Darlington Borough Council In House Home Care

Darlington In House Homecare is a reablement and supported living service providing personal care to people. The service provides support to adults of all ages. People using the reablement service were supported for up to 6 weeks with therapy led support following hospitalisation or injury. The service also supported 3 people with a learning disability living in their own home. At the time of our inspection there were 37 people using the service.

People’s experience of the 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 were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Support:

Medicines were given safely by trained and competent staff. The service had plans and guidance to support people with identified risks. Care was person centred and promoted choice and independence. People were supported to achieve positive outcomes. People were supported by staff who received an induction and ongoing training.

Right Care:

People received kind and compassionate care. Feedback from people was all positive, staff knew people well, understood and responded to their individual needs. Staff promoted and respected people's right to privacy, dignity, and respect. Staff knew how to protect people from the risk of harm and abuse.

Right Culture:

The manager listened to concerns and promoted a positive culture that was person-centred, open, and inclusive. Staff were supported and given opportunities to feedback about the service. Quality assurance processes enabled continuous improvement. As the manager had not been in post long some systems and processes were still in development, but plans were in place and being acted on.

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 on 3 November 2018.

Why we inspected

We undertook a focused inspection to review the key questions of safe and well-led only. For those key question not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Darlington In House Homecare 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.

Darlington in House provides two distinct services Reablement and Supported living. Reablement is designed to help people recover from a period of serious illness or injury which may have resulted in hospital treatment. The service provides a range of rehabilitation, care and support services for up to six weeks. The service operates throughout the borough of Darlington. Supported Living works with housing providers to provide support in Darlington for people with a learning disability. Supported Living staff provide assistance with personal care, bathing, meal preparation, supervision and assistance with medicines.

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.

The service had a manager who was registered with CQC. A registered manager is a person who has registered with CQC to manage the service. Like 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.

At our last inspection in July 2016 we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained good.

People said they felt safe with the staff and they had a say in who supported them. Staff had been trained in safeguarding vulnerable adults and knew how to report any concerns. People were assisted with their medicines in a safe way.

The provider checked new staff before they started work to make sure they were suitable. Staff had relevant training and received regular supervisions and appraisals.

Risk assessments were in place to support people’s independence. Any accidents and incidents were appropriately recorded and checked by the provider.

People’s needs were assessed before they started using the service to make sure the service could provide their support. In the Supported living service, people were supported with their nutritional health by support staff and involved in the planning and cooking of meals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to be included in their local community and lived ordinary, fulfilled lives as local citizens.

People told us staff were caring and kind in their interactions. People were empowered to make their own choices and decisions.

Staff were respectful of people’s individuality. The service provided information for people in the way that met their communication styles.

The service had detailed records about each person. This included information about peoples’ preferences and goals as well as their needs and support the service needed to give them.

People knew how to make a complaint and were confident about contacting the management team at any time.

There was a management team with clear lines of responsibility. The provider had quality assurance systems to check the service.

Further information is in the detailed findings below.

We carried out this announced inspection on 11 July 2016. We met with the registered manager, staff and people who lived in the supported living service. We spoke with people who used the reablement service on 13 July 2016.

We met with the registered manager of the service and also the home manager who looked after the three supported living schemes.. They had several years of service in management within the local authority. 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.

A team of reablement workers were based at Hundens Lane alongside other health and social care professionals such as social workers and occupational therapists. Support workers for the supported living schemes were based in people’s own homes.

People we spoke with who received personal care felt the staff were knowledgeable, skilled and the care package met their needs. People who used the service told us they felt comfortable with the members of staff who were supporting them. Staff told us people received good care and support.

Staff undertook the management of medicines safely. There were procedures in place to support staff, and staff we spoke with told us they were trained and felt confident in medicines management. We saw where medicine errors had taken place they had been investigated and procedures reviewed.

People told us they felt confident that should concerns be raised these would be dealt with appropriately. People told us they could contact the managers or staff at the service if they needed to discuss anything. People said they had the opportunity to talk about their opinions of the service during reviews and through meetings.

People were supported to maintain good health and had access to healthcare professionals and services. Where needed people were seen or referrals were made to the GP, district nursing service, occupational therapist, community physiotherapist and dietician.

People told us they were supported to prepare food and drinks of their choice. This helped to ensure that nutritional needs were met. People told us they were encouraged and supported to be independent with meal preparation.

People told us staff respected their privacy and dignity. Staff were aware of the values of the service and knew how to respect people’s privacy and dignity.

The managers and staff we spoke with told us they had attended training in the Mental Capacity Act (MCA) 2005. The MCA is legislation used to protect and empower people who may not be able to make their own decisions, particularly about their health care, welfare or finances.

Records we saw confirmed Darlington Council had effective recruitment and selection policies in place which ensured staff members were of good character and had the required skills to perform their work.

Staff we spoke with told us they felt supported and they spoke of the training provided by the organisation. Staff received training that was specific to the service for example, staff working in the supported living service had training such as autism awareness. We saw that meetings with staff both individually and collectively were positive and well recorded.

We saw care plans and risk assessments were developed with the person and staff were able to show us that they were clear and easy to follow.

There was a quality assurance process carried out by the service and registered provider as well as close monitoring of accidents and incidents. We saw the service had responded to any learning and improvements it needed to make to its service.

We also saw the provider had a system in place for checking on the quality of the service it provided which included talking to people who used the service and their families.

We saw that staff received regular training and updates and there was a robust supervision programme led by the senior carer that showed staff members were supported to carry out their roles.

Staff members also told us they were trained in the use of equipment to assist people's mobility and were clear on what to do if they felt equipment was faulty.

We saw that records were securely stored and kept up to date by the service.

We spoke with six people who had recently experienced the reablement service. People told us they were involved in discussions about whether the service would be suitable for them before they used it. They told us they had choice and control over the service, for example when they needed support and when they did not.

People described the support they received as 'very good' and 'very successful'. One person said, 'It's been a wonderful service. It helped me to get my independence and confidence back.'

The council used an external human resources service to carry out recruitment checks of new staff. We saw all necessary clearances were carried out and were reviewed by the council before new staff were employed.

The council had a clear complaints procedure. This was available in a written leaflet and could be provided in other formats. Some people could not recall receiving a copy of the complaints leaflet but felt confident about contacting the service to discuss their care.