DCA Essex

Updated 7 October 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection was carried out by 4 inspectors, 1 of which was a pharmacy inspector, and an Expert by Experience who made phone calls to people and families for feedback about 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 nine ‘supported living’ settings, so 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection was not a registered manager in post. The manager of the service had applied to be the registered manager. We are currently assessing this application.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 31 July 2023 and ended on 30 August 2023. We visited the location’s office on 2 August 2023.

What we did before inspection

We reviewed information we had received about the service, including information from a monitoring phone call we carried out with the service in February 2023. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We visited 7 addresses and had contact with the people who used the service. Where people were unable to talk with us, we used observation to help us understand their experience of using the service. We also met with 12 care staff who supported them. We had phone or email contact with 10 care staff.

We met or had phone and email contact with 12 family members for feedback about the service. We met with the manager who was applying to be the registered manager and 3 local managers. We also met with the head of area operations, the providers quality lead, the positive behaviour practitioner and the nominated individual who is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included 8 people's care records and multiple medication records. We looked at 3 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.

We had contact with 4 health and social care professionals.

Following our visit to the office, we continued to seek clarification and additional information from the provider. We met with the management team for feedback and to seek assurances about the concerns we had found.

Updated 7 October 2023

About the service

DCA Essex is a supported living service providing personal care to people with a learning disability, autistic people and people with a physical disability. 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 receive personal care we also consider any wider social care provided. At the time of our inspection there were 32 people using the service, of which 23 received personal care.

Support was provided in shared houses and flats across Essex. The main office was in Braintree.

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

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 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. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

People had varied experiences of using the service, depending largely on the area in which they lived. Some people, and their representatives told us they were unhappy with the quality of support. They did not always receive safe, person-centred care. Other people received good quality care and achieved positive outcomes.

We made a recommendation about promoting people’s quality of life and involvement in reviews of their care.

Right Support:

Staff did not always support people safely with their medicines. The provider was addressing concerns we had in this area.

The provider needed to improve how they assessed risk across the service to enable staff to consistently provide safe support.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and system in the service did not always support the provider to have oversight of this practice.

Some people did not consistently have the necessary support to take part in activities and pursue their interests in their local area. Other people had the support they needed and lived full and busy lives.

Staff enabled people to access specialist health and social care support in the community. Improvements were needed to ensure all staff had access to specialist guidance about people’s needs.

Right Care:

The service did not always have enough staff with the appropriate skills to meet people’s needs and keep them safe. Agency and new staff did not always have the skills and information to meet people’s needs.

Improvements were needed to ensure staff training was tailored to the needs of the people they supported.

People could communicate with staff and understand information given to them because staff understood their individual communication needs.

Right Culture:

The provider had not ensured there were effective tools to check and evaluate the quality of support provided to people. Improvements were needed to involve the person and their representatives, as appropriate, in the review process.

The provider needed to improve how they communicated with people when things went wrong, in line with their duty of candour.

Managers and staff were committed to improving the care and culture for people and had started to sort things out.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

This service was registered with us on 23 June 2022 and this is the first inspection.

Although this service is being inspected as a new service it was created as part of a restructure by the provider and many of the care arrangements had been in place previously as part of other registered services.

Why we inspected

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

Enforcement

We have identified breaches in relation to support with medicines, risk management, governance and quality assurance at this inspection.

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

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.