Background to this inspection
Updated
17 July 2021
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 Care Act 2014.
Inspection team
The inspection was carried out by three inspectors, one visited the offices and people in their own homes and two inspectors carried out telephone calls to staff. Two Expert by Experiences contacted relatives of people using the service. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service provides care and support to people living in 52 ‘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.
The service had a manager who had yet to complete the process of registering with the Care Quality Commission. Once registered this means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
We gave the service 24 hours’ notice of the inspection. This was because we needed to be sure that the provider or manager would be in the office to support the inspection.
Inspection activity started on 8 June 2021 and ended on 18 June 2021. We visited the office location and visited five of the 'supported living schemes' on 10 and 16 June 2021.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We used all of this information to plan our inspection.
During the inspection
We spoke with six people who told us of their experiences of the service and we visited people who had more limited verbal communication in their own homes. We spoke to 14 relatives about their experience of the care provided. We spoke face to face with seven members of support staff, three team leads, two senior co-ordinators and the manager. We spoke on the phone to 15 staff and the nominated individual. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
We reviewed a range of records. This included five people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at quality assurance records and outcomes of safeguarding investigations.
Updated
17 July 2021
About the service
Lancashire Domiciliary Care Service, provides care and support to people with learning disabilities and autism in 52 supported living tenancies. There were also a small number of people in their own homes receiving support that were not part of a supported living model. At the time of the inspection there were 161 people receiving support, mostly in the Chorley, Leyland, Preston and surrounding areas, and within four shared tenancies houses and one apartment block on site at Lisieux Hall.
People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living.
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’s experience of using this service and what we found
People were supported by staff who knew how to keep them safe and report concerns of abuse. Risk assessments had been completed to highlight risks to people’s safety and how these risks can be addressed. Staff knew people and the risks to their safety. People were provided with their medicines in a safe way. There were effective systems in place to reduce the risks associated with COVID-19.
People and their relatives were positive about the care and supported provided. Some people while satisfied with the overall support were less happy with the impact of the high turnover of support staff and managers. This had led to issues with communications and some staff reporting a lack of support and guidance.
The provider had recruited a new manager In November 2020 who in a short space of time had either addressed these issues, or had plans in place to tackle them. A new management structure had been developed and a number of posts created to strengthen and improve oversight to ensure the quality of support given to people and to the staff teams.
We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture (RSRCRC) is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.
Based on our review of safe and well-led this service was able to demonstrate how they were currently meeting the underpinning principles of Right support, right care, right culture. People were involved in the planning of their care and accessed support that met their individual interests and hobbies. People’s independence was encouraged and we saw people preparing their own meals and going out independently where able. The managers at the service and staff all described their priority as being to deliver person centred care, that met people’s individual needs.
Whilst Lancashire Domiciliary Care Service only provided personal care to people living in supported living accommodation, the provider was actively looking to expand the supported living accommodation model within the grounds of Lisieux Hall. We had concerns the provider was actively promoting a model of accommodation that could replicate a campus style model. RSRCRC guidance refers to this as an outdated model that could limit people’s opportunities to ordinary community living. We will discuss this with the provider outside of this inspection.
Rating at last inspection
The last rating for this service was good (published 12 July 2019).
Why we inspected
We received concerns in relation to keeping people safe, staff turn-over and how the service was being managed. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Lancashire Domiciliary Care Service 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.