Domiciliary Care Cheshire, a supported living service for people with learning disabilities and autism, retained a 'Requires Improvement' overall rating with continued breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance), primarily due to inadequate oversight of restrictions, incomplete care records, and inconsistent mental capacity documentation. Strengths included caring, person-centred staff practice rated 'Good', safe medicines management, robust infection control, and a positive and improving staff culture.
Concerns (10)
criticalSafeguarding: “Restrictions on people's care and support were not always appropriate or monitored clearly. There was a lack of oversight on the use of restriction at times.”
criticalGovernance: “The lack of consistent management oversight and robust governance placed people at the risk of harm and meant they did not always receive, quality, effective, person-centred care.”
criticalConsent / capacity: “Mental capacity assessments, best interests' decisions and DoLS applications did not always contain all of the required information.”
moderateCare planning: “Daily records relating to the delivery of care and support were at times incomplete or missing. The provider agreed to review this.”
moderateRecord keeping: “Records relating to what food and fluids people had consumed were at times incomplete or missing, meaning it was unclear if their needs had been met on certain days.”
moderateStaff training: “On occasion some staff members training was out of date and needed to be refreshed. At times, staff training was out of date, and this had not been rectified by the management team.”
moderateSupervision / appraisal: “Staff received supervision from management to ensure they could learn and develop within their role. However, on occasion these were completed infrequently.”
moderateStaffing levels: “There were not always enough staff to support people. At one location, we were unable to determine if a person received 2:1 support to access the community in line with their assessed needs.”
moderateIncident learning: “Accidents and incidents were not always analysed to identify key trends which could help prevent them from occurring again.”
minorCommunication with families: “Some relatives told us they would like to receive more updates from the management team regarding their loved ones. The provider agreed to look into this.”
Strengths
· Staff had received safeguarding training and demonstrated good understanding of safeguarding and whistleblowing procedures.
· Medicines were managed safely with accurate MARs, body maps for topical medicines, and person-centred PRN protocols.
· Strong infection prevention and control practices with monthly detailed audits evidencing high compliance.
· People were treated with dignity and respect; relatives praised staff approach and described teams as 'brilliant' and 'responsive'.
· People were supported to develop independence in living skills, personal care, community access and communication.
Quality-Statement breakdown (25)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Adapting service, design, decoration to meet people's needsGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
Domiciliary Care Cheshire, a supported living service for people with learning disabilities and autism, deteriorated from Good to Requires Improvement due to regulatory breaches in safe care and treatment (Reg 12), safeguarding (Reg 13), and good governance (Reg 17). Despite caring and compassionate staff and safe medicines management, the service failed to consistently assess and mitigate risks, act on safeguarding concerns promptly, maintain up-to-date care plans, or ensure robust management oversight across its six supported living settings.
Concerns (12)
criticalSafeguarding: “Systems to protect people from the risk of harm had not been consistently followed and staff concerns had not been promptly acted upon. This was a breach of regulation 13.”
criticalGovernance: “The lack of consistent management oversight and robust governance placed people at the risk of harm. This was a breach of regulation 17 (Good governance).”
criticalCare planning: “Risk assessments did not always hold sufficient information to guide staff on action to take to mitigate risk.”
criticalConsent / capacity: “People within one supported living service did not have appropriate decision-making processes in place. Restrictions did not have the required legal authorisations in place.”
moderateIncident learning: “Incidents in one service although fully recorded by staff had not been promptly reviewed and analysed. This meant lessons learned had not been identified.”
moderateStaff training: “Staff training records across all the services showed that not all staff were up to date with their essential training. The provider had identified this through audits but had failed to take action.”
moderateSupervision / appraisal: “Staff supervision was not consistently evidenced across all services. Staff at one service told us they felt unsupported and not listened to by senior managers.”
moderateRecord keeping: “Care plan reviews had documentation in place, however, did not always evidence the involvement of people, relatives and health care professionals.”
moderatePerson-centred care: “People's care and support plans did not always focus on positive outcomes or goals to aim for which could improve their quality of life.”
moderateEnd-of-life care: “There was an example of a person in receipt of palliative care who did not have a plan in place or any evidence to suggest a discussion had been held.”
moderateLeadership: “There was a registered manager in post at the beginning of the inspection. However, they left before the report was published.”
minorCommunication with families: “Two services had not promptly responded to concerns raised by relatives. Relatives told us the provider contacted them for their views but said they hadn't been asked for feedback recently.”
Strengths
· Medicines were managed safely with up-to-date MARs, individual medicines care plans, trained staff, and STOMP principles consistently applied.
· Staff demonstrated kindness, compassion and resilience, with people and relatives speaking highly of their caring approach.
· Infection prevention and control processes, including PPE use, were effective and the policy was up to date.
· Safe recruitment practices were followed including DBS checks and reference requests.
· People were supported with accessible communication formats including easy read, pictorial documents and sign language.
Quality-Statement breakdown (25)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
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effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to live healthier lives and access healthcareRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships; support to follow interests and activitiesGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Working in partnership with othersRequires improvement