DCA Essex is a supported living service providing personal care to people with a learning disability, autistic people and people with a physical disability. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. We carried out an announced assessment on 9 December 2024, as part of the assessment we visited 3 shared houses where people received personal care as well as the registered office. At the last assessment published in October 2023 the provider was rated as requires improvement. At this assessment the provider had made improvements and was rated as good. We looked at quality statements relating to areas in Safe, Effective, Caring, Responsive and Well-led. For those areas we did not assess, we used the ratings awarded at the last inspection to calculate the overall rating. We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic. The service met this guidance. Staff had received training and demonstrated a good understanding of their responsibilities to support people to manage risks. Staff told us they were well supported in their roles and there were enough staff to support people safely. Staff also told us they felt the service had improved since the last assessment.
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DCA Essex, a supported living service for people with learning disabilities and autism, was rated Requires Improvement overall at its first inspection, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) identified. Key failures centred on unsafe medicines management, inconsistent risk assessment, insufficient staff skills and training, ineffective governance systems, and poor communication with families, while caring was rated Good reflecting committed frontline staff.
Concerns (13)
criticalMedication management: “Effective arrangements were not in place to ensure medication practices were safe and risk was minimised. This demonstrated a breach of Regulation 12.”
criticalGovernance: “The provider had not ensured effective processes were in place to assess, monitor and improve the quality and safety of the service. Breach of Regulation 17.”
moderateCare planning: “Care plans did not always reflect people's needs. The delivery of care was inconsistent and did not always match the aims of care plans.”
moderateStaff competency: “Agency and new staff did not always have the skills and information to meet people's needs.”
moderateStaff training: “The provider had not ensured all staff had access to the necessary support to develop their skills, in particular for specialist medicine administration.”
moderateStaffing levels: “Most staff told us there were not enough staff to meet people's needs. A member of staff told us, 'We don't have the time or staff to do what we would like to.'”
moderatePerson-centred care: “The staffing is totally not centred on the person's needs. Because of lack of stimulus and suitable activities, [Person] spends a great deal of time in their bedroom.”
moderateCommunication with families: “Some relatives told us they had heard of mistakes around medicines from a social worker, rather than from the provider.”
moderateComplaints handling: “Most of the concerns raised during the inspection had not been recorded centrally and so the complaints process was not being used as a positive tool to drive improvements.”
moderateConsent / capacity: “Not all staff had an understanding of capacity and how to work within the principles of the MCA. Systems did not effectively support people to communicate their decisions.”
moderateIncident learning: “We found examples where incidents were not reported promptly or fully, and the manager did not have full oversight of what was happening across the service.”
moderateLeadership: “There was no registered manager at the service... the manager covered a wide geographical area and was overstretched.”
moderateRecord keeping: “We found a care plan which had not been amended and held out of date, unsafe information about support with buccal medicines, despite an audit stating the plans had been updated.”
Strengths
· Staff were committed to the people they supported and many people lived full, engaged lives with person-centred activities.
· The service received regular safeguarding notifications demonstrating an open culture, and staff were able to describe how they protected people from abuse.
· Staff supported people to access specialist health and social care support in the community with positive examples of joint working with professionals.
· People could communicate with staff effectively because staff understood their individual communication needs.
· The new manager was responsive, committed to learning, and put people's needs at the heart of everything they did.
Quality-Statement breakdown (20)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier livesGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; Supporting people to express their viewsGood
responsive: Planning personalised care to ensure people have choice and control; Supporting people to follow interests and activitiesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learningRequires improvement
well-led: Engaging and involving people, the public and staff; How the provider understands and acts on the duty of candourRequires improvement
well-led: Working in partnership with othersRequires improvement