Archived: Domriss Care

Domriss Care is a domiciliary care agency based in Biggleswade providing personal care to people in their own homes. At the time of our inspection there were 27 people using the service.

There was 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.

At our previous inspection in May 2016 we identified concerns with the leadership and governance of the service, people not receiving their visits in time and a lack of personalisation in care plans and risk assessments. Staff were not always supported, trained or regularly supervised. During this inspection we found that significant improvements had been made to the overall standard of care and management of the service.

People were kept safe and staff understood the process to follow to safeguard people or report concerns. There were personalised risk assessments in place which detailed ways in which control measures could be implemented to protect people from any risk of avoidable harm. There were enough staff deployed to meet people’s needs, and people received their care within acceptable timeframes. People were asked for their views and had their concerns and complaints listened to and resolved with positive outcomes. People told us they received good care and support from kind, compassionate and consistent staff.

Information relating to people’s healthcare and dietary needs was included within their care plans. Each care plan was personalised and reflective of the person’s needs. They were subject to regular review and evidenced consent from people to the delivery of their care and support. Whilst people’s medicines were being administered safely by staff, there was some improvement needed when accounting for this in their records.

Staff received a full programme of induction, training and supervision and felt supported and listened to by management. They were able to contribute to the development of the service through team meetings and were encouraged to share views and opinions. The registered manager was visible, transparent and had made substantial changes in response to our previous findings. There was an effective quality assurance system in place to audit the service and identify areas for improvement.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Domriss Care is a domiciliary care agency based in Biggleswade providing personal care to people in their own homes. At the time of our inspection there were 60 people using the service. Although the company responsible for operating the service remained unchanged the service was acquired by the Sevacare brand in January 2016 and the former directors and registered manager had left the service as part of this acquisition.

The service did not have a registered manager. There was a branch manager in post who intended to register but left the role on the second day of our inspection. A new branch manager was appointed immediately and planned to make an application to become the registered manager of the service. 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.

Our inspection identified serious issues regarding the management and leadership of the service and the quality of their care delivery. Whilst there was some evidence of positive progress towards developing robust systems to support the delivery of care and support, there was a lack of consistent managerial oversight. The poor feedback from people and staff regarding the quality of the care and support showed that the changes were not being implemented or embedded within acceptable timescales. As a result we took urgent enforcement action on the 27 May 2016 to restrict new care packages being undertaken by the service.

Staff were caring and compassionate and respected people’s privacy and dignity when delivering care. People told us that they generally received good care from their regular care staff, but late or ‘clipped’ (cut short) calls were reported. The electronic records that accounted for people’s visit times demonstrated that some people did not always receive care for the full duration of their visit. Because these records were poorly maintained, with a large amount of inaccurate information being manually input to the system used by the service, it was impossible to ascertain an accurate picture of exactly when staff arrived or the length of time they stayed for. Staff reported feeling under pressure and rushed since there were occasions where travel time was not incorporated into their daily rotas.

People had care plans in place which were reflective of their basic needs but lacked personalisation or detail to enable staff to offer person-centred support. Risk assessments were generic in nature and insufficient to help staff to keep people safe. People’s medical conditions were listed in their initial assessments but not always included in plans. People told us there was a lack of flexibility from staff. Staff had been told not to offer any support outside of the care plan which meant that simple tasks that needed to be completed were left unattended to. People who needed support with eating did not always have their dietary conditions detailed in their plans. People received their medicines and there were systems in place for safely managing and auditing these. However there was not always sufficient information in care plans to support staff to understand people’s preferred method of administration.

Staff were recruited safely to work in the service and checks were carried out to ensure that staff were suitable prior to commencing their employment. Staff received a full induction into the service when they first joined. All staff had received basic training in areas the provider considered essential although the majority of staff had not had their training refreshed. The provider had committed to training staff before the end of July but courses had not yet been booked at the time of our inspection. Staff did not receive training in the Mental Capacity Act and care plans did not contain information around consent or capacity. Staff had recently received supervision although these had been infrequent and no staff had received a formal appraisal of their performance. Only one team meeting had taken place since the new directors had begun in the service in February.

There were quality monitoring systems in place which were effective in identifying areas for improvement within the service. However improvements were not being made within acceptable timescales due to a lack of managerial oversight in the service. People, their relatives and the staff were not clear as to who was managing the service or who they would complain to.

The service was able to demonstrate positive progress towards improving quality during our last visit and was taking proactive measures to address the issues raised.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.