Doncaster care at home service which supports people with learning and physical disabilities requires improvement

DCA Alderwood North, based at 1 Cottage Close, Cemetery Road, Mexborough, is a care at home service providing personal care and support to people with a range of different needs including learning disabilities, autistic spectrum disorder and physical disabilities.

At the time of the inspection the service supported nine people, but not all people received regulated care and support. This was the first assessment of the service which assessed all of the quality statements in all of the five key questions.

Inspectors assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted.

The CQC report states: “Lessons were not always learnt to continually identify and embed good practice. There was limited review and analysis of incidents to identify learning and improvement. The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

“Risk assessments and care plans were completed but there was inconsistency in the quality of care plans. The provider made sure there were enough qualified, skilled and experienced staff who worked together well to provide safe care which met people’s individual needs but they did not always make sure staff received effective support, supervision and development.

“Local health and care professionals had identified improvements needed to be made to care plans to ensure care was delivered effectively. Staff teams recorded information about their care and support but there was no evidence of how this information was reviewed and analysed to identify common themes so plans for additional tailored support could be put in place.

“Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support. The provider did not always escalate concerns and identify actions to support improvement in health outcomes for people.”

It continued: “We observed care which was person-centred and members of staff knew people’s routines, habits and preferences. People had access to local health and care services. Information was provided to people appropriately in ways they could understand. People lived independently and they were supported to visit people to develop and maintain friendships and relationships.

“Members of staff knew the people they supported and they delivered care with kindness and compassion. People lived in their own homes independently and they were treated as individuals. People were supported to maintain their independence. We saw evidence they made choices and had control of their lives. Feedback from members of the staff team indicated workforce well-being was not supported by the local management team.

“There was an inconsistency in the leadership and culture of the service. There was a disconnect between the management team and the staff team. Leaders did not have the skills, knowledge, experience and credibility to lead effectively. We saw limited evidence the management team were compassionate and inclusive leaders.

“Governance systems and processes were not effective in identifying key areas for service improvement and development. Audits and reviews had not identified deficiencies in people’s care plans and risk assessments. The provider did not always encourage creative ways of delivering equality of experience, outcome and quality of life for people.

“The provider was in breach of the legal regulations relating to safe care and treatment and good governance and we have asked the provider for an action plan in response to the concerns found at this assessment.”

The inspectors were not able to communicate with everybody using the service, however they did spend time with people in their own homes and observed their interactions with staff.

The reported: “People were relaxed and happy and chose to be around the staff who supported them. They trusted the staff and looked to them for guidance and support when they needed it. They were keen to show us their homes, favourite items and activities.

“Staff were proud of the achievements people they supported had made and were keen to talk about the people they supported, their likes and dislikes and their progress. People were happy to welcome us into their homes and allowed us to spend time with them.

“When we spent time in people’s homes, we observed how members of staff communicated with the person they were supporting. We saw evidence people’s support staff used a range of communication methods with them which included clear conversations and explanations, Picture Exchange Communication System (PECS) cards and Makaton.

“Some people we spent time with shared their experiences of care and support including some concerns about the how staff spoke to them. We asked the provider to refer these concerns to the local safeguarding adults team.

“People received support from consistent staff teams which enabled them maintain routines which supported their wishes to engage in activities and past times which were important to them.

“People remained in contact with their families and spent time with them on overnight stays. There was close communication and good links with people’s families.

“We observed people spending time engaged in activities of their choice and discussions with people and their support staff confirmed they attended day centre activity sessions and they went out into the local community to visit shops and cafés.”