Domiciliary Care Cheshire

Updated 7 March 2024

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 undertaken by 1 inspector and a senior specialist adviser for people with a learning disability and autism.

Service and service type

This service provides care and support to people living in 6 ‘supported living’ settings, so that 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 there was not a registered manager in post. A new manager had recently joined the provider and had submitted an application to register. We are currently assessing this application.

Notice of inspection

We gave the service 24 hours’ notice of the inspection. This was because it is a small service and we needed to be sure that the provider or registered manager would be on-site to support the inspection.

Inspection activity started on 12 December 2023 and ended on 26 January 2024. We visited the location’s office on 9 January 2024.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. 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 spoke with 6 people and 7 of their relatives about the care provided. We spoke with 19 members of staff including the nominated individual, head of operations, service managers, deputy managers, senior support workers, and day and night support workers. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed care records, risk assessments and medicines records for 6 people. We reviewed 3 staff files in relation to recruitment. We reviewed a range of records relating to the management of the service including audits, complaints, staff training and policies and procedures.

Updated 7 March 2024

About the service

Domiciliary Care Cheshire is a supported living service which is registered to provide personal care for people with learning disabilities and autism who live in their own homes or flats within the local community. The service was providing support to 45 people and personal care to approximately 17 people at the time of the inspection across 6 supported living settings.

People supported either lived in their own home or self-contained apartments some of which had staff facilities within communal areas. 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 not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Restrictions on people’s care and support were not always appropriate or monitored clearly. There was a lack of oversight on the use of restriction at times. The provider took steps to rectify this during the inspection.

Staff received a range of training to enable them to provide safe and effective support, but at times staff training was out of date. Staff knew the people they supported well, including their likes, dislikes, needs and preferred choices. Staff were recruited safely and had a good understanding of safeguarding and whistleblowing procedures. People were supported to attend health appointments in the local community and were engaged in a range of activities.

Where people had specific health needs, these were risk assessed and staff understood people’s needs well. Where appropriate, people had positive behaviour support plans to guide staff on how to support them safely and effectively.

Right Care

Records relating to people’s recorded care needs were at times missing or incomplete. Relatives told us people received enough food and fluid to maintain a health lifestyle, but this was not always recorded clearly. Staff supported people to undertake healthy eating and regular exercise.

Relatives praised the staff approach to providing care and support, and felt their loved ones were being supported well. People received care and support tailored to their wants, needs and preferences. People were able to exercise choice over how they spent their time.

Staff treated people with dignity and respect, and supported them to develop living skills and achieve meaningful outcomes in the areas of independence, community access and taking control of their own care. People told us they were happy with being supported by their staff, and they had developed good relationships with them.

Right Culture

The management team undertook audits of the care delivered, but this had not always identified issues with the use of restrictions and staff recording care delivery. The provider had worked to instil a positive culture at their locations. Staff told us they were confident in raising concerns should they need to, and praised the management team who were described as “brilliant” and “responsive.” Staff and relatives told us morale had improved since the last inspection and staff and people were engaged in expressing their views around the delivery of care.

There was a range of professionals involved in people’s care. Some professionals felt the management team needed to be more forthcoming with requests for information. People’s care records evidenced the involvement of a wide range of health and social care professionals so people could receive effective and responsive care via good partnership working.

Leaders at the service led by example and staff, people and their relatives said there had been a positive improvements in culture and openness. Staff told us they felt supported, valued and listened to by the management team, and people and their relatives were confident in raising concerns should they need to.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 8 June 2023). The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

At our last inspection we recommended that the provider worked with partner agencies to review people's accommodation needs and to ensure compatibility within services was being considered. At this inspection we found this recommendation had been met.

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, restrictions placed on people and staffing. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Domiciliary Care Cheshire on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe care and treatment and good governance 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.

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