Checkers were used. Quality Checkers are paid to check health and social care services. They perform a unique role in monitoring services.

On the day of our visit 16 people were using the service. They were supported by 47 care workers, administration staff, a deputy manager, a service manager and the registered manager. We spoke with five relatives of people who used the service, four care workers, the service manager and the area manager.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and care workers told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found;

Is the service safe?

People's relatives told us the service was safe. One said "I know my son feels safe and I have no concerns about that safety". Another said "safe? totally. Very much so. I have every confidence in United Response and I would recommend them".

Care workers had received training in safeguarding vulnerable adults and displayed a good knowledge of abuse, the types of abuse and what to do if they suspected abuse was happening. This showed us that the provider had taken appropriate steps to prevent abuse from happening in the service.

People's care plans reflected their needs and we saw that appropriate risk assessments were in place to reduce the risk of inappropriate care, treatment or support. Risk assessments were regularly reviewed.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware of the recent Supreme Court judgement in relation to the Deprivation of Liberty Safeguards and was taking appropriate action. The service had one person subject to a DoLS. We saw that this person had been appropriately assessed and their best interests considered.

Is the service effective?

Relatives we spoke with were happy with the care people received. One said "they enable my daughter where possible and I also have a big input. They supported her to find voluntary work, I can't praise them too highly". Another said "communications are excellent, we have regular contact with them".

Care plans were person centred and care was delivered to meet people's needs. We saw that people were involved in their care and offered choices. Their decisions were respected and support was given in line with people's wishes.

Care workers were appropriately trained to carry out their role. Specialist training was also given where appropriate. For example, one person had autism and the care workers who supported this person had been trained in autism awareness.

Is the service caring?

We spoke with five relatives. Everyone we spoke with was complimentary about the care received. One said "I am very happy with the service, they are very good. They look after my son well". Another said "they are excellent in every way. The care is good and the carer's are excellent. They enable my daughter to be as independent as possible".

We observed the interactions between a care worker and the person they cared for. The care worker showed genuine warmth and affection for the person and had given them a small gift. The person was clearly delighted with this and was smiling.

Is the service responsive?

People's needs were assessed. People's self sufficiency, communication and daily living skills were assessed and these assessments allowed the service to create care plans appropriate to the person's individual needs. People's likes, dislikes and preferences were recorded and we saw that people's wishes and choices were respected.

The provider responded to people's requests. For example, we saw that one person had asked for a name plate. The issue was raised at a staff meeting and a care worker was identified to action this request. We looked at the minutes of the following meeting and saw it was recorded that the name plate had been provided.

We saw that complaints were dealt with in line with the provider's policy and were resolved in a timely fashion. The complaints policy was held in a support file by people who used the service and care workers were trained to assist people if they wish to make a complaint.

Is the service well led?

There was a registered manager in post who was available for people and care staff to raise any concerns. During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the home had an effective system to regularly assess and monitor the quality of service that people received.

The provider held regular meetings with care staff, people who used the service and their relatives. Actions from these meetings were followed through to improve the service.

The agency operated from premises that were accessible and provided a room for meetings. We saw evidence that the premises were checked for the safety of those who worked there and visitors.

We spoke with the registered manager and three support staff. They were all committed to the values of the organisation and clearly enjoyed providing the service. They all spoke highly of the organisation and support workers described having access to management and on-going backing if needed.

People were provided with information about how to make a complaint in an easy read format. It explained people's rights to complain and how they would be responded to. The people we spoke with had no complaints but spoke favourably about the support they received, those that worked with them and the organisation.

People who used the service were given appropriate information and support regarding their care or treatment. The guide for people who used services gave information about staff including their qualifications and experience. It was in pictorial and written format and explained what people could expect. The guide also contained information about making a complaint.

We looked at the policy for safeguarding vulnerable people, noted it had been updated in November 2012 and was included in the quality manual 'Getting it right'. It defined what constituted abuse and gave information for staff about the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS).

We spoke with a member of staff who had worked for the service for 23 years. They told us they 'love their job' and got the support they needed.

People who used the service, their representatives and staff were asked for their views about their care and treatment.