The inspection took place on 10 October and was announced. The inspection continued on 12 October 2017 and was again announced.

United Response - Wiltshire DCA delivers domiciliary personal care to people with learning disabilities and autism. Personal care was provided to 12 people across six supported living locations..

The service had a registered manager in place. 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.

Medicines were mostly managed safely. We found that temperature checks were not completed or recorded in medicine cabinets. One person received liquid medicines which could not be stored over a certain temperature. We noted that this medicine bottle did not have an open date recorded on it either. On day two the area manager confirmed that this had been addressed. Medicines were securely stored and only given by staff that were trained to give medicines.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. However, people’s records did not always contain an assessment of their capacity. Where decisions had been made in people’s best interests around their care and treatment these were not always being recorded fully.

People, relatives, friends and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received safeguarding training.

Personalised care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they chose to live their lives. Each person had a care file which also included outcomes and guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, epilepsy and diabetes.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. A staff member told us, “I receive regular supervisions and find them useful”.

People were supported with shopping, cooking and preparation of meals in their home. The training record showed that staff had attended food hygiene training.

People were supported to access healthcare appointments as and when required and staff followed GP and community learning disability nurses advice when supporting people with on-going care needs.

People and relatives told us that staff were caring. During home visits we observed positive interactions between staff and people. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes, interests and communication needs. Information was available in various easy read and pictorial formats. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before using the service and care packages reflected needs identified in these. Outcomes were set by people and person centred reviews took place. These evidenced that people were actively supported to work towards their outcome areas and that achievements were recorded. Additional support was highlighted and provided. We saw that these were regularly reviewed by the service with people, families and health professionals when available.

People, staff and relatives were encouraged to feedback. We reviewed the findings from quality feedback questionnaires which had been sent to people, families, professionals and staff and noted

This inspection was in response to a safeguarding alert. We investigated this and found that the provider had taken appropriate action and addressed our concerns.

On the day of our visit 16 people were using the service. They were supported by 47 care workers, administration staff, a deputy manager, a service manager and the registered manager. We spoke with five relatives of people who used the service, four care workers, the service manager and the area manager.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and care workers told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found;

Is the service safe?

People's relatives told us the service was safe. One said "I know my son feels safe and I have no concerns about that safety". Another said "safe? totally. Very much so. I have every confidence in United Response and I would recommend them".

Care workers had received training in safeguarding vulnerable adults and displayed a good knowledge of abuse, the types of abuse and what to do if they suspected abuse was happening. This showed us that the provider had taken appropriate steps to prevent abuse from happening in the service.

People's care plans reflected their needs and we saw that appropriate risk assessments were in place to reduce the risk of inappropriate care, treatment or support. Risk assessments were regularly reviewed.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The manager was aware of the recent Supreme Court judgement in relation to the Deprivation of Liberty Safeguards and was taking appropriate action. The service had one person subject to a DoLS. We saw that this person had been appropriately assessed and their best interests considered.

Is the service effective?

Relatives we spoke with were happy with the care people received. One said "they enable my daughter where possible and I also have a big input. They supported her to find voluntary work, I can't praise them too highly". Another said "communications are excellent, we have regular contact with them".

Care plans were person centred and care was delivered to meet people's needs. We saw that people were involved in their care and offered choices. Their decisions were respected and support was given in line with people's wishes.

Care workers were appropriately trained to carry out their role. Specialist training was also given where appropriate. For example, one person had autism and the care workers who supported this person had been trained in autism awareness.

Is the service caring?

We spoke with five relatives. Everyone we spoke with was complimentary about the care received. One said "I am very happy with the service, they are very good. They look after my son well". Another said "they are excellent in every way. The care is good and the carer's are excellent. They enable my daughter to be as independent as possible".

We observed the interactions between a care worker and the person they cared for. The care worker showed genuine warmth and affection for the person and had given them a small gift. The person was clearly delighted with this and was smiling.

Is the service responsive?

People's needs were assessed. People's self sufficiency, communication and daily living skills were assessed and these assessments allowed the service to create care plans appropriate to the person's individual needs. People's likes, dislikes and preferences were recorded and we saw that people's wishes and choices were respected.

The provider responded to people's requests. For example, we saw that one person had asked for a name plate. The issue was raised at a staff meeting and a care worker was identified to action this request. We looked at the minutes of the following meeting and saw it was recorded that the name plate had been provided.

We saw that complaints were dealt with in line with the provider's policy and were resolved in a timely fashion. The complaints policy was held in a support file by people who used the service and care workers were trained to assist people if they wish to make a complaint.

Is the service well led?

There was a registered manager in post who was available for people and care staff to raise any concerns. During our inspection we looked at the quality assurance systems that were in place. The information reviewed demonstrated that the home had an effective system to regularly assess and monitor the quality of service that people received.

The provider held regular meetings with care staff, people who used the service and their relatives. Actions from these meetings were followed through to improve the service.

We spoke with two people who received a service from the United Response domiciliary care agency. People who received services exercised choices and gave consent to the support they received. They were involved in planning their support needs that were well documented and reviewed to show who had attended, what had been discussed and actions arising. People told us, and we saw that they had varied lifestyles and were supported by staff of their choosing.

The agency operated from premises that were accessible and provided a room for meetings. We saw evidence that the premises were checked for the safety of those who worked there and visitors.

We spoke with the registered manager and three support staff. They were all committed to the values of the organisation and clearly enjoyed providing the service. They all spoke highly of the organisation and support workers described having access to management and on-going backing if needed.

People were provided with information about how to make a complaint in an easy read format. It explained people’s rights to complain and how they would be responded to. The people we spoke with had no complaints but spoke favourably about the support they received, those that worked with them and the organisation.

We spoke with a person who received a domiciliary care service. They described the service as “excellent” and said their needs were met “very well”. They told us about the team of regular carers and that they knew who was supporting them because they had a rota. They said they always received a good service from the office when they made contact and told us that they would speak with the manager if they had any concerns. We also spoke with a relative and a person's friend.

People who used the service were given appropriate information and support regarding their care or treatment. The guide for people who used services gave information about staff including their qualifications and experience. It was in pictorial and written format and explained what people could expect. The guide also contained information about making a complaint.

We looked at the policy for safeguarding vulnerable people, noted it had been updated in November 2012 and was included in the quality manual ‘Getting it right’. It defined what constituted abuse and gave information for staff about the Mental Capacity Act 2005 and Deprivation of Liberty safeguards (DoLS).

We spoke with a member of staff who had worked for the service for 23 years. They told us they “love their job” and got the support they needed.

People who used the service, their representatives and staff were asked for their views about their care and treatment.

We spoke with one person who told us that the support they received was very good because they had a good team of staff. They said “staff do not let you down”, are “always on time” and “they understand my support needs”.

The person told us that they were consulted about their care plan and agreed to all the help they get. They confirmed there was a communication book used and that they knew what was written about them.

We spoke with two relatives of people that used the service. One of them told us they thought that the service was “fantastic” and they could not speak too highly of the organisation. They described the organisation as ‘open’ and that this led to a sense of working together with families.

United Response DCA Wiltshire is a domiciliary care service providing care and support to people in their own homes and in supported living services. When we visited 13 people were using the service at eleven separate addresses. Nine people lived on their own with four people living in two services shared with one other person.

The inspection was announced. We gave the provider 48 hours notice of our inspection. We did this to ensure we would be able to meet with people and staff at the service.

There was no registered manager in post at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. 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. The provider had informed CQC when the previous manager left. They had put in place a temporary manager and have completed their recruitment process for a permanent manager. The provider said when the newly appointed manager commences they will begin the application process to register with CQC as manager.

People were safe because staff understood their role and responsibilities to keep people safe from harm. They knew how to raise any safeguarding concerns. People were supported to take appropriate risks and promote their independence. Risks were assessed and individual plans put in place to protect people from harm. There were enough skilled and experienced staff to meet people’s needs. Staff underwent employment checks before working with people to assess their suitability. Medicines were managed safely. Equipment was regularly serviced and well maintained and staff prevented and controlled the risk of infection.

The service was effective because staff had been trained to meet people’s needs. Staff received supervision and appraisal aimed at improving the care and support they provided. People were supported to maintain their independence. Staff understood their roles and responsibilities in supporting people to make their own choices and decision. People were supported to eat a healthy diet and drink sufficient fluids. People’s health care needs were identified and met.

People received a caring service because staff treated people with dignity and respect. People were actively involved in planning the care and support they received. People were supported to develop and maintain relationships with family and friends.

The service was responsive because the care and support provided was individualised. The service adapted to people’s changing needs. Staff providing care and support were familiar to people and knew them well. The service made changes in response to people’s views and opinions.

People received a service that was well led because the temporary manager and other senior staff provided good leadership and management. The values, vision and culture of the service was clearly communicated. The quality of service people received was continually monitored and any areas needing improvement were identified and addressed.