Archived: Dementia Concern

Dementia Concern is a community based adult service for people living in their own homes in the community. Dementia Concern comprises of dementia link workers who support people's acute needs, information and advice provided through dementia advisers, social clubs, community support and dementia cafes. We inspected the Call and Care part of the organisation that provides a respite service for people living with dementia who live at home with a family carer. The main role of the Call and Care worker was to undertake activities with people during their call, as people using the service received their personal care from either family carers or other agency care workers. However, Dementia Concern Call and Care workers provided personal care if the circumstances necessitated it. At the time of the inspection 22 people were using the Call and Care service.

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

During the inspection we found risk assessments were not always undertaken where risks were identified for people, and where there were risk assessments these did not always record enough detail to provide staff with the relevant guidance to provide a safe level of care. We also found medicines competency testing was not undertaken annually which placed people at risk of not receiving medicines safely.

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. However, the systems in the service did not always support this practice in terms of assessing people’s mental capacity and gaining consent.

The provider did not operate effective systems to monitor, manage and improve service delivery and to improve the care and support provided to people.

The provider had systems in place to safeguard people, and safe recruitment procedures were followed. Staff followed appropriate infection prevention and control practices. Staff were supported through training and team meetings.

There was a complaints procedure in place and people knew who to raise concerns with.

Relatives reported the manager was available and responsive.

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 requires improvement (published 27 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made/ sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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. We will continue to monitor the service.

We have identified breaches in relation to safe care, consent to care and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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.

Dementia Concern is a community based adult service that provides support services to people living with dementia in the local community. Dementia Concern comprises of dementia link workers who support people’s acute needs, information and advice provided through dementia advisers, social clubs, community support and dementia cafes. We inspected the Call and Care part of the organisation that provides a respite service for people with dementia who live at home with a family carer, as this was the part of the Dementia Care service that provided personal care to people in their own homes. The main role of the Call and Care worker was to undertake activities with people during their call, as people using the service received most of their personal care from either family carers or agency care workers. However, Dementia Concern Call and Care workers provided personal care if the circumstances necessitated it. At the time of the inspection 22 people were using the Call and Care service.

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

During the inspection, we found risk assessments and risk management plans were not always robust or in place. Some were generic and therefore did not always address risks in a person-centred way. This meant the provider did not always assess, monitor and mitigate risks to people to help minimise their exposure to the risk of harm.

Medicines were not always managed safely. Care workers administered as required (PRN) medicines but there were no individual or general PRN protocols in the medicines policy and there was a lack of guidelines around medicines administration.

When a relative raised a concern, we saw action had been taken but the provider could not access the investigation outcome document to demonstrate their learning outcomes. This was also the case with complaints.

Care workers supervision had not been regularly undertaken in 2019 and appraisals had not been completed in 2019 to help care workers develop the necessary skills to support people using the service. Training was over a year old and there were no competency tests or spot checks for care workers to ensure they were providing safe and effective care to people.

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. People and their relatives had signed consent forms about their information being shared but there was not a record of people consenting to their care. Where mental capacity assessments had been completed, they were not decision specific.

The service user profiles had not always been updated to reflect peoples’ current needs and reviews were not consistently carried out, which meant people may not have been receiving care that met their needs.

People's wishes, views and thoughts about end of life care had not been considered as part of the care planning process.

The provider had some quality assurance systems in place, but they had not effectively monitored and managed service delivery to improve the care and support provided to people. For example, although we saw evidence of people’s care files being audited, not all the information in the service user profiles was up to date which meant people may have been receiving care that was not appropriate to their needs.

The provider did not display their CQC ratings on their website as required by the regulations.

We recommended the provider consider current guidance on preventing and controlling infection and take action to update their practice accordingly. We also recommended the provider develop person centred records in line with recognised guidance.

Safe recruitment practices were followed. Care workers knew how to respond to possible safeguarding concerns. They were kind and respectful of people’s preferences and provided support in a respectful manner. Care workers respected people’s dignity and provided day to day choices for people.

People were supported to maintain health and access healthcare services. Where appropriate, people were supported to access the community to reduce the risk of social isolation.

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 (published 25 August 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to people consenting to their care, safe care, staffing and good governance at this inspection.

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

Additionally, the provider did not meet the requirement to display performance assessments on their website and we are considering our regulatory approach regarding this breach.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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.

The last inspection took place on 17 May 2016, when we identified breaches of Regulations relating to safe care and treatment, staffing and good governance. After the inspection, the provider sent us an action plan dated 25 August 2016 detailing how they would address the issues raised at the inspection. During the 17 July 2017 inspection, we saw improvements to the service had been made.

Dementia Concern provides a number of support services to people living with dementia in the local community. We inspected the Call and Care part of the organisation that provided a respite service for people with dementia who lived at home with a family carer as this was the part that provided personal care to people in their own homes. Respite was usually for three to four hours once a week. During this time, the care worker undertook a leisure activity with the person such as going out for a walk or reading. Although people using the service received most of their personal care from either family carers or agency care workers Dementia Concern care workers provided personal care if the circumstances necessitated it. At the time of the inspection, 64 people were using the Call and Care service.

The service had a registered manager. 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.

At the inspection on 17 July 2017, we saw that care workers had the relevant training and knew how to raise safeguarding concerns to keep people safe from potential harm.

People and family carers we spoke with said they were very satisfied with the care provided by the service. Care workers told us they were respectful of people’s wishes and treated them with dignity.

Risks were assessed and action taken to minimise the risks to people using the service. Care workers knew how to respond appropriately to incidents and accidents.

There were a sufficient number of staff to meet people needs and care workers regularly supported the same people to provide consistency. Safe recruitment procedures had been followed to ensure suitable staff were employed.

The service had a medicines policy and procedure and an appropriate recording system for the administration of medicines.

Care workers were supported to have the skills and knowledge required to care for people through relevant training and supervision.

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’s dietary and nutritional needs were recorded on their care plan and care workers would alert the family carer and the registered manager of any health concerns if they had any about the person using the service.

People and their family carer contributed to the planning of their care. Reviews were signed by people or their family carer appropriately. Information on people’s files was person centred and people’s preferences and wishes were recorded.

People using the service knew how to complain but there had been no complaints to the service.

People using the service and care workers said the registered manager was approachable and responsive.

The registered manager had good links with the community and was aware of their responsibility of when to notify relevant bodies including the Care Quality Commission of some events and incidents within the service.

The provider had management systems in place to monitor the quality of the service and reduce risks to people using the service.

The last inspection took place on 07 November 2013 at which time the service was meeting the assessed five standards.

Dementia Concern provides a number of support services to people living with dementia in the local community. We inspected the Call and Care part of the organisation that provides a respite service for people with dementia who live at home with a family carer. Respite was usually for three to four hours once a week. At the time of the inspection, 71 people used the Call and Care service.

The service had a registered manger. 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.

The service was not always safe. The service’s policies and procedures did not indicate the service was doing all that was reasonably practical to mitigate risk. For example risk assessments were standardised.

The service did not have a staff appraisal system in place, which meant the service lacked a formal mechanism for setting targets for the year and monitoring the outcomes.

The service was not always well led because it lacked systems to monitor the quality of the service delivered and ensure peoples’ needs were being met.

We found breaches in 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.

Disclosure and Barring Service (DBS) were initially completed but the service did not renew DBS checks within a reasonable time period. We recommended the service renew DBS checks within a reasonable period of time to ensure staff are of good character.

The service had not always assessed people’s capacity to consent to care and treatment and we saw several care plans where family members had signed on behalf of the person using the service although there was no indication that the person was unable to sign the care plan. We recommend that consent is sought for care and treatment and where a person lacks mental capacity, the provider acts in accordance with the requirements of the Mental Capacity Act 2005.

Care reviews were not always signed. We recommended reviews should be signed by the person using the service or by an appropriate other person, for example a relative with Lasting Power of attorney in health and welfare matters

The service had a safeguarding policy and care assistants were aware of how to respond to any safeguarding concerns.

There was a medicines policy and staff attended medicines training.

There were an adequate number of staff to meet the needs of the people who used the service.

Family carers were happy with the level of support they received.

Care assistants had inductions, supervisions and relevant training to support the people who used the service.

Stakeholders we spoke with said the manager was accessible and responsive. Most care assistants told us they felt supported by their manager.

There was a complaints system and people felt able to raise concerns.

The service had good relationships with other professionals.

We looked at the care plans for eight people using the service. We saw the care plans detailed people's care needs and the support their care workers should provide. The plans were updated regularly and people were involved in reviewing the care they received.

The provider had policies and procedures for supporting people with their prescribed medication. Care workers understood the procedures and were trained to provide appropriate support.

We looked at training and supervision records and saw care workers had access to appropriate training and support to enable them to care for people using the service. One care worker told us 'the training is good, it really helps.'

There were procedures in place for responding to complaints. People using the service told us they knew how to make a complaint and they were confident they would be listened to. One person told us 'they gave me information about complaints but I've never needed to use it.'

People told us they were very happy with the Call and Care service provided by Dementia Concern. Comments included "we've had the same care worker for a few years. They always tell us if there's any change'. 'We have a consistent carer, someone we trust. We did have one person who was not right and she was changed very quickly'. 'They are lovely people, so flexible. I can go out and not worry'.

Care workers understood the risk of abuse and were able to tell us how they would respond if they had any concerns about people's welfare. Staff recruitment processes were followed to make sure care workers were suitable to work with people using the service. People said they were confident to raise a complaint and could speak with the organisation's managers if they had any concerns. They also told us if they had any concerns or complaints they would speak with their care worker or the organisation's managers about them.

We saw that systems were in place for monitoring the quality of service people received. The care plan records we saw were comprehensive, people were asked for their views about the service and these were acted on.