Disablement Association of Barking and Dagenham Also known as DABD (uk)

About the service

Disablement Association of Barking and Dagenham is registered as a domiciliary care agency based in the London Borough of Barking & Dagenham.

The service provides personal care to adults in their own homes and also in a supported living setting. People who were supported in a supported living setting had their own flats and a communal lounge. At the time of the inspection the service provided support to older people, 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, the service was supporting 8 people with personal care.

People’s experience of the service and what we found:

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support:

The provider did not always assess the risks people were exposed to. This meant there were no plans to manage these risks and to help keep people safe. Staff received safeguarding training but were not always knowledgeable about the action to take if they witnessed or came across allegations or suspicions of abuse or neglect. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff were safely recruited and received training and an induction. Staff told us they were supported by the provider and received supervision to discuss their performance.

Right Care:

People did not always receive kind and compassionate care. Some relatives of people using the service raised concerns about people not being safe. The concerns included staff shouting at people and handling people rough when supporting them with personal care. There were concerns of people being woken up early in the morning to be showered, which was not always according to their preferences. The provider did not always ensure sufficient numbers of suitable staff were deployed to care for and support people using the service. People did not always receive personalised care which met their needs. Staff received training in a range of areas to help equip them with the skills and knowledge required to meet the needs of the people using the service. However, some staff did not always implement best practice from their learning.

Right culture:

People were not empowered to make decisions and achieve their aspirations. They did not always receive good quality care and support because some staff did not understand, or did not want to deliver a personalised service which reflected best practice for people with learning disabilities and autistic people. Staff told us they had good relationships with people, however, the support they provided focused on basic tasks and not on promoting individuality and independence. There was a risk of a closed culture because staff did not always act in an open and transparent way and did not always accept the view of others, including people who used the service, which challenged the way they wanted to work.

For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk

Why we inspected

The inspection was prompted in part due to concerns received about unsafe care , care plans, staffing and safeguarding concerns. , A decision was made for us to inspect and examine those risks.

Enforcement and recommendations

We have identified breaches in relation to person-centred care, consent to care, safeguarding people from the risk of abuse, safe care and treatment, good governance, dignity and respect and staffing at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

We have made a recommendation for the provider to carry out medicines competency assessments for the staff who support people with their medicines.

Follow Up

We will work alongside the provider and local authority to monitor progress with making improvements at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements. If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Disablement Association of Barking and Dagenham is a domiciliary care agency that also includes a supported living setting. The supported living service accommodates up to 16 people, not all of whom require support with personal care. The provider was supporting eight people there at the time of inspection and a further three people living in the community.

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

Systems were in place to help protect people from the risk of abuse. Risk assessments were in place which included information about how to mitigate risks people faced. Infection control and prevention measures had been put in place. There were enough staff working at the service to support people in a safe way, and

pre employment checks were carried out on staff to check their suitability. Accidents and incidents were reviewed to reduce the risk of similar incidents re-occurring.

Quality assurance and monitoring systems were in place to help drive improvements at the service. Some of these included seeking the views of people who used the service. The service had links with other agencies to help develop best practice. There was a clear management structure in place and staff spoke

positively about the support they received.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 January 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an announced comprehensive inspection of this service on 22 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Disablement Association of Barking and Dagenham on our website at www.cqc.org.uk.

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.

Disablement Association of Barking and Dagenham is a domiciliary care agency based in the London Borough of Barking & Dagenham. The service provides personal care to adults in their own homes and also in a supported living setting. People who were supported in a supported living setting had their own flats and a communal lounge.

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, the service was supporting ten people with personal care.

People’s experience of using this service

Risk assessments had not been completed in relation to people’s health conditions and current circumstances to ensure the safe delivery of care at all times. Medicines were not being managed safely to ensure people received their prescribed medicines. Lessons were not being learnt when people sustained minor injuries to ensure the risk of re-occurrence was minimised. We made a recommendation in this area.

Robust quality assurance systems were not in place to ensure shortfalls were identified and prompt action was taken to ensure people received high quality care at all times.

Staff had received training to carry out their role effectively. People were supported to have maximum choice and control of their lives and staff were aware on how to support people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People told us they were safe when supported by staff. Systems were in place to ensure staff were available to support people in a timely manner. Systems were in place to control infections.

People received care from staff who were kind and compassionate. Staff treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported. They understood people’s needs, preferences and what was important to them.

Care plans were person centred and included people’s support needs. Systems were in place to obtain feedback from people and relatives.

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 9 March 2017).

Why we inspected

This was a planned inspection based on the rating of the last inspection.

Enforcement

We have identified breaches in relation to risk assessments, medicine management and good governance. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection the service was meeting all of the legal requirements.

Disablement Association of Barking and Dagenham provided a number of services to support to adults and children in the community which included transport services, support with independent living and personal care.

At the time of the inspection 35 people at the service were receiving personal care.

The service required a registered manager. 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. The service was in the process of recruiting a registered manager. The service was supported by a personal support service lead (PSSL) who managed the day to day running of the service.

People at the service were supported by staff who kept them safe as they had been trained in safeguarding adults and children and knew how to report abuse to their manager. Staff also explained they would whistleblow to external agencies if they thought someone they supported was at risk of abuse.

People told us they received their medicines on time and that staff supported them fully where it was a requirement of the care package. Staff were trained in the safe management of medicines and explained how they administered or prompted people with their medicines.

Staff stated they always risk assessed people’s homes when they arrived. Risk assessments surrounding people’s environment and any equipment used were produced to protect people from any harm.

Safe recruitment was carried out. Records showed that staff’s previous employment history was checked and suitability to work was confirmed with a criminal records check.

In the event of an emergency staff explained how they would respond to keep people safe, by seeking further advice or calling the emergency services. The service had an out of hours telephone line for staff and people to use.

Staff received regular training, supervision and an annual appraisal. Staff felt well supported when they first joined the service and that they could approach their colleagues for advice. People were listened to at the service and encouraged to make choices. Staff emphasised they were there to encourage people’s own decision making, seek their consent and give care according to people’s wishes.

People were supported to eat healthily and people saw appropriate health professionals to maintain their health and wellbeing.

People received support from staff who were kind and compassionate. Staff took the time to find out people’s interests so they could actively engage in conversation and get to know people.

People’s care plans were personalised and reviewed regularly. Care plans detailed how to support people with their daily choices and routines and support their goals. People took part in a number of activities of their choice and some of which were provided by the service to avoid isolation.

People and their relatives spoke positively about management at the service and felt they could contact them easily. Staff were happy with management and felt well supported to raise concerns they had about people or their work within the service.

The service had number of quality monitoring systems at the service which included spot checks to monitor staff and sending questionnaires to staff.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. All the records we reviewed contained needs assessments that defined what was in people's care plans.

Appropriate arrangements were in place in relation to the recording of medicine. There was a medication profile record for each person who was taking medication.

There were enough qualified, skilled and experienced staff to meet people's needs. The staff we spoke with told us that they never felt pressure to work quicker and had enough time to do their jobs well. People described the service as 'Really good' said they were 'very satisfied' with the service.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. We saw that customers were given a 'your feedback' form that gave them the opportunity to give feeback about the service.

We saw that the management were aware of the care needs of people and of their preferences and daily routines. 'Staff attend to my needs and they treat me very well', an individual receiving care had told us.

People receiving care indicated that they were well treated and felt safe with the care staff. They commented positively on staff timekeeping, stating, 'I am always told beforehand if there was any problem'. They commended care staff's competency, commenting that 'they talk to me in such a way that l feel at ease'.

We observed people who use the service were asked for their views about their care which were acted on.