About the service: Domiciliary Care Service is operated by Hertfordshire County Council (HCC) from main offices within Farnham House, Stevenage. At the time of our inspection 358 people received care and support from teams of staff who were responsible for particular sites and geographical areas.

Not everyone using Domiciliary Care Service receives the 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.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them

People’s experience of using this service:

People and their relatives were confident that people were safe and well protected from the potential risks of abuse and avoidable harm. Staff received training about how to safeguard people from harm and were knowledgeable about the risks and potential signs of abuse. Where potential risks to people’s health, well-being or safety were identified, staff were knowledgeable about these risks and knew how to respond safely.

Staff received fire awareness training. Practice evacuations took place to help ensure staff and people knew how to make their way to ‘safe zones’ as quickly as possible. Fire safety equipment was made available including evacuation chairs and slides. Staff had received infection control training, the houses we visited as part of this inspection were clean. Incidents and accidents were recorded, investigated and reviewed by the management team. This helped to ensure steps were taken to identify, monitor and reduce risks.

Safe and effective recruitment practices helped ensure staff were of good character and sufficiently experienced, skilled and qualified to meet the complex needs of people who used the service. People, their relatives and staff confirmed there were enough experienced, qualified staff to meet people’s individual support needs. Regular bank and agency staff covered for staff shortages and unforeseen absences such as sickness. People’s medicines were stored, managed and disposed of safely. Staff were trained and supported people to take their medicines at the right time in accordance with the prescriber's instructions and had their competencies checked by senior colleagues.

People's needs and preferences were assessed and the care provided was based on this assessment. Staff received training and refresher updates in a wide range of subjects relevant to their roles and specific to the needs of the people supported. Newly recruited staff completed an induction programme and did not work unsupervised until assessed as competent to provide care and support in practice. Staff said they felt valued, listened to and were well supported by their management team.

Staff were knowledgeable about people’s nutritional needs, and supported them to eat a healthy balanced diet wherever possible. Staff had good relationships with external professionals who told us they were confident that people received good support from the service. People had access to a wide range of health and social care professionals relevant to their needs. Staff sought people’s consent to the care and support they received, together with that of their relatives where appropriate.

People were positive about the quality of care provided by the staff and managers who supported them. People’s relatives complimented the staff team for the care and support t

Domiciliary Care Service is operated by Hertfordshire County Council (HCC) from main offices located in Farnham House, Stevenage. The service provides personal care and support to people with learning disabilities in their own homes. The people who receive support live in 22 different areas across the county; predominantly in and around Bishops Stortford, Hoddesdon, Welwyn Garden City, Letchworth, Stevenage, Watford, Hemel Hempstead and St. Albans. While people had their own flats or bedrooms, most typically shared some communal areas and facilities with others who lived and received support in close proximity. At the time of our inspection 333 people received care and support from teams of staff who were responsible for particular sites and geographical areas.

Because of the size and nature of the service our inspection took place over a number of dates, namely; 14, 15, 18, 19, 20, 21, 22 and 25 April, 03 and 12 May and 02 and 10 June 2016. This enabled us to visit and talk with people who lived in different areas, together with relatives and staff members, and gather a range of information relevant to the inspection. The visits were announced which meant that senior representatives of the provider were given a 48 hour notice period before each site visit. This was to help facilitate the inspection and make sure that people who used the service and staff members were available to talk with us.

At our last inspection on 17 and 18 October 2013, we found that the service was not meeting the required standards in some of the areas we looked at. This included some aspects of the care and support people received, the management of medicines, the way in which services were quality assured and how staff were supported to do their jobs. At this inspection we found that the required improvements had been made and that the service was meeting all of the fundamental standards.

There was a manager in post who had 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 and associated Regulations about how the service is run. The registered manager was supported by area managers and a number of unit managers based at and responsible for the day-to-day operation of each site where people received care and support.

People told us that staff helped them stay safe, both where they lived and when out and about in the local community. Staff had received training in how to safeguard people from abuse and were knowledgeable about the potential risks and how to report concerns. Robust recruitment practices were followed and there were sufficient numbers of suitable staff available to meet people’s individual support needs.

Where necessary and appropriate, people were supported to take their medicines safely and as prescribed by trained staff. Potential risks to people’s health and well-being were identified, reviewed and managed effectively. Plans and guidance were in place to help staff deal with unforeseen events and emergencies in a safe and effective way.

People and their relatives were positive about the skills, experience and abilities of staff who provided care and support. Staff received training and refresher updates relevant to their roles and the needs of people who used the service. They worked closely with managers and senior colleagues and had frequent opportunities to discuss and review their personal development and performance.

Staff provided appropriate levels of support to help people maintain good health and to attend appointments and access health and social care professionals when necessary. Where appropriate, people were encouraged and supported to eat a healthy balanced diet that met their individual needs and dietary requirements.

People were asked for their consent, vie

The people who used the service told us that they were very happy with their care and that the staff were lovely. They told us that the staff were easy to talk to and if they had a problem.

One person told us that they had been unhappy with the care they received from other services and that they were now happy with the care and support they were given. Other people said that they would like more involvement in menu planning and the opportunity to go shopping for food.

We found that sometimes the people were offered an inconsistent service. For example on location we visited closely involved the people in planning and delivering their care while another did not have an up to date care plan.

We found that staff were well trained to meet the needs of the people and we were told that the staff felt very well supported, particularly when they were caring for people with very complex needs.

The provider had included people in how the service was planned to ensure their needs and wishes were recognised and where possible met. People had been involved in the recruitment and selection of staff.

On this occasion we were not able to speak with people who receive a care and support service during our visit to a supported living location on the 28 October 2011, as they were out undertaking a range of activities in the community.

We sent out questionnaires to 60 people who used the service and also enclosed a separate questionnaire for their relatives/advocates. We received 19 completed replies from people who used the service. During our inspection we visited four sites and we spoke with 11 people who received care from this agency and with the relative of one person. We also spoke with 14 staff members and received information from another relative.

Generally, when asked how the care would be rated from the agency, people told us that services were good. One person told us, “Staff are very nice, they are helpful when I’m ill, upset or done something wrong...The staff talk about it and help me solve things”. However, a lack of planning and completion of ‘purple folders’, the records that provided information to health care professionals, meant that there was a risk that people’s needs would not be met in a timely way.

We found that people were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

Staff had not received all the relevant training to ensure that they could care for people to an appropriate standard.

There was not an effective system in place to regularly assess and monitor the quality of service that people received.

There was an effective complaints system available. People told us they felt staff listened to them.