Richmond Village Letcombe Regis DCA

Richmond Village Letcombe Regis is a domiciliary care agency. It provides personal care to people living in their own flats and apartments within the retirement village. The service was providing personal care to 16 people.

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

People were not always supported to have maximum choice and control of their lives. Medicines were locked away for people’s best interest. There was no written agreements or documentation in place to support this practice, therefore the service did not always support people in the least restrictive way possible.

Medicine management required improvement to ensure people received their medicines as prescribed, and that all staff were trained adequately to carry out their role. Medicines systems and processes did not always evidence that people had access to their medicines.

Care plans and risk assessments were not always kept up to date and factual. We found conflicting information had been recorded. Staff did not always have the information to support people safely.

Oversight of the service required improvement. Systems and processes were not always effective in identifying improvements needed and mitigation of risks.

People and relatives had not been asked to feedback on the service.

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

The last rating for the service was good, published on 18 February 2020.

Why we inspected

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

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. We have found evidence that the provider needs to make improvements.

Enforcement and recommendations

We have identified breaches in relation to regulation 17 good governance. You can see what action we have asked the provider to take at the end of this full report.

We recommend the provider reviews management understanding in the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Richmond Letcombe Regis DCA 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.

Richmond Village Letcombe Regis is a domiciliary care agency. It provides personal care to people living in their own flats and apartments within the retirement village. The service was providing personal care for 36 people.

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

The service ensured people received safe care from skilled and knowledgeable staff. People told us they felt safe receiving care from the service. Staff understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely and people received their medicines as prescribed.

We received positive feedback from people and relatives which reflected staff were kind, caring and committed. People complimented the continuity of care provided by regular staff which contributed to building of meaningful relationships. Staff recognised what was important to people and ensured an individually tailored approach that met people's personal needs, wishes and preferences was delivered.

People were supported by caring staff that knew them well. People were supported to maintain relationships with their families and friends. People's independence was promoted, and they received support to achieve their goals and reduce social isolation.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health and to meet their nutritional needs.

The service was well-led by a registered manager who was committed to improving people’s care. The registered manager had only been in post for a year and had identified areas to improve and was working through an action plan. The provider had quality assurance processes in place which were effectively used to drive improvement.

Rating at last inspection:

At our last inspection we rated the service good. Our last report was published on 17 August 2017.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

We undertook this focused inspection of Richmond Village Letcombe Regis DCA on 28 June 2018. This inspection was prompted by the provider’s statutory notification to CQC of a significant event. The information shared with CQC about the incident indicated potential concerns about safe care and treatment. This inspection examined those risks and reported on the findings in the safe and well-led domains. The incident is subject to a separate external investigation and as a result we did not examine the circumstances of the incident as part of this inspection.

This report only covers our findings in relation to the above topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Richmond Village Letcombe Regis DCA’ on our website at ‘www.cqc.org.uk’. The last inspection was carried out 11 July 2017. At that inspection the service was rated as “Good” and was meeting all of the relevant regulations.

Our findings at this inspection have not changed the current rating of “Good for the key question in Safe, the current rating of ‘good’ for the key question Well-led or the overall rating of ‘good’ for this service because we did not look at all the areas for the key question Safe and Well-led. We will review all areas of the key questions of Safe and Well-led in full at our next comprehensive inspection.

Richmond Village Letcombe Regis DCA provides personal care services to people in their own homes. At the time of our inspection 25 people were receiving personal care from the service.

The service has a registered manager. 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.

Risks to people’s well-being had been assessed and recorded. Staff had clear guidance how to assist people so the risks associated with their care, such as moving and handling or the risks of falls were managed safely.

Systems were in place to monitor risks and quality of service. The registered manager ensured improvements were made when risks had been identified. The provider took prompt action following the safety incident to ensure people received safe care and treatment.

At the previous inspection in September 2016 we found the provider had not taken the necessary steps to mitigate the risks associated with people’s care in that not everyone had appropriate risk assessments in place. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014. We also found that the services quality monitoring systems were not always effective. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulations 2014.

At this inspection we found that the service had made significant improvements to address the areas of concern and bring the service up to the required standards. People’s care records contained up to date and accurate information and guidance for staff to mitigate the risks associated with people’s care. The manager conducted regular audits to monitor the quality of service. Learning from these audits was used to make improvements.

The service had a registered manager. 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 told us they were safe. Staff understood their responsibilities to identify and report all concerns in relation to safeguarding people from abuse. Staff had completed safeguarding training. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

People received their medicines as prescribed. Records confirmed where people needed support with their medicines they were supported by staff that had been appropriately trained.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with staff who had a caring approach to their work.

People were supported by staff who had been trained in the MCA and applied it's principles in their work .

Staff spoke positively about the support they received from the registered manager. Staff had access to effective supervision. Staff and the registered manager shared the visions and values of the service.

The service sought people's views and opinions. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

Richmond Village Domiciliary Care Agency (DCA) provides personal care services to people in their own homes. At the time of our inspection 35 people were receiving a personal care service.

There was a registered manager in post. 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 told us they were safe. People were supported by staff who could explain how they would recognise and report abuse. However people were not always protected as people’s care records did not always include up to date risk assessments.

The provider and the registered manager conducted regular audits to monitor the quality of the service. However these systems were not always effective. Staff told us they felt supported and had access to effective supervision. However records relating to staff supervision were not always completed.

Staff knew the people they cared for and people told us they received person centred care. However care records did not always evidence this. Care records were not always accurate or complete.

The service sought people's views and opinions and acted upon them. People and their relatives told us they were confident they would be listened to and action would be taken if they raised a concern.

People received their medicines as prescribed. Records confirmed where people needed support with their medicines, they were supported by staff that had been appropriately trained. People told us and staffing rotas confirmed there were sufficient staff to meet people's needs.

People were supported by staff who had the skills and training to carry out their roles and responsibilities. People benefitted from caring relationships with staff who had a caring approach to their work. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

The registered manager and staff understood the Mental Capacity Act (MCA) 2005 and applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves.

Staff and the registered manager shared the visions and values of the service and these were embedded within service delivery. People were supported to maintain good health. Various health professionals were involved in assessing, planning and evaluating people's care and treatment.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Is the service safe?

People and their relatives told us that they felt safe with the provider's support. One person told us, "I feel safe.' People and relatives told us that they felt their rights and dignity were respected.

Staff had received safeguarding training and understood how to safeguard people they supported. This involved recognition of signs of possible abuse and how to report concerns.

Staff knew about risk management and we saw examples of this in the care plans. People had access to choice and remained in control of decisions about their care and lives.

Is the service effective?

People told us they were involved in their care. One person told us they had 'signed the care plan yesterday'. People's health and care needs were assessed with them, and they were involved in writing their care plans. People said that their care plans were reviewed and reflected their current needs.

Is the service caring?

We spoke with people or their relatives being supported by the service. People said that they valued having visits from regular care staff. One person told us 'I think most are extremely caring and thoughtful.' A member of staff told us that it was important to ask people's preferences about their care.

People using the service and their relatives completed an annual satisfaction survey. This helped to identify good practice and areas for development.

Is the service responsive?

One person told us that staff visited at the arranged times and 'they're quick at knowing what to do' if there were changes to the care plan.

The provider monitored the quality of the service and responded to feedback from people and relatives. People knew how to make a complaint if they were unhappy.

The service worked with other agencies and services to make sure people received effective care.

Is the service well-led?

There was no registered manager in place at the time of our inspection. The village manager told us that the service manager had applied to become a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

The service has an effective quality assurance system, and records showed that identified problems and opportunities to improve the service were addressed. As a result the quality of the service was improving.

Staff told us they understood their roles and responsibilities and that senior staff supported them well.

People told us that they were treated with respect and were involved in their care. One person said 'They certainly look after you.'

A variety of facilities and activities were arranged by the provider. People said that these were of great benefit. One person told us 'There's plenty for everybody.'

People reported that they felt safe. One person said 'I feel safe. I like it here. I like the people here.'

The provider assessed the quality of its service regularly. A relative we met said 'I can't speak too highly of the care.' A staff member told us 'It's a lovely company to work for.'

Staff told us that they enjoyed their work and that they felt supported by managers. One staff member told us that she had achieved her NVQ 2 in social care and health. She did not think she would achieve but with support from other staff was able to. Staff were positive in ensuring that people where involved in all their aspects of care. Staff were also positive about the provider.