Domiciliary Care Agency North West

Domiciliary Care Agency Northwest is registered to provide personal care and support to people who live in their own homes. The agency office is based in Ellesmere Port and provides support to people with complex health needs or people who have a diagnosis of autism or a learning disability in the Manchester area. At the time of our inspection the service supported five people.

This service provides care and support to people living in four 'supported living' settings, so that they can live in their own home as independently as possible. People's care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people's personal care and support.

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. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

The service has a registered manager. 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 a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in November 2016 we found that there were a number of improvements needed in relation to the Mental Capacity Act and evidence of capacity assessments and how best interest decisions were recorded. Care plans were not always person centred and audit systems had not identified the areas of improvement that were required. These were breaches of Regulation 11 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Effective, Responsive and Well-led to at least Good. The provider sent us an action plan that specified how they would meet the requirements of the identified breaches.

This inspection was done to check that improvements had been made to meet the legal requirements planned by the registered provider after our comprehensive inspection in November 2016. One adult social care inspector visited the service and inspected it against all of the five questions we ask about services: Is the service Safe, Effective, Caring, Responsive and Well-led? We found that the registered provider was meeting all the legal requirements.

The Care Quality Commission is required by law to monitor the operation of the Mental Capacity Act (MCA) 2005 and report on what we found. We saw that the registered provider had policies and guidance available to staff in relation to the MCA. Staff demonstrated a basic understanding of this and had all completed training. Care records reviewed included mental capacity assessments and best interest decision records.

People supported had a person-centred care plan with risk assessments in place that reflected their individual needs. People's needs that related to age, disability, religion or other protected characteristics were considered throughout the assessment and care planning process. Clear guidance was in place for staff to ensure that people's needs were appropriately met.

Audit systems were in place that were consistently completed. Areas for development and improvement were identified where required and action plans were prepared and completed. Accidents and incidents were analysed to identify any trends or patterns within the service.

The registered provider had robust recruitment systems in place that were consistently followed. All staff had undertaken an induction before they started work. Mandatory training was regularly undertaken with refresher updates in accordance with best practice guidelines. The management team supported staff through supervision and team meetings.

Staff understood what abuse may look like and were confident they could raise any safeguarding concerns and they would be promptly acted upon. Safeguarding policies and procedures were in place and staff were familiar with these.

Medicines were ordered, stored, administered and disposed of in accordance with best practice guidelines. Staff had all undertaken medicines training and their competency was regularly assessed. The registered provider had medicines policies and procedures in place.

People spoke positively about the activities that they undertook. They told us they were always offered choice in all areas of their life. People's privacy and dignity was respected.

People told us they had enough to eat and drink and that they enjoyed the food. They described choosing their meals and also how their independence was promoted by preparing their own breakfasts and lunch. Clear guidance was in place for staff to follow for people that had specific dietary needs.

People had developed positive relationships with the staff that supported them. Staff knew people well and treated them with kindness. People appeared to genuinely enjoy spending time with the staff team.

The registered provider had a complaints policy and procedure in place and available in accessible formats. People knew how to raise a concern and felt confident they would be listened to.

The five questions we ask about services and what we found