We carried out a review of the data available to us about Domiciliary Care Agency North West on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Domiciliary Care Agency North West, you can give feedback on this service.
Domiciliary Care Agency Northwest is registered to provide personal care and support to people who live in their own homes. The agency office is based in Ellesmere Port and provides support to people with complex health needs or people who have a diagnosis of autism or a learning disability in the Manchester area. At the time of our inspection the service supported five people.
This service provides care and support to people living in four 'supported living' settings, so that they can live in their own home 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 has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The service has a registered manager. 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.
At the last inspection in November 2016 we found that there were a number of improvements needed in relation to the Mental Capacity Act and evidence of capacity assessments and how best interest decisions were recorded. Care plans were not always person centred and audit systems had not identified the areas of improvement that were required. These were breaches of Regulation 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Effective, Responsive and Well-led to at least Good. The provider sent us an action plan that specified how they would meet the requirements of the identified breaches.
This inspection was done to check that improvements had been made to meet the legal requirements planned by the registered provider after our comprehensive inspection in November 2016. One adult social care inspector visited the service and inspected it against all of the five questions we ask about services: Is the service Safe, Effective, Caring, Responsive and Well-led? We found that the registered provider was meeting all the legal requirements.
The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we found. We saw that the registered provider had policies and guidance available to staff in relation to the MCA. Staff demonstrated a basic understanding of this and had all completed training. Care records reviewed included mental capacity assessments and best interest decision records.
People supported had a person-centred care plan with risk assessments in place that reflected their individual needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. Clear guidance was in place for staff to ensure that people's needs were appropriately met.
Audit systems were in place that were consistently completed. Areas for development and improvement were identified where required and action plans were prepared and completed. Accidents and incidents were analysed to identify any trends or patterns within the service.
The registered provider had robust recruitment systems in place that were consistently followed. All staff had undertaken an induction before they started work. Mandatory training was regularly undertaken with refresher updates in accordance with best practice guidelines. The management team supported staff through supervision and team meetings.
Staff understood what abuse may look like and were confident they could raise any safeguarding concerns and they would be promptly acted upon. Safeguarding policies and procedures were in place and staff were familiar with these.
Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. Staff had all undertaken medicines training and their competency was regularly assessed. The registered provider had medicines policies and procedures in place.
People spoke positively about the activities that they undertook. They told us they were always offered choice in all areas of their life. People's privacy and dignity was respected.
People told us they had enough to eat and drink and that they enjoyed the food. They described choosing their meals and also how their independence was promoted by preparing their own breakfasts and lunch. Clear guidance was in place for staff to follow for people that had specific dietary needs.
People had developed positive relationships with the staff that supported them. Staff knew people well and treated them with kindness. People appeared to genuinely enjoy spending time with the staff team.
The registered provider had a complaints policy and procedure in place and available in accessible formats. People knew how to raise a concern and felt confident they would be listened to.
People lived in “supported living”. These are schemes where people are provided with regulated personal care as part of the personalised support that they need to live in their own home as independently as possible. Personal care is provided under separate contractual arrangements to those for their housing. The accommodation can be in shared houses and flats, but can also be in single household premises. Single household premises can be located together in shared schemes such as blocks of flats, but also singly anywhere in the community.
The service had two registered managers: one of whom has recently left the organisation. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The registered manager responsible for overseeing the services in Cheshire had left the organisation and an interim manager had been appointed by the registered provider. There was a registered manager in post responsible for overseeing the Manchester services.
We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.
Staff practice showed that consent was sought from people prior to care being provided. Staff promoted choice and helped people to make decisions as much as possible. However, people's care plans did not always contain information guided by the principles of the Mental Capacity Act 2005 (MCA). Records did not always evidence how people’s capacity had been assessed and how decisions had been made in people’s best interests.
The registered provider had recognised where some improvements were required to be made at the service. However, this was not always robust and we found that not all areas of concern we had raised during our inspection had been identified or addressed in a timely manner through the registered provider’s quality assurance systems. The CQC were not always notified as required about incidents and events which had occurred at the service.
Records showed that people’s needs were assessed and basic information was available for staff. However, we found that some care plans were task orientated and lacked person centred information. Communication care plans for people who did not use the spoken word contained limited information to guide and support staff with meeting their individual needs. This meant that staff less familiar with a person may not have the information required to provide the correct level of support.
New staff underwent an induction programme, which included training relevant to their role and shadowing experienced staff, until they were competent to work on their own. Training records identified that staff had not always received supervision and training in line with the registered providers own timescales. This meant that people were at risk of receiving care from staff that did not have the relevant skills and knowledge necessary for their role.
People received support with their medication. Care staff had completed competency training in the administration and management of medication. Medication administration records (MAR) were appropriately signed and coded when medication was given. However, we noted that care plans for PRN (as required) medication were not always in place for staff guidance.
Concerns were raised by family members regarding consistency of staffing and the impact that this could have on a person. The registered provider was in the process of filling vacant posts. Robust recruitment practices were followed and there were sufficient numbers of suitable staff available at all times to meet people's needs during our visit. Rotas were managed closely by the managers at the service to ensure that people were kept safe at all times.
People and their family members were encouraged to share their concerns and complaints. The registered provider investigated any complaints or concerns thoroughly in line with their own policy and procedures. However, records did not demonstrate what actions had been taken when a complaint had been investigated, resolved and closed.
Individual risk assessments were completed to ensure both people supported, relevant others and staff were protected from the risk of harm. Assessments relating to activities undertaken within people’s living environments and outdoor spaces had been completed.
Staff had a good awareness of the support and help that people required. Staff understood their specific needs relating to their age and complex needs. Where there was continuity, staff had built up relationships with people and were familiar with their personal histories and preferences.
People's health needs were met and staff were observant in spotting concerns and took appropriate action. Advice and guidance was sought from other professionals where appropriate to ensure that people remained well.
The registered provider had safeguarding policies and procedures in place. All staff received training to raise awareness of how to recognise signs of potential abuse and poor practice and what actions they would need to take. Staff were confident in their knowledge and understanding of abuse and were familiar with the registered providers whistle-blowing policy and procedures.