Voyage (DCA) Warwickshire

Voyage (DCA) Warwickshire is a domiciliary care agency which is registered to provide personal care and support to people in their own tenancies. The service has three shared home 24-hour supported living services. The service is registered to provide support to younger adults and older people with a learning disability, autistic spectrum disorder, sensory impairment or mental health support need.

At the time of the inspection the service was supporting 17 people who were receiving 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.

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

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.

Right Support

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. People's freedom was not unnecessarily restricted, and people were not physically restrained.

People's support was provided in supported living shared homes. Checks were undertaken by the management team to ensure homes were safe, clean, equipped and maintained. Any maintenance issues were passed to the landlord to address and followed up when needed.

Staff worked with people, their relatives and health and social care professionals to maintain people's overall health and wellbeing. Staff supported people to take their medicines safely and as prescribed.

Right Care

People were supported by staff who knew them well and were kind toward them. People's safety and care needs were identified, their care was planned, and their needs were met. Staff understood how to protect people from abuse and were confident the service manager would take action to protect people, should this be required. Robust recruitment checks made sure staff were of suitable character to support people.

Right Culture

Improvement had been made to create a positive and person-centred culture at the service. Meetings had been introduced for people to share feedback on what was and was not going well so actions could be taken to address any concerns. Staff were involved in sharing feedback about the service and felt the management team had improved significantly since the last inspection. Staff felt valued in their roles.

The positive culture meant people received care that was tailored to their needs. The service manager and operations manager undertook safety and quality checks on people's care and used their findings to improve the quality of the service and to take learning

from incidents.

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 2 November 2022) and there were breaches of regulation. 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

This inspection was carried out to follow up on action we told the provider to take following the last inspection.

The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

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

Voyage (DCA) Warwickshire is a domiciliary care agency which is registered to provide personal care and support to people in their own tenancies. The service provides up to twenty-four hour supported living services. The service is registered to provide support to younger adults and older people with a learning disability or autistic spectrum disorder, mental health support needs, physical disability or sensory impairment. At the time of our inspection the service was supporting 41 people who were receiving 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.

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

Whilst most people and their relatives were satisfied with the care and support they received, we found risks were not always well-managed and staff did not always identify or act on risks of potential harm or injury. Risk assessments had not always been completed accurately. Staff did not always follow healthcare professional guidance or embed this into care planning. We could not always be assured actions to mitigate harm or injury to people had been taken by staff because important records lacked detail.

Some practices related to the handling of medicines were not safe. Medication incidents had occurred where people had not always received their prescribed medicines. We could not be assured people always received their medicines as prescribed due to discrepancies in stock. Immediate action was taken by the operations manager to ensure medicine practices were in line with best practice guidance and the medication policy and staff re-training was planned for.

Quality checks, such as staff skill and competency assessments and audits, were in place, but these had not always been effective. Following our inspection feedback, the managing director (central region) shared a service improvement plan with us and assured us immediate actions would be taken to make the needed improvements.

Pre-employment checks were undertaken on staff to ensure they were suitable. Staff had received training but did not always have the skills or knowledge they needed for their job role.

People had individual plans of care and some gave staff detailed information. Others required improvements to be made.

People were supported by staff to keep their shared supported living homes clean and tidy. Improvement was needed by some staff to follow best practice when wearing face masks to reduce the risks of cross infection.

Overall, people were supported by consistent staff who knew people well. Staff had a caring approach toward people, showing kindness in the hands-on day to day care. People and their relatives felt safe with staff in their homes and protected from the risks of abuse.

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.

Right Support: Model of Care and setting that maximises people’s choice, control and independence

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support least restrictive practices.

Right Care: Care was not always person-centred and did not always promote people’s dignity, privacy and human rights

Right Culture: The ethos, values, attitudes and behaviours of leaders and care staff did not always ensure people using the service led confident, inclusive and empowered lives.

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 and the report was published on 19 February 2018.

Why we inspected

This inspection was prompted in part by concerns received about medicines management and other reported incidents to us. We decided to inspect and examine those risks.

Enforcement

We identified breaches in relation to safe care and treatment, safeguarding people from abuse and improper treatment and the governance of the service.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Follow up

The provider has taken some immediate actions to make improvements following our inspection feedback and shared a service improvement plan with us.

We will request a further 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.

Not everyone using Voyage (DCA) Warwickshire receives a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. Thirty-eight people were receiving support with the regulated activity of Personal care at the time of our inspection visit.

At the last inspection in December 2015, the service was rated Good overall and in safe, effective caring and responsive. Well-led was rated as Requires Improvement. At this inspection we found the service remained Good in safe, effective, caring and responsive, and had improved from Requires Improvement to Good in well-led. The overall rating remains Good.

There was a registered manager in post. 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.

Since our previous inspection in December 2015, we have reviewed and refined our assessment framework, which was published in October 2017. Under the new framework certain key areas have moved, such as support for people when behaviour challenges, which has moved from Effective to Safe. Therefore, for this inspection, we have inspected all key questions under the new framework, and also reviewed the previous key questions to make sure all areas were inspected to validate the ratings.

The provider had taken action to improve the management and governance of the service since our previous inspection. Their improvement plan included the dates the improvements would be completed by and named the member of management responsible for ensuring the agreed actions were taken.

The provider had implemented a revised management structure that ensured senior staff were supported to carry out regular quality assurance checks at a specified number of properties. Any issues identified during the audits were collated into a service-wide action plan to enable the whole staff team to learn from each other’s practice.

The provider has supported the registered manager with a recruitment campaign, which had reduced the level of staff vacancies and the need to use agency staff, and thereby minimised the risks of medicines errors. Medicines management and administration was subject to daily, weekly and monthly checks, to ensure any errors, omissions were identified and acted on promptly.

Field support supervisors had been appointed, with defined responsibilities for quality assurance work and supervision of support workers. The provider had implemented an electronic call monitoring system that ensured they knew immediately whether staff had arrived at people’s homes as planned.

People were protected from the risks of abuse because support workers were trained in recognising and reporting any safeguarding concerns. The provider checked support workers were suitable for their role before they started working for the service and made sure there were enough support workers to support people as agreed.

Risks to people’s individual health and wellbeing were identified with the person and their representative and care was planned to minimise the identified risks. People had health action plans and were supported to obtain healthcare services when required.

People were cared for and supported by support workers who had the skills and training to meet their needs effectively. People were supported to eat and drink enough to maintain a balanced diet that met their preferences.

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

People and support workers felt well cared for. The registered manager and support workers understood people’s diverse needs and interests and encouraged them to maintain their independence according to their wishes and abilities.

Support workers were happy working for the service. People were supported and encouraged to maintain their interests and links with the local community, in accordance with their agreed support plans. Support workers respected people’s right to privacy and supported people to maintain their dignity.

People and relatives were confident any complaints and concerns they raised would be dealt with. People and their relatives were encouraged to share their opinions about the quality of the service at annual service reviews and six monthly care reviews.

Further information is in the detailed findings below.

We spoke with a range of care and support staff, the interim manager, the interim operations manager and the provider's managing director for the central region. We also spoke by telephone with three people who used the service and a relative of a person who used the service.

The evidence we collected helped us to answer five key questions, these being: Is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary is based on our observations, our discussions with people, staff and relatives and the records we looked at. If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

The managing director we spoke with told us a registered manager from another service had been brought over to the Warwickshire domiciliary care service to implement and embed the provider's systems and processes. We were told this was because a recent internal quality audit had identified that this had not been done satisfactorily or effectively since the provider took over the service in November 2013.

The interim manager had introduced the provider's processes and systems for monitoring and checking the quality of the service provided for people. The provider's own quality assurance team had recently carried out a full audit (check) of the service and had provided an action plan which the interim manager was working through. We were provided with a copy of the audit, action plan and recent update which demonstrated that action was being taken and improvements were being made.

Staff were working to care and support plans that had not been reviewed for some considerable time. We found the interim manager had begun the process of implementing new support plans for people who received a supported living service but not the domiciliary care service due to the very short time the interim manager had been at the service. This meant people were at risk of receiving inappropriate or poor care as the care records available were not always current.

Is the service effective?

Staff we spoke with told us they could see changes taking effect since the interim manager had arrived. A staff member told us, "It seems a lot more professional now."

Is the service caring?

People we spoke with who used the service told us they were satisfied with the levels of care and support they received. Comments made to us included, "The service is good" and "it's very good, I get looked after alright."

Is the service responsive?

The interim manager had identified an action plan following the providers internal quality assessment and had commenced working through this in a planned an systematic way. Supported living staff were able to see positive changes in the way the service was being provided. The interim manager and operations manager were working with staff to ensure they took on board the providers processes and systems.

Is the system well led?

Staff received regular one to one supervision and unannounced visits (spot checks) on their work. These had recently been introduced had been introduced. Team meetings had also been reintroduced and staff told us they felt well supported by the senior staff, interim manager and senior management team.