Cephas Care Ltd Domiciliary Care Agency

Feedback from people using the domiciliary care service was positive overall but some people had been impacted by challenges with the electronic scheduling system and staff changes, which had led to some missed calls. The provider was monitoring these closely and told us that they had commissioned a new electronic system which they were about to start using. This provided us with some assurance that risks were reducing further.

Feedback from relatives of people using the supporting living service was inconsistent with some relatives telling us that their family member was happy and had a good relationship with staff, but others expressed concerns about staff skills and the use of agency staff. We have made a recommendation about staff training and the use of techniques to prepare people moving between services to increase the opportunities for a more positive experience.

Staff were in the processes of reviewing care plans. We have made a recommendation about accessing sensory assessments for some people to assist with the care planning process. End of life care planning was not well developed, and we have made a recommendation about this.

Throughout the inspection, the management team displayed a transparent approach. They spoke openly about challenges and shared their plans to address them. Audits were more robust and new systems had been put into place. We have made a recommendation about developing more observational audits.

People had increased choice and control over their lives and there was improved oversight of restrictions.

The provider recognised that further progress is needed, and they had an action plan in place to drive improvement.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. 'Right support, right care, right culture' is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right support: • The service had enough staff to meet peoples' needs and promote people's choice and independence. People had greater access to the community as staff were available to support them. • Staff were clearer as to their responsibilities in relation to the Mental Capacity Act and care plans were clearer about how people communicated and made their views known.

Right Care: • Risks to people's safety were identified and taken seriously. Guidance was available to staff on how they should reduce the risk of harm and promote people's dignity and human rights. • Incident reports were completed in more detail and reviewed by the management team to reduce the likelihood of further incidents. We saw that the numbers of incidents had reduced. • People were supported to maintain relationships with friends and family, and we saw that there were a variety of arrangements in place reflecting people's individuality.

Right culture: • The new management team were accessible and visible to people using the service and staff. There was a greater focus on improving people's experience. • Staff morale had significantly improved, and we saw that staff were encouraged to raise issues. • Staff had greater confidence in the safeguarding systems and that their concerns would be taken seriously. • The quality assurance systems had been strengthened and provided greater oversight.