Delrow Community

Delrow Community is a domiciliary care agency providing personal care to people with a Learning disability and autistic people. At the time of our inspection there were 50 people using the service, however 14 people were being supported under the regulated activity of personal care.

People’s experience of the 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 assessment and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way; however this was not always documented appropriately and the policies and systems in the service did not support this practice.

Staff supported people to play an active role in maintaining their own health and wellbeing and enabled people to access specialist health and social care support in the community.

Staff supported people with their medicines in a way that promoted their independence and achieved the best possible health outcomes.

Right Care

The provider made sure that there was enough skilled staff to meet people's needs and keep them safe, as well as ensuring they met best practice guidance. Staff had training; however further specific training was required to meet people’s individual needs. This was something the provider planned to continue developing.

People had risk assessments that detailed their immediate risks and how to mitigate the risk.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The registered manager and staff worked well with other agencies to do so. People were supported by staff who treated them with respect and staff were kind and caring.

Right Culture

Professionals spoke positively about the responsiveness of staff, however they felt that the communication with the management needed to improve.

Managers completed quality audits which covered all aspects of care, although some of these audits did not identify some of the concerns we identified as part of the inspection.

People and staff were involved in the running of the service and fully understood and considered people's protected characteristics.

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 30 March 2018).

Why we inspected

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

Enforcement and recommendations

We have identified breaches in relation to documenting decisions made in people’s best interests. We also recommended the provider reviews the training they offer to ensure that staff are skilled to support people to meet their individual needs. 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.

Delrow Community is registered to provide domiciliary care to adults with learning disabilities, mental health needs and older people. The service supports up to 55 people living within nine separate houses. People living at Delrow Community receive care in line with the supported living model where all staff employed by Camphill Village Trust provide care and support to people over a twenty four hour period. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

At the time of this inspection 51 people were being supported to live independently. Some people being supported by this service had complex needs including learning disabilities, physical disabilities and Autism.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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.

People told us they felt safe at the service and they liked the way staff supported them to live their lives with choices and opportunities. Relatives told us they were happy how people were looked after and they felt the service was safe and met peoples` needs.

People were involved in developing their care and support plans and relatives where appropriate were invited to participate in developing and reviewing people`s care and support plans.

Relatives and staff told us there were enough staff to meet peoples` needs and support them with the activities they chose to do.

People lived an active life and had been provided with opportunities to pursue their hobbies and interests both within the service and in the wider community.

People were supported by staff who were trained and received regular supervision. People were encouraged to eat a healthy, balanced diet and there was access to healthcare professionals when needed. Staff understood the importance of giving people choice and listening to their views and opinions.

Staff members understood their roles and responsibilities and were supported by the management team to maintain and develop their skills and knowledge.

People’s personal care records were kept securely to ensure unauthorised people did not have access to them. Staff spoke with people in a kind, patient and friendly way and people were treated in a dignified manner. Staff consistently ensured people’s social needs were met, and people felt staff listened to them and valued their views.

There was a complaints process available and people were asked for their views at meetings. In addition relatives told us they were regularly asked to give feedback about the service and they felt positive about how the home was managed.

The management team were passionate about providing the best possible support for people and they actively supported people and staff to achieve this. There were quality assurance systems in place which were used effectively to identify any areas in need of improvement. Actions were taken to improve the quality of the care people received when it was necessary.

Delrow Community is registered to provide domiciliary care to adults with learning disabilities, mental health needs and older people. Delrow Community is part of Camphill Village Trust. The service supports up to 55 people living within nine separate houses. Until 2014 people lived as part of a ‘life sharing model’ of support which meant that staff, known as co-workers, and their families lived together with people who used the service and supported them on behalf of the Delrow Community. People living at Delrow Community now receive care in line with the supported living model where all staff employed by Camphill Village Trust provide care and support to people over a twenty four hour period but did not live within their houses.

There were 50 people accommodated at the service at the time of this inspection. The service had a manager in post who is currently in the process of being registered with the Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 that they felt safe at Delrow community and were confident to approach the staff for support. People had health care and support plans in place which ensured staff knew how people liked their needs to be met. Risks to people’s safety and welfare had been identified and care had been planned to enable people to live as safely and independently as possible. There were sufficient numbers of staff available to meet people’s care and support needs.

Robust and effective recruitment processes were used to ensure that all staff employed at the service were of good character and had the skills, abilities and experience necessary to do their jobs.

Staff received training in how to safeguard people against the risks of abuse and knew how to report any concerns they had, both internally and externally if the need arose.

There were sufficient numbers of staff available who were deployed in a consistent and effective way across the service. Staffing arrangements reflected and took account of people’s individual needs and levels of dependency which meant that care and support was provided in a calm and patient way.

Appropriate steps were taken to ensure that identified risks to people’s health, safety and well-being were mitigated in a safe and effective way that promoted their independence. Accidents, falls and injuries were recorded and investigated thoroughly to identify emerging risks, patterns and trends.

Medicines were stored, administered and managed safely. People were supported by trained staff to take their medicines on time and in accordance with prescriber’s instructions

.

Staff members understood their roles and responsibilities and were supported by the management team to maintain and develop their skills and knowledge.

The atmosphere within each of the houses was welcoming and relaxed. We found that staff had developed positive and caring relationships with the people they supported. People were actively involved in all aspects of their care and support as much as they were able to. People were supported to access support from external advocacy services to help them make decisions about matters in their daily lives. Relatives and friends were encouraged to visit at any time and people were actively supported to maintain family relationships. Staff promoted people’s dignity and treated them with respect.

Measures were in place to monitor the quality of services provided, reduce potential risks and drive improvement. The management team co-ordinated and delegated specific responsibilities with regard to monitoring of all aspects of service provision. They personally and regularly checked key aspects of service provision in a formalised and structured way.

responsive, safe, effective and well led?

Below is a summary of our findings.

Is the service safe?

By safe, we mean that people were protected from abuse and avoidable harm. We found that staff were aware of the risks to people and they cared for them in a way that kept them safe. Staff members were able to demonstrate that they knew how to support people safely and minimise risk. We saw evidence that staff members had received training in the protection of vulnerable adults. Staff members we spoke with were aware of different types of abuse, and were able to describe the process they followed if they needed to raise any concerns.

We found concerns and inconsistencies around the way staff members and volunteers were recruited. We spoke to the provider about this and there were plans in place to address the way staff and volunteers were 'engaged'.

Is the service effective?

By effective, we mean that people's care, treatment and support achieved good outcomes

and promoted a good quality of life which was evidence-based where possible. We reviewed the care and support plans for five people who lived at Delrow Community. We found that

they contained generic support plans but that the information recorded was inconsistent.

Staff supported people to be as independent as possible and everyone had their own responsibilities within the community. We saw that people had given their consent to the care and support they received.

Is the service caring?

By caring, we mean that staff involved and treated people with compassion, kindness,

dignity and respect. We observed positive interactions between staff members and people who used the service. Staff members knew people well and were able to support people appropriately. We saw that they were patient and understanding with people who used the service.

Is the service responsive?

By responsive, we mean that services were organised so that they met people's needs. We observed the staff to be responsive when they interacted with people. We saw evidence that the staff were aware of people's needs and likes and dislikes. Care and support was planned appropriately to support people. People were supported to retain skills, and these were developed to ensure people remained as independent as possible.

Is the service well-led?

By well-led we mean that the leadership, management and governance of the organisation

assured the delivery of high-quality person-centred care. This supported learning and innovation and promoted an open and fair culture.

There was no registered manager at Delrow Community at the time of our inspection. However the current manager was in the process of being registered with the Care Quality Commission. There had been other changes in the management structure within the organisation. We found that the overall management at Delrow Community was appropriate to support good outcomes for people who used the service.

The people we spoke to were satisfied with the care they received and liked living in their home within the village. One person told us, 'I've lived here for a long time' and that, 'we do a lot of activities, we go dancing and do the workshops. I'm very happy here'.

However, we identified concerns around how peoples care was planned because documentation was not sufficiently detailed to adequately support people. We also found that some incidents had not been reported to safeguarding or the Care Quality Commission. Arrangements for supervision and appraisal were not consistent amongst different groups of workers. Complaints were recorded and responded to appropriately.

The provider had developed contracts for private fee payers. The recruitment processes had been improved, although the service had not employed anyone since our previous visit. We also found that progress had been made with regards to audits but that they had not been formally recorded and a broader range of audits was needed.

Although people we talked to were happy with the care they received we identified concerns around some of the systems and practices during our visit. People paying for the service were not provided with a contract detailing the services provided or the fees due. We found that some people may have been doubled charged for personal care, although this had already been indentified by the provider and was in the process of being rectified.

There was a general lack of quality monitoring including; audits and surveys had not being undertaken. Internal investigations for reported serious incidents had not being undertaken.

Pre-employment checks were being undertaken but were in need of improvement.