This inspection took place on 4 January 2016 and was announced. Domiciliary Care Services (UK) Limited is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were 98 people using the service.
Domiciliary Care Services (UK) Limited had a registered manager in post. 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People we spoke with and information we received through questionnaires showed that people felt safe when receiving care and support from staff. People told us this was because staff were friendly and helpful. Staff had a good understanding of their role in reporting potential abuse and were aware of the types of abuse people were at risk of.
Potential risks to people’s safety were assessed and plans to minimise risk were developed, however these were not always sufficiently detailed to provide clear information for staff as to how risk was to be reduced. Staff we spoke with were aware of potential risks with regards to the people they supported and told us how they reduced risk through the use of equipment to safely move people within their home.
People we spoke with and information we received through questionnaires stated that staff arrived on time to provide people’s care and support and that staff completed the tasks they were commissioned for.
People told us that where they needed support with their medicine this was provided by staff. We found there were sufficient staff to provide people’s care and keep them safe and that staff had received training to enable them to meet people’s needs safely.
People we spoke with and information we received through questionnaires showed that people were supported by a consistent group of staff and that in a majority of cases people using the service had been introduced to staff to ensure they were compatible. People told us that individual requirements were met, which included receiving care from staff who spoke their first language and had an awareness of their cultural and religious beliefs.
People using the service and staff told us that ‘spot checks’ were carried out to ensure the care being provided was reflective of people’s plans of care and that staff interacted with people well. However we found that the information recorded about these checks to be very limited and did not provide a record to evidence the assessment and outcome of staff’s competency.
People we spoke with told us that staff sought their views about their care and support and listened to them. Staff told us that they always sought people’s views to ensure that the care they provide is as they wished it to be.
Where people require support with nutritional needs this is provided, which includes the preparation of drinks and meals. People’s plans of care provide information for staff as to the support people need, which ensures people have access to food and drink throughout the day when required.
Staff we spoke with were aware of their role in dealing with unexpected situations, which included arriving at someone’s home to find them unwell. Staff were clear of their role in contacting emergency services where appropriate, seeking guidance from managerial staff and supporting people to access health care.
People we spoke with and information we received through questionnaires recorded that people found staff to be kind and caring. They told us they were supported by a consistent group of staff which meant positive relationships had been developed. People stated that their privacy and dignity was promoted and we found staff were able to provide practical examples of how they promoted people’s dignity.
People told us that staff’s ability to communicate with them in their first language was positive. However a minority of people did express concerns that on occasion’s staff spoke in their first language, which excluded them as they did not understand what was being said.
People’s plans of care provided an overview as to the care and support people required which had been developed from their initial assessment. The style and content of people’s plans of care was currently under review. A quality assurance audit carried out by representatives of the local authority who commission packages of care for people had identified improvements were needed to ensure people’s plans of care were person centred and were developed with the involvement of the person or their representative.
Information we received through questionnaires showed that a majority of people who used the service felt they were involved in the service they received. However people we spoke with felt involved in their care but did not always have knowledge of their plans of care and other information written about them and was kept within their home.
People we spoke with and information gathered from our questionnaires showed that people were confident to raise concerns with staff about their care and that they had confidence that any concerns would be listened to and acted upon.
We found there was not an effective system in place to asses, monitor and improve the quality and safety of the service and to identify where improvements were needed. This meant the provider had not identified areas for improvement and therefore did not have a plan of action to bring about improvement with a view to continually improving the service provided.
The registered manager acknowledged that improvements were needed in some areas, many of which had been brought to the attention of the provider by the quality assurance monitoring visit carried out by representatives of the local authority who commission packages of care for people.
We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
You can see what action we told the provider to take at the back of the full version of the report.