One to One Plus North is rated Good overall following a January 2020 inspection of this domiciliary care service supporting 20 people, with Effective rated Requires Improvement due to failures in applying the Mental Capacity Act and incomplete DoLS/Court of Protection processes. Governance systems also failed to identify concerns around topical medicine storage and absent end-of-life care plans prior to inspection.
Concerns (5)
critical
Consent / capacity
: “People did not always have mental capacity assessments for restrictive interventions and it was not always clear if decisions made were in their best interest.”
criticalConsent / capacity: “The service had applied for Deprivation of Liberty Safeguards (DoLS) with the local authority but had not pursued an application to the court of protection. DoLS is not applicable to people living in their own homes.”
moderateMedication management: “Topical medicines, such as creams or lotions did not always have a date of opening on them. This meant that there was a risk of people receiving topical medicines which had expired.”
moderateEnd-of-life care: “The service did not always have end of life care plans, we saw one person with a life limiting health condition did not have an end of life support plan in place.”
moderateGovernance: “These systems had not identified the areas of concern we identified regarding end of life care, medicines storage and the mental capacity act.”
Strengths
· Oral medicines were administered, stored and recorded safely with protocols in place for 'as required' medication.
· Staff were knowledgeable about safeguarding and knew how to escalate concerns internally and to outside agencies.
· Accidents and incidents were analysed monthly for trends with actions taken to reduce risk and share learning.
· Staff were recruited safely with pre-employment checks including full work history, references and DBS checks.
· People were treated with kindness and respect; care records were person-centred and promoted independence.
Quality-Statement breakdown (24)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: End of life care and supportRequires improvement
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships and follow interestsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service and continuous learningGood
One to One Plus North received a Good rating across all five key questions at its December 2016 inspection, demonstrating safe, person-centred care for 20 people with learning disabilities and autism. The service showed particular strength in consistent staffing, individualised care planning, comprehensive staff training, and robust quality assurance systems.
Strengths
· Risks assessed and managed safely without unduly restricting people's independence, including behaviour and autism-related risks
· Sufficient staffing levels with consistent staff allocation to meet individual needs and preferences
· Safe recruitment practices including DBS checks, reference checks and employment history verification
· Medicines managed safely with thorough staff training and individualised care plan guidance
· Comprehensive training programme including autism, Positive Behaviour Support, MCA and Care Certificate induction
Quality-Statement breakdown (18)
safe: Safeguarding people from abuseGood
safe: Risk assessment and managementGood
safe: Staffing levels and deploymentGood
safe: Safe recruitment practicesGood
safe: Medicines managementGood
effective: Staff training and inductionGood
effective: Supervision and supportGood
effective: Consent and Mental Capacity ActGood
effective: Health needs assessment and referrals
Good
caring: Treating people with dignity and respectGood