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Archived: Direct Health (Sheffield) Requires improvement

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Inspection report

Date of Inspection: 25, 30 June 2014
Date of Publication: 26 July 2014
Inspection Report published 26 July 2014 PDF


Inspection carried out on 25, 30 June 2014

During a routine inspection

Two adult social care inspectors carried out this inspection. This was a scheduled inspection in addition to checking improvements had been made following concerns identified at our last inspections of 2 October 2013 and 11 February 2014.

On the 11 February 2014 we took enforcement action against the provider and issued a warning notice to protect the health, safety and welfare of people using the service. As well as assessing whether improvements had been made in these areas, the focus of the inspection was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

Over the course of 4 days we visited the services office and spoke to the agency manager, area manager, 2 care coordinators and 4 support staff. We checked records and we spoke with 25 people who used the service and 12 of their relatives. We also visited 5 people in their own homes and spoke with them, and 5 of their relatives about the care and support they received and checked records at their home relating to their personal care.

Below is a summary of what we found. The summary describes what people we spoke with told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to promote people's welfare. Staff used risk assessments. There were risk assessments in place with people�s planned care. These gave details of how individual risks to a person could be removed or minimised.

Staff were aware of potential environmental risks and said documentation to reflect any changing risks was always updated and communicated to all staff.

We found that one person was not protected against the risks associated with medicines because staff were not administering their medication at the correct times and some medication was not being administered at all. The person�s medication chart was not being accurately completed by staff.

Is the service effective?

People and their relatives told us they were actively involved in making decisions about care and support. People�s health and care needs were assessed with them and their representatives, and they were involved in writing the support plans. People and their relatives said support plans were up to date and reflected their current needs.

Is the service caring?

People and relatives of people who used the service said they felt their privacy was respected when staff assisted them with care and support .They said, �staff are always friendly and polite� and �staff treat him with respect, they always make sure curtains are drawn and he is appropriately covered when they are washing him.�

Care workers we spoke with demonstrated a good understanding of the people�s needs and were able to give examples of how they promoted people�s independence.

We asked people and their relatives for their opinions about the support provided. Feedback and comments were very positive, for example; �mums care staff are brilliant�, �staff really know my husband, they are excellent� and �very happy with my care�, �a good team of carers�, �can�t praise the carers enough� and �the care staff are smashing, beyond description, they are very reliable.�

The majority of people and their relatives we spoke with said that many aspects of the service had improved. They said care workers generally read their care plans and followed the tasks in them. They said their care plans had been reviewed recently by a care coordinator and said that staff were visiting on time and staying the allocated time to provide care and support.

We spoke again with five people and their relatives who we had spoken with or visited during our inspection in February 2014 to ask them how they found the service �today� compared to the service in February 2014. People said, �the care staff are more reliable, we have had no missed visits, we are generally happy� , �I now know which care staff are coming and at what time, I�ve much more confidence in the agency� and �the carers who come know what they are doing, things are much better, staff come on time, I�m very happy.�

When speaking with staff it was clear that they had a good knowledge of the person�s interests, personality and support needs.

People and their relatives who used the service said their care needs had been recorded and staff provided support in accordance with their wishes.

Is the service responsive?

We saw that the provider had a system in place to monitor incidents. The system was electronic based and was therefore accessible to all the senior management team of Direct Health. We raised two issues of concern with the provider following our visits to people in their own homes. During our office visit at the agency we saw evidence that our concerns had been documented and follow up action had been taken by the provider to address these issues.

We found that a policy and procedure was in place for handling complaints to ensure that any complaint was responded to appropriately.

Relatives and people we spoke with told us they were �a lot happier� with the service. When we asked them if they did want to raise a concern, or were worried about anything what they would do, they all said they would go to the manager and talk to them. They said, �I see the manager face to face� and �I can phone the office with problems, things are better now.�

Is the service well-led?

We looked at a sample of the service's policies and procedures. We found the policies and procedures to be detailed, clearly written and easy to understand. Policies and procedures had been reviewed and updated in line with service requirements.

The service had a quality assurance system. We saw evidence the care coordinator and manager completed monthly audits to ensure systems were in place to promote people�s safety. The manager, people and their relatives said support plans daily records and medicine records were checked regularly by the managers as part of the quality assurance measures in place. This helped to ensure people received a safe, good quality service at all times.

People and their relatives said the manager and care coordinators completed �direct observation� visits in people's homes to observe how staff provided care and support for people who used the service. We saw evidence that the manager and care coordinators also spoke with people at these visits to check that they were happy with the support they had received.

Staff said they were clear about their role and responsibilities and said they were �much happier� at the agency. They said �we are supported and there is more consistency in our visits.�