About the service: United Response Matlock DCA is a domiciliary care agency that provides personal care to adults with a learning disability living in their own homes. Some people lived alone and others with one or two other people that were also receiving a service from United Response Matlock DCA. Some people received support from staff at various times of the day and others over a full 24-hour period. Not everyone using the service received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection 16 people were provided with the regulated activity of personal care.

People’s experience of using this service:

There were systems in place to monitor the quality of the service and drive improvement but these had not been used effectively to ensure support plans were kept up to date. Some people’s support files, at the time of the inspection were not up to date. This meant that staff did not have clear guidance to ensure people’s needs and preferences were met.

Staff understood the support people needed to make decisions when people could not independently make specific decisions regarding their care. Although mental capacity assessment forms were seen in people’s support files, these had not been completed. This meant we could not be confident that people’s rights were upheld or that they were supported to have maximum choice and control of their lives and were supported in the least restrictive way possible.

Support plans were in place to promote positive behaviours and safeguard people from injury when they became anxious. The interim service manager confirmed that they were working through everyone’s positive behaviour plans to ensure they were up to date and relevant. They were able to demonstrate through their action plan that they were auditing all support files on an ongoing basis and had introduced shift planners that provided details of people’s routines. This supported staff, particularly new and agency staff to ensure people’s preferred routines were followed. We saw staff feedback was also included on the planner to demonstrate people were supported to follow their preferred routines.

There were several staff vacancies at the time of the inspection and several shifts were being covered by agency staff, who were working alongside permanent staff whilst new staff were being recruited. We saw that despite the staff vacancies, sufficient staff were available through the use of regular agency staff, where needed.

The outcomes for people using the service reflected the principles and values of Registering the Right Support in the following ways; People were supported to take reasonable risks to enable them opportunities to lead a full life. People were supported to make decisions about what they ate and drank. People spent their day as they preferred were supported to take part in social activities of their choice to enhance their well-being.

Staff understood their responsibilities to safeguard people and were clear on reporting any concerns. People were supported to take their medicines in a safe way. Recruitment checks were undertaken, to determine the suitability of new staff and protect people that used the service. The risk of people acquiring an infection, was minimised as infection control procedures were in place and followed.

People were supported as needed, to ensure their preferences and dietary needs were met. Healthcare services were accessible to people with staff support as needed, and they received coordinated support, to ensure their preferences and needs were met.

Information was available in an accessible format to support people’s understanding. People maintained relationships with their family and friends and were encouraged to give their views about the service. This included raisi

We spoke with one person using the service, two relatives, five staff and three health and social care professionals. This is a summary of what we found.

Is the service safe?

We received information of concern in May 2014 that suggested people’s ability to make decisions was not being properly assessed and consent to activities with risks was not being properly sought. However, we found people had been involved in the discussion about their care and we saw there were relevant risk assessments in place for specific activities.

A health professional described the service as excellent and was able to give examples of how staff had worked with people using communication aids to ensure they understood the decision they were making. We discussed taking risks and they said of staff “They do everything they should do” and confirmed that accurate records were maintained.

We found the premises were suitable for the running of the agency. There was sufficient equipment, including computer, to ensure the service ran smoothly.

Is the service effective?

Feedback from external health and social care professionals was positive. One told us “The service is excellent at communicating with us” and another said “They’re very professional”. One professional gave an example of how someone had improved and said this was due to the skills of the staff.

Staff we spoke with were able to demonstrate they had the knowledge and skills to work safely with people and training records we saw confirmed that there was relevant training arranged to maintain their skills.

Is the service caring?

One person told us “I like living there and I like the staff” They told us they had different activities they were involved in and went out in to the community to local shops. We saw they had a warm relationship with the staff supporting them. One relative we spoke with described the support for the person they were involved with as brilliant and another said “All has gone well since he moved there”.

Is the service responsive?

We found staff worked with other health professionals and made appropriate referrals for specialist advice. This showed that the service was responsive to change, ensuring peoples safety and welfare.

We saw there were a sufficient number of staff available to meet people’s needs and staff we spoke with confirmed this. The manager was able to demonstrate how any unexpected absences were covered.

Is the service well led?

We found the service had well established quality assurance procedures and we saw records that showed the provider carried out a variety of monthly and weekly checks on environmental issues, such as fire equipment and health and safety checks in the locations where care was provided.

We received information of concern in May 2014 that suggested people’s complaints were not listened to or properly addressed. We found there was no formal record of the issue raised with us at the Commission, although the provider was aware of the dissatisfaction of the person concerned. Failure to address dissatisfaction via the complaints procedure does not ensure that people’s concerns are taken seriously.

Staff told us they felt well supported by the management team and one person described the registered manager as approachable. All the staff confirmed they were able to access guidance as required.

People had care records which included up to date information about how they wanted their care and support provided.

People were supported to take part in activities that were interesting and stimulating so they had a meaningful lifestyle. People were able to choose what recreational activities to be involved with and were supported by staff.

We saw that people were protected from the risks of abuse because the staff had received the necessary training to identify and report safety concerns.

Staff told us they received appropriate training and support in order to provide positive outcomes for people using the service.

We saw that the provider had an effective system in place to assess and monitor the service, which focussed on improvement.

United Response provide personal care and support to adults with learning disabilities who need care in their own homes. The service is run from an office in Cromford near Matlock and they provide care to people in North Derbyshire. We carried out this inspection at the provider’s office on 28 October 2015. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to make sure the manager was available. In addition we also carried out visits to people using the service on 2 November 2015. There were four people receiving personal care at the time of our inspection.

A registered manager was 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.

We found some inconsistencies in how medicines were recorded. People’s medicines records were not always fully completed so we could not be sure the risk of errors was minimised.

We found the management of complaints had improved since our previous inspection visit. People we spoke with knew how to make a complaint and how to contact the office. A relative said “I know how to make a complaint but I’ve not needed to.” The provider took opportunities to listen and learn from people’s experiences, concerns and complaints to improve the quality of care provided.

Risks to people were identified and managed. They were reviewed on a regular basis which meant staff had up to date information to ensure people were supported safely. People were protected from abuse because staff understood the provider’s procedures and followed them.

There were sufficient staff to ensure people’s needs were met in a timely manner. Recruitment procedures were comprehensive and ensured suitable staff were employed to work with people using the service.

People were involved in making decisions where possible and their legal rights upheld, which ensured that the least restrictive option was taken in a best interest decision for them.

We found people’s health care needs were addressed promptly. They had access to health care professionals and attended scheduled appointments.

Staff were appropriately trained and supported. They had all undergone a comprehensive induction programme and, where necessary, had received additional training specific to the needs of the people they were supporting.

Most people using the service were supported in their food choices and had sufficient to eat and drink.

People were cared for by staff that were caring and who respected people’s views and choices. We saw they were well cared for and felt comfortable and safe with the staff who provided their support.

People’s privacy and dignity was maintained. People received care that was personalised and responsive to their needs. We saw people had varied social lives and were encouraged to participate in interests on their choice.

The provider had systems in place to monitor and improve the service provided and there were regular audits of key areas such as care records and health and safety. We saw people and their relatives were asked their opinions through surveys and discussions with staff.