Background to this inspection
Updated
2 May 2018
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’
This inspection took place on 15 March 2018 and was undertaken by two adult social care inspectors and a pharmacist inspector at the office. Three experts by experience made phone calls to people or family members to gain their views of the service. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.
We gave the service 48 hours’ notice of the inspection as we needed to be sure the registered manager would be available for the inspection visit.
The provider had not been asked to complete a Provider Information Return (PIR). The PIR is information we require to providers to send us at least once annually to give key information about the service, what the service does well and improvements they plan to make.
Before the inspection we reviewed information we held about the service, including the notifications we had received from the registered provider. Notifications are changes, events or incidents the provider is legally obliged to send us within required timescales. We also contacted the local authority commissioners for the service to gain their views.
On the day of the inspection there were 348 people using the service. We looked at ten care records, including medication administration records (MARs), eight staff files and other records related to the running of the service. We spoke with the registered manager, the head of customer engagement and two staff members. A further ten staff members provided responses to our questions via a questionnaire. We visited two people in their homes and spoke with 36 people and two relatives over the telephone.
Updated
2 May 2018
This inspection took place on 15 March 2018 and was announced. We gave the provider 48 hours' notice that we would be visiting the service. This was because the service provides domiciliary care to people living in their own homes and we wanted to make sure staff would be available in the office. This was the services first rated inspection under the new provider.
Direct Health is a domiciliary care agency which is registered to provide personal care to people in their own homes. At the time of our inspection the service was providing personal care to 348 people.
There was a registered manager in post who became registered with the Care Quality Commission in March 2017. 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.
We looked at the systems in place for medicines management and found they did not always keep people safe. There was not an effective system to check to see if medicines records at the office reflected current medicines people were being supported with. Records written by staff did not provide the correct or enough information to support safe administration.
Risk assessments were in place; however they did not always provide detailed information for staff to mitigate the risk. Where new risks had been identified through a review a new risk assessment was not always in place.
Records needed to be more consistent and contain more detail. We have made a recommendation about this. Although the provider and registered manager completed audits, they had not highlighted all the concerns we raised.
People were supported to receive care from the agency following an assessment. This covered all aspects of the care required by the person. Such as how many calls they would need each day, what their needs were in relation to mobility, continence and personal care, moving and handling and nutrition.
Staff took action to minimise the risks of avoidable harm to people from abuse and understood the safeguarding process.
Recruitment checks were in place and demonstrated that people employed had satisfactory skills and knowledge needed to care for people. All staff files contained appropriate checks, such as two references and a Disclosure and Barring Service (DBS) check.
Staff recruitment was continuously on-going to make sure the service had enough staff in the event of holidays and sickness or staff leaving.
People were supported to have maximum choice and control of their lives and staff understood the importance of consent and best practice in decision making related to the Mental Capacity Act (2005).
People were generally complimentary about staff and told us that they were treated with kindness and consideration. They had good relationships with their allocated care staff.
Staff received effective training in safety systems, processes and practices such as moving and handling, food hygiene and infection control. Staff had received supervision and a yearly appraisal that helped them to perform their duties and supported their development.
Processes were in place to protect people and staff in regards discrimination and equality. People told us they were able to make choices and take control in regards their care and support and who entered their home. People confirmed they were encouraged to remain as independent as possible. Care workers had built up positive and caring relationships with people they were supporting.
People said they would be comfortable to make a complaint and were confident action would be taken to address their concerns. The provider treated complaints as an opportunity to learn and improve.
Staff told us they felt supported by the registered manager and the registered manager kept people informed of events and news relating to the agency via a newsletter.
This is the first time the service has been rated Requires Improvement.
We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risk assessments were not always in place and more detail was needed and medicines management was not always safe. You can see what action we told the registered provider to take at the back of the full version of the report.