United Response Derwent 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 Derwent DCA. 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.

The service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. The aim of the guidance is to assist services in enabling people with learning disabilities and autism using the service to live as ordinary a life as any citizen.

We inspected this service on 22 June 2018. This inspection was announced. This meant the provider and staff knew we would be visiting the service’s office before we arrived. There were nine people in receipt of personal care support at the time of this inspection visit.

The service had a registered manager 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.

At our previous inspection on 7 and 23 February 2017 although the service was not in breach of any regulations; the overall rating given was ‘requires improvement’. This was because not all staff were able to effectively communicate with people using their preferred method of communication. We had received mixed views from people’s families and the staff team regarding how approachable local managers were and some staff reported a lack of confidence in their line managers. Some staff did not know who the registered manager was or that they were an additional person they could raise their concerns with. At this inspection visit we saw improvements had been made.

Staff had a good understanding of people’ communication methods and received training in Makaton sign language when they supported people that used this method of communication. Makaton uses signs and symbols and is used to support hearing people with learning or communication difficulties.

The registered manager had sent out information to staff, people that used the service and their family representatives to remind them of their role and contact details. A logbook had been put in place to enhance the communication received by the registered manager.

People were supported to understand how to keep safe and staff were clear on their role on protecting people from the risk of harm. Staff understood their responsibilities to raise concerns and record safety incidents. These were reviewed and analysed to ensure actions could be taken to reduce risks and promote a safe environment.

Individual risks to people were identified and people were supported to take reasonable risks to promote independent living. Environmental risks within people’s homes were also undertaken and people were supported to raise any concerns regarding improvements with their landlord, to ensure they were protected by the prevention and control of infection and reduce the risk of trips and falls.

People were protected against the risk of abuse, as checks were made to confirm staff were of good character. There were sufficient staff to support people and the skill mix of staff ensured people’s needs were met. Medicines were managed safely and people were supported as needed to take their medicine as prescribed.

People were consulted regarding their preferences and interests and these were incorporated into their support p

This inspection took place on 7 February 2017 and was announced. The provider was given 48 hours’ notice because the location provides a domiciliary care service and we wanted to visit the office, talk to staff and review records. The inspection team included one inspector. Telephone calls were made to staff, family members and other professionals between 13 and 23 February 2017.

At the time of this inspection, United Response Derwent DCA provided support to 17 people in their own homes. This inspection covered services provided for seven people who received the regulated activity of personal care. These seven people lived in four separate premises.

Some people used Makaton signs and symbols as they were unable to verbally communicate. Not all the staff had the skills, knowledge or competence in Makaton to effectively communicate with people. This had led to people who used Makaton to develop other ways of communication with staff.

Families and staff had mixed views on how approachable local managers were.

People received support from staff with other skills and knowledge to meet their needs, including how to support people with their nutrition and hydration needs. Staff had supervision and appraisal, however not all staff felt fully supported by their managers. People were supported to access other healthcare provision when needed.

Staff understood how to provide care to people in line with the Mental Capacity Act 2005 (MCA). Any restrictions on people had been taken in line with the MCA and took a least restrictive approach to ensure people’s safety.

People received safe care. Staff had been trained and were knowledgeable about what actions to take to safeguard people from abuse. Any risks to people’s health or risks in their homes were identified and assessed for what actions to take to reduce risks. Staff recruitment and deployment was managed safely. Procedures were followed by staff managing and administering medicines to ensure people received their medicines safely.

People were cared for by staff who were friendly and caring and who had built up positive relationships with people. People had their independence promoted and their privacy and dignity respected. People were supported to make choices and their views were reflected in their care plans. People were supported to enjoy a range of interests and hobbies in their communities.

The service responded to any issues raised and a procedure was in place to record and investigate formal complaints.

Care was responsive and personalised as it was focussed on meeting the needs of each individual person. Care was regularly reviewed and evaluated to ensure it remained responsive. People and families had the opportunity to contribute to reviews of their relatives care.

There was a registered manager at the service at the time of our inspection. 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.

Systems and processes to check on the quality and safety of services and reduce risks to people were in place. Developments were in progress for staff to have improved access to IT. The service had also been developed with reference to person centred models of care and work.