Archived: East Kent Mencap Domiciliary Service

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.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways [promotion of choice and control, independence, inclusion] e.g. 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

People’s experience of using this service: The service met the characteristics of Good in all areas.

People, staff and health care professionals told us or indicated that the quality of care and support was good and that the service was well managed. People said, “I like all the staff and they help me when I need it” and “The staff are good”. A health professional told us that people’s goals, aspirations and choices were discussed and agreed with people at their reviews.

• People told us they felt safe with staff from East Kent Mencap supporting them in their homes.

• People were kept safe from abuse, harm and discrimination and were supported by a regular staff team who knew them well.

• Risks to people were assessed, monitored and reviewed and staff followed the guidance provided to help people stay safe.

• People’s physical, mental, emotional and social needs were assessed and monitored to help promote a good quality of life.

• People were encouraged and empowered to remain as independent as possible and to make day to day decisions about their care and support.

• People told us they liked the staff and that they were kind and caring.

• People had built strong, trusting relationships with the staff and said they would talk to them if they were worried about anything.

• People’s care and support was tailored to their individual needs and preferences. When people’s needs changed the care records were updated to reflect this.

• Information was provided in different formats to make sure it was accessible to everyone.

• People told us they didn’t have any complaints but that they would speak to the staff or management if they did.

• The management of the service was consistent and regular checks continued to be completed to make sure the quality of service was good.

• The management team and staff continued to explore different ways of improving the service and regularly asked people for their feedback and ideas. They worked collaboratively.

Rating at last inspection: Good when we inspected on 18 October 2016 (Published 15 November 2016)

Why we inspected: This was a planned inspection based on the rating at the last inspection. The service maintained Good in all areas and Good overall.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

East Kent Mencap Domiciliary Service is registered to provide personal care to people living in their own homes. Each person had a tenancy agreement and rented their accommodation. The service supports adults who have learning disabilities, physical disabilities and mental health needs throughout East Kent. At the time of the inspection six people were receiving a personal care service, they were all living together and sharing their support.

The service had a registered manager in post. A registered manager is a person who is 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.

People received their medicines when they needed them and were encouraged to be as independent as possible when taking their medicines. Staff had sometimes hand written people’s medicine administration records (MARs). These were not signed by two staff members to confirm that they had been checked and were accurate. This was an area for improvement.

The registered manager carried out audits to identify any shortfalls in the service and ensure consistent, high quality, personalised care was being provided. However, these audits were not carried out in line with the timescales contained within the provider’s policies and procedures. This was an area for improvement.

To enable the provider to continuously improve the service, people, their relatives and staff were regularly surveyed to gain their thoughts on the service. The results of the surveys were collated and displayed on the provider’s website. Any areas of improvement were identified and actioned. Other stakeholders, such as health care professionals had provided informal feedback about the service but there was no system in place to process and act on this information. This was an area for improvement.

The registered manager had identified that people’s emergency evacuation plans needed to be reviewed and these were being updated. There was a contingency plan in place in the event of an emergency to ensure people still received the support they needed. Staff told us they could always contact a manager out of hours for advice or guidance if necessary.

Any accidents and incidents were looked into to so they did not happen again. Risks relating to people’s health, their behaviour and other aspects of their lives had been assessed and minimised where possible.

Staff had sought advice and guidance from a variety of healthcare professionals to ensure people received the best care possible. The registered manager was seeking advice from people’s doctors to ensure unstable health conditions such as epilepsy were managed fully.

People told us there was always staff available when they needed them and there was enough staff to meet people’s needs. Staff had been checked before they started to work with people. Staff had received induction, training, and supervision to support people effectively. There was an ongoing training programme to ensure that staff had the skills and knowledge to meet people’s needs. Staff knew how to recognise and respond to abuse. The registered manager had reported any safeguarding concerns to the local authority and these had been investigated fully.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). In supported living applications for DoLS are made to the Court of Protection. DoLS are a set of checks that are designed to ensure that a person who is deprived of their liberty is protected, and that this course of action is both appropriate and in the person’s best interests. The registered manager had made some applications to the Court of Protection but these had not yet been authorised. Staff had up to date knowledge on the Mental Capacity Act 2005 (MCA) and DoLS. They supported people to make their own choices where possible.

People were supported to eat healthily. They were involved in planning and preparing meals. Staff told us they supported people to go to supermarkets of their choosing to buy the food they wanted.

The provider’s values included ‘being people-centred’ and ‘empowering, including and respecting all people.’ There was a culture of openness and honesty and people were supported to be as independent as possible. They helped to clean and maintain their homes. People and their relatives said that staff were kind and caring. Staff always asked people if they wanted support and knocked on the doors of their flat and rooms before entering.

Staff were responsive to people’s needs. People were able to meet staff and other people using the service before moving in. People were involved in writing their care plans and in regular reviews and meetings with staff to check they were happy with the care they received. People attended the day service attached to the office, if they wished, and participated in a range of activities there.

There was a complaints policy in place and people told us they knew how to complain if they needed to. Complaints were documented, investigated and responded to.

Both people and staff told us they thought the service was well led. The registered manager was experienced in working with people with learning disabilities and providing person centred care. The Care Quality Commission (CQC) had been informed of any important events that occurred at the service, in line with current legislation.

The provider had been nominated at the Kent Learning Disability Partnership Awards in the ‘supporting people with learning disabilities’ category.

The majority of the people supported by the service did not recieve support with their personal care, however the service did provide this regulated activity for a small number of people.

People spoken with confirmed that they had given consent to their care and felt in control of the care received. Overall people spoken with had no concerns with regard to the quality of care and were complimentary about the staff and the support offered. People told us they felt safe receiving a service from the agency.

Staff received appropriate professional development. People who used the service told us they were supported by a consistent staff team, that they were competent and knew how to care for them safely.

There were regular audits of medication, health and safety and accidents and incidents. Regular surveys were also carried out to gain the views of people who received the service. Daily care needs were recorded and collated and checked by the manager with changes made to care plans and risk assessments. This meant that the service regularly monitored the quality of care provided.

Detailed guidance for staff was not clear within care planning documentation so that they supported people consistently with actions that achieved the desired goal. Examples were seen where support was identified but no guidance on how. Whilst following discussions with people who use the service and evidence within the care planning process people's wishes and consent was taken into account for all decisions that effected their rights, mental health assessments under the Mental Capacity Act 2005 were not in place or made reference to.