United Response York DCA achieved a Good rating across all five key questions at its July 2017 inspection, having fully remediated prior breaches in medicines management and governance identified in May 2016. The service demonstrated robust safeguarding, person-centred care, effective quality assurance systems, and a well-supported workforce delivering consistent care to 27 people with learning disabilities or autism.
Strengths
· Previous breaches of Regulation 12 (medicines) and Regulation 17 (governance/records) fully remediated with completed action plans
· Robust medicines management with regular staff training, competency spot-checks, accurate MARs, and quarterly audit checks
· Sufficient staffing with internal 'relief pod' of accredited workers ensuring continuity and consistency for people
· Person-centred care plans written from the person's perspective, reviewed at least every six months, with involvement of people, families and health professionals
· Strong safeguarding culture with staff trained to recognise and escalate concerns; electronic recording and trend analysis by health and safety manager
York DCA (United Response) was rated Requires Improvement overall following a May 2016 inspection, with two regulatory breaches identified: unsafe medication administration records (Regulation 12) and incomplete, inaccurate care records and governance processes (Regulation 17). The service demonstrated genuine strengths in safeguarding, staffing consistency, and person-centred caring practice, but quality assurance systems failed to drive sufficient improvement in medication management and care planning documentation.
Concerns (6)
criticalMedication management: “PRN had been recorded as administered on two occasions but only initialled on one of those occasions with a recording of 'G' for the second occasion.”
criticalRecord keeping: “Accurate and complete records were not maintained to ensure care workers had sufficient information to act in people's best interest. Breach of Regulation 17 (2) (b) (c).”
moderateCare planning: “One core assessment was last reviewed in November 2013 and another in September 2014. Information in people's care files was not always up to date or consistent.”
moderateConsent / capacity: “Best interest assessments...the information was not always completed with enough information to ensure staff understood why the decision had been made.”
moderateGovernance: “Despite the quality assurance checks in place...management of medicines and care planning were being audited but we had concerns about these areas of practice.”
minorIncident learning: “The recording form provided limited opportunity to learn from these types of incidents and to reduce re-occurrence.”
Strengths
· Care workers received up-to-date safeguarding training and understood how to report concerns.
· Sufficient staffing levels with good retention; people supported by consistent, familiar care workers.
· Robust recruitment checks including DBS verification before independent working.
· Person-centred care planning with people involved in their own reviews and care worker selection.
· Strong multi-disciplinary working with local authority, GPs, SALT, and other health professionals.
Quality-Statement breakdown (16)
safe: Safeguarding people from abuse and harmGood
safe: Staffing levels and recruitmentGood
safe: Medication management and administrationRequires improvement
effective: Staff training and inductionGood
effective: Supervision and support of staffGood
effective: Mental Capacity Act / consent and best interest decisionsRequires improvement
effective: Accuracy and completeness of care recordsRequires improvement
effective: Nutrition and health supportGood
caring: Person-centred care and dignityGood
caring: Involvement of people and families in care planningGood
caring: End of life care planningGood
responsive: Personalised care plans and activity supportGood
responsive: Complaints and compliments handlingGood
well-led: Leadership and management structureGood
well-led: Quality assurance and audit effectivenessRequires improvement
well-led: Record keeping and governance systemsRequires improvement