Custom Home Care

Custom Home Care is a service used by autistic people or people with a learning disability but is not registered as a specialist service. The service supported people with a learning disability some of whose primary care need was not their learning disability. We assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities most people take for granted. We were not assured the provider fully understood or met the requirements of CQC’s guidance for the provision of support for people with a learning disability. We spoke to the registered manager and they confirmed they intended to submit a notification about provision of support for autistic people and people with a learning disability. CQC will review this notification using the ‘Right support, right care, right culture’ guidance.

The provider had systems and processes in place to log, review and analyse accidents and incidents. Lessons were learnt to continually identify and embed good practice. The provider raised concerns about people’s safety with local partners and followed local safeguarding processes. There was a safeguarding policy in place and staff received training to keep people safe. We were not assured the principles of the Mental Capacity Act 2005 (MCA) were understood by the provider or the registered manager. There were no references or evidence of assessing or reviewing people’s capacity following the principles of the MCA. People’s care needs were risk assessed and reviewed, however, some elements of people’s care plans lacked detail. The provider made sure there were enough qualified and experienced staff, who received effective support, supervision and development. Members of staff received training to deliver care safely, however, there was limited evidence of training to support staff to understand the needs or provide care and support to people with a learning disability or autistic people. The provider made sure medicines and treatments were safe and met people’s needs and preferences.

Care plans were person-centred and people were involved in developing and reviewing their care plans, however, there were some key elements missing from care plans including details about people’s communication preferences and needs, information specific to people’s learning disabilities and assessments of people’s capacity to make informed decisions. The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. The provider routinely monitored people’s care and treatment to continuously improve it.

The provider always treated people with kindness, empathy and compassion and respected their privacy and dignity. Members of staff were kind and caring. The provider treated people as individuals and made sure people’s care, support and treatment met people’s needs and preferences. People were encouraged to be independent and help was there when they needed it. The provider cared about and promoted the wellbeing of their staff and supported and enabled staff to always deliver person-centred care.

The provider understood the diverse health and care needs of people and their local communities, so care was joined-up, flexible and supported choice and continuity. People and their relatives told us communication between themselves, members of staff and the management team was good. However, people’s communication preferences were not recorded in their care plans and no specific reference was made to communication styles or aids for people with learning disabilities.

The provider did not have a clear shared vision, strategy and culture. Leaders had the skills and knowledge to lead effectively; however, they did not always understand the context in which the provider delivered care, treatment and support. The provider did not always have clear responsibilities, roles, systems of accountability or good governance. We did not see evidence of performance and quality monitoring reports or discussions between the registered manager and the provider where quality was discussed.