Archived: Devana Care

Devana Care is a domiciliary care agency providing personal care to people in their own homes. They support older people, who may have a sensory impairment, dementia, mental health needs and/or a physical disability.

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. At the time of the inspection, four people were in receipt of personal care.

People’s experience of using this service and what we found

At the last inspection in September 2019 we found there were breaches of two regulations. At this inspection we found the required improvements had not been made and the registered person was still in breach of the same two regulations. These are, safe care and treatment and governance of the service.

Medicines were not safely managed. For example, handwritten additions to medicines administration records were seen which did not contain the information required of the National Institute for Health and Care Excellence guidance.

People were not always protected from the risks of harm. For example, risk assessments in people's care plans in their homes were not all up to date. This meant, when providing care, staff did not always have details of actions to take to reduce risks to people who use the service and keep them safe.

The registered person had not implemented an effective system to ensure their compliance with the fundamental standards. For example, the registered person failed to maintain an accurate, complete and contemporaneous record in respect of each person using the service.

Staff had received training in topics the registered manager considered mandatory. The registered person had not followed up on the recommendation made at the last inspection relating to referring to best practice guidance regarding staff training.

Employment checks, including criminal record checks had been obtained for new staff. Staff had received training in safeguarding adults and were aware of their responsibilities to protect people from the risks of abuse. They were able to state what action they would take in response to witnessing abuse, including contacting the local authority safeguarding team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 31st October 2019) and there were two breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found enough improvements had not been made and the provider remained in breach of regulations. The service remains rated requires improvement.

Why we inspected:

We carried out an announced focused inspection to follow up on regulation breaches and a recommendation. This report only covers our findings in relation to the key questions safe, effective and well-led which contain those requirements.

The ratings for the key questions caring and responsive from the inspection in September 2019 were used in calculating the overall rating for the service. The overall rating for the service has not changed.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Devana Care on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Devana Care a is a Domiciliary Care Agency (DCA) providing personal care to adults. Staff provided care to people within their own homes. At the time of inspection, the service was supporting 5 adults. They supported 2 adults with personal care in a supported living house.

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.

People’s experience of using this service and what we found

We found that medicines were not always managed safely by the service. We were told that there had been no medicines recording errors. The registered manager stated that the team leader completed medicines audits. However, when reviewing peoples medicine administration records (MAR), it was found there were four missed signatures where staff had failed to sign. People’s daily notes did state that people had received their medicines on the days the signatures were missed. This therefore meant that errors went unnoticed or unrecorded.

We found when reviewing peoples training records not all staff members mandatory training had been renewed in line with the providers policy.

We have made a recommendation about the management of staff training.

We did not see any effective quality assurance systems in place for monitoring and improving the service. We asked the registered manager for any systems they used to retain good governance of the service, but they stated, “We do not have any”.

The service had not undertaken a feedback survey with people, relatives or staff since 2016. The registered manager stated that they would gain feedback from staff through supervision and team meetings.

Peoples care files did not detail their preferences for how they would like to receive end of life care.

We recommend that the provider seeks to reflect the preferred preferences in the design of peoples care to ensure their needs are met.

People's care plans had detailed guidelines to ensure staff supported them including personal care, support with communication, risk assessment around physical and mental health and behaviour management plans.

People’s needs were assessed, planned and reviewed to ensure they received support that met their changing needs. Risk assessments and care plans were person-centred and considered all aspects of their lives.

Care plans and risk assessments were reviewed annually, which allowed measures to be taken to ensure people’s care needs and preferences were accurately reflected.

All peoples care files contained a “who am I” guide that contained specific information about people’s history, routine, hobbies and support needs. Staff were knowledgeable about the needs, choices and preferences of the people they provided care and support.

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

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (report published 08 March 2017).

We have found evidence that the provider needs to make improvements. Please see the safe and well led sections of this full report.

Enforcement

We have identified two breaches. Regulation 12 proper and safe management of medicines and the registered person failed to ensure risks relating to the safety and welfare of people using the service were assessed and managed at this inspection. Regulation 17 The registered person had not established an effective system to enable them to assess, monitor and improve the quality and safety of the service provided.

You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection a registered manager was 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.

Recruitment procedures were not always robust and the provider did not always have all the required information relating to staff. However, the registered manager took immediate action. Following the inspection they provided us with evidence of the required information and improvements they had made to the recruitment process.

Risks to people’s well-being were assessed and guidance provided for staff to minimise risks. However, the management plan for the risks related to moving and positioning one person was not sufficiently detailed to ensure their safety. This was reviewed immediately and an updated management plan made available to staff.

People received support with their medicines when they required it and there was a system in place to manage medicines safely. There were sufficient staff deployed to provide safe and effective support to people.

Staff received training to ensure they had the skills to care for people safely and effectively. They were knowledgeable and showed awareness of how to keep people safe. They understood the policies and procedures used to safeguard people.

People’s right to make decisions was protected. People and where appropriate their relatives and other professionals had been involved in making decisions about their care. Staff understood their responsibilities in relation to gaining consent before providing support and care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice .

People were treated with kindness and compassion. Staff were respectful and people’s dignity was protected. People were supported to be as independent as possible.

Staff were kept up to date with information concerning people or changes to their support. Staff contacted health or social care professionals to seek advice when concerns were identified regarding a person’s well-being. People were supported to maintain a balanced diet and have sufficient to eat.

There was an open culture in the service. Staff were comfortable to approach the registered manager for advice and guidance. Staff felt supported, they had regular meetings with their manager and were provided with appropriate training. They said they were listened to and were confident action would be taken promptly to manage any concerns raised.

Regular feedback was obtained from people using the service. The quality of the service was monitored through a system of audits, which were used to make improvements. A complaints policy was available and people were made aware of it. No complaints had been received in the last year.