Domiciliary Care Cheshire

People supported either lived in their own home or self-contained apartments some of which had staff facilities within communal areas. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

Right Support People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Restrictions on people's care and support were not always appropriate or monitored clearly. There was a lack of oversight on the use of restriction at times. The provider took steps to rectify this during the inspection.

Staff received a range of training to enable them to provide safe and effective support, but at times staff training was out of date. Staff knew the people they supported well, including their likes, dislikes, needs and preferred choices. Staff were recruited safely and had a good understanding of safeguarding and whistleblowing procedures. People were supported to attend health appointments in the local community and were engaged in a range of activities.

Where people had specific health needs, these were risk assessed and staff understood people's needs well. Where appropriate, people had positive behaviour support plans to guide staff on how to support them safely and effectively.

Right Care

Records relating to people's recorded care needs were at times missing or incomplete. Relatives told us people received enough food and fluid to maintain a health lifestyle, but this was not always recorded clearly. Staff supported people to undertake healthy eating and regular exercise.

Relatives praised the staff approach to providing care and support, and felt their loved ones were being supported well. People received care and support tailored to their wants, needs and preferences. People were able to exercise choice over how they spent their time.

Staff treated people with dignity and respect, and supported them to develop living skills and achieve meaningful outcomes in the areas of independence, community access and taking control of their own care. People told us they were happy with being supported by their staff, and they had developed good relationships with them.

Right Culture The management team undertook audits of the care delivered, but this had not always identified issues with the use of restrictions and staff recording care delivery. The provider had worked to instil a positive culture at their locations. Staff told us they were confident in raising concerns should they need to, and praised the management team who were described as "brilliant" and "responsive." Staff and relatives told us morale had improved since the last inspection and staff and people were engaged in expressing their views around the delivery of care.

There was a range of professionals involved in people's care. Some professionals felt the management team needed to be more forthcoming with requests for information. People's care records evidenced the involvement of a wide range of health and social care professionals so people could receive effective and responsive care via good partnership working.

Leaders at the service led by example and staff, people and their relatives said there had been a positive improvements in culture and openness. Staff told us they felt supported, valued and listened to by the management team, and people and their relatives were confident in raising concerns should they need to.