The inspection of Mencap in Kirklees took place on 8 February 2018. We previously inspected the service on 20 September 2016; we rated the service Requires Improvement. The service was not in breach of the Health and Social Care Act 2008 regulations at that time.

Mencap in Kirklees is a domiciliary care agency. It provides personal care to adults with learning disabilities living in their own homes. On the day of our inspection 22 people were receiving support from Mencap in Kirklees. 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 registered manager in place. 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 felt safe, staff were aware of their responsibilities in the event they were concerned a person was at risk of harm. Care files contained individual risk assessments to reduce risks to people’s safety and welfare.

Staff recruitment was safe. Plans were in place to implement an electronic call monitoring system to alert office based staff in the event a person’s call had been missed. Not all staff were happy with the management of duty rotas.

People’s medicines were only administered by staff with the knowledge and skills to do so. All medicine administration records were routinely audited on return to the office to enable any concerns to be addressed promptly. Where people were prescribed medicines to be taken ‘as required’ (PRN) there were no directions for staff as to how to ensure their administration was safe and consistent. The registered manager assured us action would be taken to address this shortfall.

New staff received induction and there was a system in place to ensure staff received regular training. Staff had completed the theory aspect of the Care Certificate but the field based assessment of their competency had not always been completed. Staff had not received regular management supervision and there was no system to ensure all staff had received a regular field based performance assessment.

People received support with meals and drinks. Care plans recorded the support people needed with this aspect of their lives.

Staff were aware of how to access additional healthcare support for people and we saw evidence of this within peoples care files.

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. We saw evidence people had given their consent to the care and support they were receiving.

Staff were caring and kind. People’s right to privacy was respected and staff treated people with dignity. People were encouraged to retain their independence and complete tasks with staff support. People and their relatives were involved in their care plan and this was evident in the care plans we reviewed. Staff enabled people to make their own choices and decisions, implementing other methods of communication where people’s verbal skills were limited.

Staff supported people to engage in activities which interested them.

Care plans were person-centred and contained relevant information to enable staff to deliver peoples care. Where people may present behaviour which may challenge others, we saw care plans recorded how the behaviour was displayed and the actions staff should take to defuse the behaviour.

People did not raise any complaints with us and informatio

The inspection took place on 28 July and 3 August 2016 and was announced. The last inspection of the service was in January 2014 and was compliant with the regulations at that time.

Mencap Kirklees DCA is registered to provide personal care to people in their own homes. There were 19 people receiving personal care at the time of the inspection.

There was no registered manager in post at the time of the inspection, but there was an interim manager in charge whilst a new manager was being recruited.

People felt safe and staff demonstrated understanding of safe practice. Procedures for safeguarding people were in place, although lacked full detail about what staff should do to report any concerns other than internally.

Risk assessments identified each person’s risks, although these were not always updated following significant incidents, such as choking or falls.

Recruitment procedures ensured staff were vetted and their suitability to work with vulnerable people was checked. Staffing levels were supportive of people’s needs.

The interim manager identified weaknesses in medication management and was taking steps to improve this.

Staff had opportunities to update their skills and professional development. Staff demonstrated an understanding of the impact of the Mental Capacity Act (MCA) 2005. There was work being done to improve the quality of the recording of people’s mental capacity assessments.

People told us kind and caring staff supported them and relatives said staff were professional in their approach.

Staff worked well together and felt supported by managers and the organisation, with recent improvements reported to us by staff about the management of the service.

Care records contained information covering all aspects of people’s individualised care and support, with details easy to locate, although some records lacked detail and were in the process of being reviewed. Daily notes about individuals’ care were maintained but not promptly brought into the office for reviews.

People felt supported to complain if they were unhappy about any aspect of their care and there was plenty of information for people to understand. The complaints record did not always illustrate the detail or the outcome where complaints had been received.

There were developing systems for auditing the quality of the provision and the interim manager had identified the strengths of the service and devised an action plan for the areas to improve. There was an open and transparent culture in which staff felt able to approach managers.

The Care Quality Commission only regulates the personal care part of the services provided by Mencap In Kirklees (DCA). At the time of our visit only seven people of the people supported by Mencap in Kirklees were receiving personal care.

We looked at care plans for three people and saw they were clear, detailed and appropriate to the individual concerned.

We looked at how staff supported people with their medication and found a safe system was in place.

We saw there were enough appropriately trained and experienced staff available to support people as per their schedules.

We saw when people had raised a concern a complaint, it had been managed properly.

We saw the service provided to people was audited on a regular basis and ways in which improvements could be made were identified and explored. We saw the following comments had been made from relatives of people who used the service:

"I really appreciate the practical way my sister is being looked after".

"I would like to thank all the managers and support workers that I have had contact with through the support of my daughter. I have been very impressed with their professionalism and the care they have shown towards both her and myself. I wish all services were like your own"

"Everything is discussed with the service user".

We spoke with two support workers from the service. These are some of the things they told us:

"There is always someone to speak to if I need any help"

"I love it, best job I've ever had, it doesn't feel like a job"

"I'm doing my NVQ at the moment and I love going on training courses"

"I'm still doing my induction. I was introduced to the people I support. I would never go out to someone I hadn't been introduced to"

We spoke with one person who used the service. They told us that they liked to organise what they like to do and that staff support them to do this. The said they were excited about going on holiday abroad with their support worker. They told us that their support workers are kind and friendly.

At the time of the visit only seven of the forty people supported by the agency were receiving personal care.

The Registered Manager was on leave at the time of the visit therefore we spoke with the two team managers who were managing the service in their absence. We also spoke to the relatives of three people who use the service and five members of staff.

The relatives we spoke with were very complementary about the care and support provided by the agency. Comments included “I cannot fault the service provided, both the management and staff are excellent” and “I have used the agency for a number of years and have always been highly delighted with the care and support provided.”