United Response - Cornwall DCA

United Response (Cornwall DCA) is a domiciliary care agency which provides personal care to people who have learning disabilities or complex needs. At the time of our inspection, the service was providing care and support to 27 people in 19 different supported living settings. In the accommodation we visited, some people lived in self-contained flats, and others in houses. People had their own bedroom and shared bathroom, as well as shared communal areas.

In 'supported living' settings, people's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support.

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:

Due to a shortage of staff available to some people, they were not always able to make choices or take part in meaningful activities which were part of their planned care and support.

People were supported by staff who were trained in medicines management. However, records were not always completed accurately.

People who experienced periods of distress had proactive plans in place which ensured restrictive practices were only used by staff if there was no alternative.

Systems were in place to report and learn from any incidents where restrictive practices were used.

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 did not support this practice.

Right Care:

There were not always enough staff at each service to meet people’s needs. Some staff had not promptly received the training they needed to keep themselves and the people they supported safe.

People received kind and compassionate care from staff. People were supported by staff who understood how to recognise and raise concerns.

People were able to communicate with staff because staff who supported them understood their individual communication needs.

Individualised risk assessments were undertaken. Where appropriate positive risk taking was encouraged.

Right Culture:

Oversight, audits and quality checks had not always been completed when required due to a lack of staff.

Staff morale had been affected by low staffing levels and recent changes to the structure of the service.

People’s relatives provided positive feedback about the service.

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 29 January 2020).

Why we inspected

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

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. Please see the safe and well led key question sections of the full report.

Enforcement and Recommendations

We have identified a breach in relation to staffing. Please see the action we have told the provider to take at the end of this report. We have also made recommendations in relation to the Mental Capacity Act 2005 (MCA) and how changes to the service are monitored and reviewed.

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.

United Response (Cornwall DCA) is a domiciliary care agency which provides personal care to people who have learning disabilities or complex needs. At the time of our inspection, the service was providing care and support to 31 people in 25 different supported living settings. In the accommodation we visited, some people lived in self-contained flats, and in other houses, people had their own bedroom and shared bathroom, as well as shared communal areas.

In 'supported living' settings, people's care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living; this inspection looked at people's personal care and support.

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.

The service had been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

People using the service consistently told us they felt safe and that staff were caring and respectful. Their comments included, “I love it here, they [staff] are here for me”.

We received positive feedback about United Response Cornwall DCA. Relatives told us their family members seemed happy being supported by the organisation. Comments included “The care from the team is second to none from the top to the bottom.” The staff we saw were caring and treated people with dignity and respect.

The service’s rotas were well organised and there were enough staff available to provide all planned care visits. No one reported having experienced a missed care visit.

People were safe and protected from avoidable harm or abuse. Staff were trained in safeguarding and were supported by effective policies.

Risks had been assessed and staff were provided with guidance on how to manage and mitigate risks while providing support.

People were safely supported to take their medicines as prescribed.

Staff were recruited safely and there were sufficient numbers to ensure people’s care and social needs were met. Staff received induction, training and supervision to assist them to carry out their work

Staff were well motivated and there was a positive open culture within the service. People’s feedback was valued, and records showed action had been taken to address and resolve any issues reported to managers

People were able to make choices and staff respected their decisions. Care plans gave guidance to staff about what people could do for themselves and how best to provide support.

People received care and support that was individual to their needs and wishes. People and their relatives were involved in the development and review of care plans and told us they were an accurate reflection of people’s needs.

People were supported to pursue their interests, hobbies and gain new skills.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

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.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

There was a clearly defined management structure and regular oversight and input from senior management. Staff were positive about the management of the service and told us the registered managers were supportive and approachable.

The service was well led. Management roles were clearly defined and there were effective quality assurance processes in place. People and relatives were complimentary of the service.

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 (13 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

At the time of our inspection 38 people were receiving a personal care service. These services were funded through Cornwall Council or the NHS.

There were three registered managers in post who was responsible for the day-to-day running 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 and associated Regulations about how the service is run.

We carried out this announced inspection on 19, 20 and 21June 2017. The service was last inspected in March 2015 and was found to be meeting the regulations and was rated as ‘Good’.

Most of the people we met, had limited verbal communication skills. However we were able to speak with some people, who were positive about the support they received from the service. They said the service was, “Good”, and “Fine”. Relatives we spoke with said, the service had “Transformed (my relative’s) life…previously (they) were not supported just looked after,” “I cannot speak highly enough” (about the service), “Excellent, I could not want for a better organisation,” and “(My relative) is looked after superbly.”

People were safe. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

There were enough suitably qualified staff available to meet people’s needs. The service was flexible and responded to people’s changing needs. People told us they had a team of regular staff and their visits were at the agreed times.

People received care from staff who knew them well, and had the knowledge and skills to meet their needs. People and their relatives spoke very highly of staff and typical comments included; “I have nothing but praise for them”, and “They listen.”

Staff were knowledgeable about the people they cared for and knew how to recognise if people’s needs changed.

Staff were aware of people’s preferences and interests, as well as their health and support needs, which enabled them to provide a personalised service. Staff were kind and compassionate and treated people with dignity and respect.

The management had a clear understanding of the Mental Capacity Act 2005 and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected.

Staff told us there was good communication with the management of the service. Staff said management were, “Really good,” and “Very supportive.”

There were effective quality assurance systems in place. The service had an effective management team, and Care Quality Commission registration, and notification requirements had been complied with.