The announced inspection of Mencap York Domiciliary Care took place across several dates in December 2016 and January 2017. We visited the agency offices on 13 and 20 December. We visited some of the supported living schemes on 14, 15 and 20 December. Interviews with relatives of people that used the service took place on 13, 16 and 19 December and further interviews with relatives and other stakeholders took place on 3 January 2017.

Mencap York Domiciliary Care provides personal care and support to people with a learning disability and/or Autism spectrum living in and around York. At the time of our inspection, the service supported 50 adults, many living in twelve supported living schemes. People were tenants of housing association properties and Mencap York Domiciliary Care provided personal care to people within their home. The housing providers were responsible for the buildings and their maintenance. Mencap York Domiciliary Care ran a small ‘community service’, which provided domiciliary care and support to people living elsewhere in the community.

The registered provider is required to have a registered manager in post. On the day of the inspection there was a manager that had been registered and in post for the last nine months. 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.

At the last inspection on 10 November and 10 December 2015 the service did not meet all of the regulations we assessed under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The registered provider was in breach of four regulations. These related to Regulation 12: Safe care and treatment, Regulation 18: Staffing, Regulation 10: Dignity and respect and Regulation 17: Good governance.

This was because the registered provider had not managed risk safely, ensured staffing levels were adequate to meet people's needs, monitored staff training, respected privacy and dignity and identified concerns, which meant that service delivery was inconsistent.

At the last inspection we made three recommendations, because there were shortfalls with management of medicines, providing person centred care and managing complaints.

At this inspection the registered provider had made sufficient changes to demonstrate compliance with the regulations.

The registered provider had ensured risks to people that used the service were appropriately assessed and managed. Risks assessments were detailed, covered areas of risk and were regularly reviewed. They cross-referenced with the information held in people’s support and health action plans, which also noted the risks people might face.

Staffing numbers were sufficient in all of the supported living schemes we visited. Everyone we spoke with felt staffing levels were adequate and that vacancies were covered by other support workers when necessary. Rosters were adequately covered to meet the needs of people that used the service.

The registered provider ensured support worker training needs and updates were monitored. The service had a high proportion of employees and relief workers whose training was up to date. The training matrix (record) was well managed and colour coding enabled quick and easy identification of training gaps and when training updates were needed. Dates of completed training were clearly identified. Support worker training had improved and was being managed appropriately.

We found that people’s privacy and dignity were respected.

The registered manager had implemented further audits and widened the range of safety checks to include people’s environments. Quality assurance and monitoring systems were much improved and the service was becoming more consist

Mencap York Domiciliary Care provides personal care and support to people with a learning disability living in and around York. At the time of our inspection, the service supported approximately forty adults living in 12 supported living houses and bungalows. This accommodation was not owned or provided by Mencap York Domiciliary Care and people living in these supported living schemes were tenants of a housing provider. The housing provider was responsible for the buildings and their maintenance. Alongside this, Mencap York Domiciliary Care ran a small ‘community service’, which provided domiciliary care and support to people living outside these supported living schemes.

We inspected this service between 10 November and 10 December 2015. This inspection was announced. The provider was given 48 hours’ notice because we needed to be sure that someone would be in the location offices and supported living schemes when we visited.

This was the first inspection of the location. Mencap York Domiciliary Care was previously registered at a different location where the service was last inspected on 9 May 2013 and, at which time, they were found to be compliant with all of the outcomes assessed.

Before our visit, concerns were raised about a number of issues including medication management, the lack of support with activities for people using the service, concerns about poor communication and concerns about how risks were identified and managed. We have recorded our findings in relation to these concerns in the body of this report.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager 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 2008 and associated Regulations about how the service is run.

During this inspection we found that the service was not always safe. Care workers we spoke with understood the types of abuse they might see and what action they would take to keep people using the service safe. However, we found that risk management was not consistent meaning that risks had either not been identified or, where risks had been identified, appropriate risk management was not always in place. This was a breach of Regulation 12 (2) (a) (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that staffing levels were not sufficiently monitored and maintained meaning that the level of staffing provided was sometimes less than the level assessed as required to meet people’s needs. This was a breach of Regulation 18 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the service had a safe recruitment process and an effective induction, however, on-going training had not been kept up-to-date and the system used to monitor and ensure that mandatory and service specific training was completed was not robust enough. This had led to gaps in training which impacted on care workers ability to provide effective care and support. This was a breach of Regulation 12 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that people's privacy and dignity were not always maintained. This was a breach of Regulation 10 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the service was not always well-led as the systems used to monitor the quality of the service were not robust enough. This meant that concerns we noted had not been identified and addressed. This was a breach of Regulation 17 (2) (a) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take in respect of these breaches at the back of the full version of this report.

We found that the safe storage of medication had not always been properly risk assessed and have made a recommendation about this in the body of the report.

People we spoke with told us that comments, concerns and complaints were not always well managed and told us that communication was not always effective. We have made some recommendations to the registered provider about the lack of staff training in how to support people to communicate and about improving the management of comments, concerns and complaints.

Relatives we spoke with raised concerns about the level of activities available to people using the service and staff we spoke with highlighted how staffing levels impacted on the availability of support to take people out.

We found that people were supported to make decisions in-line with principles of the Mental Capacity Act 2005 and that potential instances where people using the service were deprived of their liberty had been alerted to the supervisory body, which was the contracting local authority.

We found that people were supported to eat and drink enough and access support from healthcare professionals where necessary.

People we spoke with generally reported that care workers were kind and caring. We observed a number of positive interactions during the course of our inspection.

People were supported to make decisions and express their wishes and views; however, we found specific examples where a lack of training meant staff could not effectively support people to communicate.