Kent and Medway Domiciliary Care Agency

Updated 2 September 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 4 inspectors.

Service and service type

This service provides care and support to people living in 5 ‘supported living’ settings, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post.

Notice of inspection

We gave the service 48 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or manager would be in the office to support the inspection.

Inspection activity started on 2 August 2023 and ended on 15 August 2023. We visited the location’s office on 2 August 2023. We visited 2 supported living settings on 4 August 2023 and another 2 supported living settings on 7 August 2023. We reviewed records and information between 7 August and 15 August 2023 and carried out calls with staff between 10 August 2023 and 15 August 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection, which included the provider’s action plan. We sought feedback from the local authorities and other professionals who work with the service. We also sought feedback from Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

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

During the inspection

We spoke with 9 people who used the service about their experience of the care provided and 4 relatives. We are improving how we hear people’s experience and views on services, when they have limited verbal communication. We have trained some CQC team members to use a symbol-based communication tool. We checked that this was a suitable communication method and that people were happy to use it with us. We did this by reading their care and communication plans and speaking to staff or relatives and the person themselves. In this report, we used this communication tool with 1 person to tell us their experience.

We spoke with 15 members of staff including the acting manager, training manager, field care supervisor, care coordinator, senior support worker, support workers, a regional manager and service optimisation managers.

We observed staff interactions with people and observed care and support in communal areas. We reviewed a range of records. This included 8 people's care records and medicines records. We looked at 4 staff files in relation to recruitment, staff supervision and training. A variety of records relating to the management of the service, including checks and audits were reviewed.

Updated 2 September 2023

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.

About the service

Kent and Medway Domiciliary Care Agency is a supported living service registered to provide personal care. The service provides support to people with a learning disability and/or autism living in supported living settings, so that they can live in their own home as independently as possible. At the time of the inspection they were providing support to 12 people who were in receipt of the regulated activity personal care. 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.

People lived in their own flats and had access to their own facilities such as bathrooms and kitchens. There were a number of different locations across Kent where the service was providing support to people.

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

Right Support

The service followed good infection control practice. Staff supported people to have the maximum possible choice, control and independence. People had control over their own lives. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life.

People received support in a safe, clean, well equipped, well-furnished and well-maintained environment that met their sensory and physical needs. People had a choice about their living environment and were able to personalise their flats.

Staff enabled people to access specialist health and social care support in the community. Staff communicated with people in ways that met their needs.

Right Care

Staff understood how to protect people from poor care and abuse. However, there had been an incident of verbal abuse between 2 people living at one of the supported living premises (which was a safeguarding concern), this had not been appropriately reported. Staff had appropriately recorded the incident. The management team had not taken the relevant action to report to the local authority and CQC.

Medicines were mostly managed safely. The provider had not followed NHS choices guidance about paracetamol for people weighing less than 50kg. After we raised this, actions were taken and the provider shared this as a lesson learned with their other registered services across the country. New staff were adequately checked to ensure they were suitable to work with people to keep them safe.

Staff and people cooperated to assess risks people might face. Risks relating to fire safety and flammable creams known as emollients were not always thoroughly assessed, the management team acted on this and shared the learning with the provider. Where appropriate, staff encouraged and enabled people to take positive risks. People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. A relative told us, “[Loved one] has said she is happy with them. She is happy living where she is. The actual hands-on staff are wonderful.”

The service had enough appropriately skilled staff to meet people’s needs and keep them safe. A person told us, “I feel safe and this is home.” People could communicate with staff and understand information given to them because staff supported them consistently and understood their individual communication needs. People’s care, treatment and support plans reflected their range of needs and this promoted their wellbeing and enjoyment of life.

Right Culture

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability and autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff knew and understood people well.

Staff were responsive, supporting people’s aspirations to live a quality life of their choosing. Staff placed people’s wishes, needs and rights at the heart of everything they did. People and those important to them, were involved in planning their care. People’s quality of life was enhanced by the service’s culture of improvement.

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 inadequate (published 16 March 2023).

At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, there were still some improvements to make which the provider was working on.

This service has been in Special Measures since 15 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

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

Follow up

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