Mencap North East Domiciliary Care Agency

Mencap North East (Durham, Gateshead, Darlington, Northumberland South and South Tyneside) is regulated to provide personal care and support to adults with learning disabilities and autistic people living in their own homes. Some people lived in their own individual home and some in ‘supported living’ settings, so that they could live in their own home as independently as possible. At the time of the inspection there were 144 people using the service, of which 70 people required assistance with 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’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

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff communicated with people in ways that met their needs. Staff focused on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. Staff supported people to achieve their aspirations and goals. They had supported people to make significant changes to the lifestyle which had led to major improvements in their health. People were supported safely with medicines. Infection prevention and control practices reflected current guidance.

Right Care

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to people’s individual needs. Staff understood how to protect people from poor care and abuse. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. The service worked well with other agencies and were regularly complimented on how well they engaged with healthcare professionals and supported people to receive the healthcare they needed. 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/or autistic people may have. This meant people received compassionate and empowering care that was tailored to their needs. Staff placed people’s wishes, needs and rights at the heart of everything they did. Staff were aware of and were working to best practice guidance for supporting people with a learning disability and/or autistic people.

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 1 September 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

This report only covers our findings in relation to the key questions safe and well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mencap North East (Durham, Gateshead, Darlington, Northumberland South and South Tyneside) on our website at www.cqc.org.uk.

Follow up

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

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. Not everyone using Mencap receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of inspection there were 60 people using the service.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There were two registered managers in place who had worked together for over ten years and demonstrated strong oversight of the service. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

People were protected from harm by staff who were aware of the risks they face. These risks were individualised, well documented and assessed, with clear preventative plans in place.

There were no concerns regarding the safety of the service raised by relatives or external professionals. Clear protocols were in place for when staff encountered problems out of hours or when a support visit was missed.

Medicines and finances were managed safely, with all staff receiving appropriate training and annual competency assessments, as well as audits by the provider’s quality assurance team.

Specific training was implemented as a result of national audits which identified areas where people who used the service may be at particular risk, for example choking.

Where incidents or accidents occurred, the registered managers ensured lessons were learned and appropriate action taken to improve the service in future.

All staff were passionate about people who used the service getting access to the health care they needed and achieving outstanding quality of life outcomes. People who used the service and their relatives provided unanimously exceptional feedback about how staff helped them stay healthy. We saw consistent evidence of significant improvements in people's health and wellbeing thanks to the support of staff.

Technology was embraced to ensure people and their relatives could play as full a role in the planning and delivery of their care as possible. Outcomes included relatives abroad being involved in weekly discussions, where previously they had felt isolated, and people using devices that enabled them to more fully engage in conversations.

People’s nutrition was prioritised by staff who regularly found inventive ways to ensure people could improve their health and wellbeing through healthy eating. People who wanted to lose weight had done so and people who were at risk of malnutrition were supported successfully to regain weight. Where people had particular religious beliefs in relation to food, staff spent additional time becoming knowledgeable in this area to ensure they were respectful at all times.

Staff were extremely well supported by way of a comprehensive array of training the provider considered mandatory as well as regular supervision meetings with the line manager. The registered managers embraced new training which was based on recognised best practice.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. Best interest decision making adhered to the Mental Capacity Act 2005 (MCA) code of practice and the need for consent was embedded in the culture. Staff used the principles of the MCA to ensure people’s best interests were supported fully and without restriction. We found these assessments have been completed to a high standard and were extremely person-centred.

People received support from familiar and consistent staff they had built strong relationships with. People who used the service and relatives consistently praised the caring and positive attitudes of staff.

Staff respected people’s religious and cultural beliefs and valued their individuality.

People were supported and encouraged to pursue a range of activities meaningful to them. Staff were proactive in supporting people to socialise more and achieve goals such as trying new sports and attending further education.

Reviews, surveys and tenant meetings were in place to ensure people who used the service had a voice in the planning and delivery of their care.

Care files were detailed and, whilst on occasion needed updating in relation to people’s planned goals and achievements, were person-centred.

Complaints procedures were easily accessible and all people who used the service and their relatives knew how to raise concerns.

The registered managers led the service well, ensuring staff were well equipped to provide high standards of care to people. The provider had in place a range of national auditing and training frameworks, which the registered managers accessed for the benefit of staff and, ultimately, people who used the service.

Local oversight of the service was strong with all staff praising immediate line managers and the registered managers. Morale was high and the culture was focussed on ensuring people could achieve outstanding health and wellbeing outcomes as independently as possible.

Further information is in the detailed findings below.