Arch Domiciliary Care Services Ltd was rated Good overall at its June 2019 inspection, with all five key questions rated Good, demonstrating safe, person-centred care delivered by skilled and empathetic staff under visible and effective leadership. The service was particularly notable for empowering people to achieve positive life outcomes, proactive health support, strong multi-agency collaboration, and an inclusive culture embracing diversity and independence.
Strengths
· Exceptional commitment to empowering people and building relationships, with staff proactively supporting people to achieve positive life outcomes beyond the limitations of their conditions.
· Highly person-centred care with tailored care plans, accessible communication formats, and people involved in choosing and training their own staff team.
· Proactive health monitoring by staff, including alerting people to changes in their health and supporting those with histories of disengaging from services to access healthcare.
· Strong multi-agency working, including staff shadowing health professionals in hospital prior to discharge to ensure seamless transitions into community care.
· Robust safeguarding systems with relatives included in training to support the safety of their loved ones.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
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 lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; 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 supportGood
well-led: Planning and promoting person-centred, high-quality care and support; duty of candourGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people, the public and staff; continuous learning and improving careGood
This assessment included a visit to the service on 17 and 18 April 2024, and was completed on 30 April 2024 . We looked at 3 quality statements; learning culture; involving people to manage risks; and safe and effective staffing. We expect health and social care providers to guarantee autistic people and people with a learning disability respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it. The service met this guidance. Staff told us they were well supported in their roles. Safe staff recruitment processes were in place and there were enough staff to support people safely. Staff had received training and demonstrated a good understanding of their responsibilities to support people to manage risks.
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Arch Domiciliary Care Services received an overall Good rating following a focused inspection of the Safe and Well-led key questions, with the ratings for both remaining Good from the previous inspection. Minor recording inconsistencies in medication administration records and an isolated infection control observation were identified, both already being addressed by the registered manager.
Concerns (5)
moderateMedication management: “'when required' prescribed medicines were administered; the reason was not recorded on the MAR but in the daily notes. Handwritten entries did not have a second staff signature.”
minorInfection control: “We noted a staff member wearing jewellery and long false nails. This posed an infection and safety risk and we raised this with the registered manager.”
minorConsent / capacity: “They had relied upon external health and social care professionals to undertake MCA assessments and best interest decisions.”
minorRecord keeping: “MAR were not consistently dated, and codes used to record such as 'refusal' were not consistently completed.”
minorCommunication with families: “Feedback from two professionals reported documentation and communication in some instances could be better.”
Strengths
· People received consistent, person-centred care from named staff teams with stable rotas and continuity of support.
· Staff received bespoke training including accredited physical intervention training, with a registered nurse conducting health-related training and competency checks.
· Robust safeguarding systems in place; staff understood how to recognise and report abuse, and all concerns were reported to the local authority and CQC as required.
· Physical intervention used as a last resort with debrief meetings held afterwards to support staff and people and identify lessons learnt.
· Overwhelmingly positive feedback from external professionals, people using the service, and relatives about leadership, responsiveness and quality of care.