St Anne's Community Services - York DCA

St Anne’s Community Services – York DCA provides personal care to people living in their own homes and supported living settings. The service provides support to people with a learning disability and autistic people. At the time of the inspection, 35 people were using the service.

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, 4 people were receiving personal care.

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:

Risks to people were not safely assessed, monitored, and managed. There was insufficient guidance in place to support staff to keep people, themselves and others safe. People’s medicines were not safely managed. Medicines were not always in stock and records were not always in place, or clear and up to date. Incidents and potential safeguarding concerns were not always dealt with appropriately. People were not always supported by staff who were safely recruited. People were not always well supported with their communication needs. We received positive feedback about the care and support provided from the domiciliary care agency side of the service.

The service did not have copies of relevant Mental Capacity Act (MCA) documentation and therefore we could not be assured that people were being supported in the least restrictive way possible and in their best interests. People were not supported to have maximum choice and control of their lives. Systems in the service did not support best practice in this area and we have made a recommendation about this.

Right Care:

There were not always enough staff to provide person-centred care within the supported living setting. Activities and outings were limited, and some staff told us this was due to staffing levels. Assessments of people’s needs were not always up to date and did not always reflect the person as a whole. Support plans did not promote strategies to enhance people’s independence and did not contain clear pathways to future goals and aspirations. People’s sensory needs had not been explored fully. People’s nutritional needs were not always clearly communicated to staff. People’s social needs were not met, and people were not provided with appropriate stimulation.

Right Culture:

The provider had not created a culture in which people were able to develop and flourish. Support delivered was not person-centred and did not empower people to lead their best lives and increase their independence. Quality assurance systems and processes were ineffective. Systems were not in place to support continual improvement of the service. Relatives told us they felt comfortable in raising concerns, and staff and relatives spoke positively about the registered manager. The provider responded to feedback and an action plan was in place.

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 2 July 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding and record keeping. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe and well-led only. Due to concerns identified on inspection, the scope of the inspection was expanded to include the key questions of effective and responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for St Anne’s Community Services – York DCA on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, person-centred care, staffing and good governance.

Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about ensuring compliance with the Mental Capacity Act (MCA).

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.

Follow up

We will request an 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.

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.

Not everyone using St Anne’s Community Services York – DCA receives regulated activity. CQC only inspects the service being received by people provided with ‘personal care’ in their own home; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. The service was providing personal care to three people in their own homes.

At our last inspection we rated the service good. At this inspection we found the service had remained good.

People were overwhelmingly positive about the support they received and the relationships they had developed with support staff and the management team. They consistently described a service which was person centred. People, relatives and supporting professionals were encouraged to give feedback about the service and spoke highly about the care provided.

There was a focus on people’s strengths and a positive joint approach to risk management. People were encouraged to focus on what they wanted to achieve from their support. They were placed at the centre by their support staff, management team and the wider organisation.

People were supported to engage in activities which were of importance to them and to form links with their local communities in order to promote their emotional well-being. Two people were being supported on holiday which was important to them.

Staff were provided with a high level of support to enable them to do their jobs to a high standard. They described feeling well supported by the management team.

People trusted their support staff and were provided with safe care and support. There were sufficient staff to meet people’s needs. Staff were safely recruited. Staff understood how to recognise abuse and to report this.

When people’s needs changed the service was able to respond flexibly. For people with deteriorating health conditions the planning of future care, and in some cases, their end of life care was considered with warmth, compassion and kindness.

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

Quality assurance systems were well developed and embedded in practice.

There was a commitment to ongoing service improvement and a culture of continuous development across all levels of the organisation. Staff were highly motivated and committed to providing an excellent standard of care and support.

The service supports a small number of people with medication. Staff had received training on this and people were generally supported to take the medication they needed safely. However, we found that recording on the medication administration records could be improved. This would make it easier to see if people had received the correct medication and reduce the risk of confusion when changes to people's medication are made.

We found that staff received appropriate training and support, to help them do their jobs well. Comments made by staff included 'If I had an issue, the managers would see me whenever needed' and 'I have received a great deal of training from St Anne's.'

There were systems in place to seek the views of people who used the service and involve them in the development of St Anne's. There were also arrangements in place to monitor quality, through checks and reports completed by the manager and monitoring visits by the area manager.

We found that people were involved in making decisions about their care wherever possible. Where people did not have capacity or needed support to make decisions appropriate arrangements had been put in place. Suitable arrangements for planning and reviewing the care people needed were also in place.

Staff were recruited safely, with the relevant checks being completed before they started work. People who used the service were also involved in the recruitment of their staff.

People knew how to make a complaint about the service if they needed too. Staff knew how to report any concerns they had and felt confident that their manager would listen and respond appropriately.