We carried out a review of the data available to us about Quality Care Services (Derbyshire) Limited on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Quality Care Services (Derbyshire) Limited, you can give feedback on this service.
People’s experience of using this service:
People told us they had a good relationship with staff and management. They felt they were well cared for and the carers knew their needs. People said they preferred to have the same staff and didn’t like different one’s at each call.
At our last inspection medicines management was not effective. At this inspection we found improvements had been made and the registered manager had identified a new electronic system to make further improvements.
Quality assurance processes were in place, however the provider was in the process of transferring information onto an electronic system to give the management more oversight of the service and staff.
Staff training was up to date and staff received supervision of their practice, training was carried out by eLearning and staff received practical training on moving and handling on induction. People had access to health professionals when they needed specialist assistance, or their health needs changed.
Since our last inspection we found there had been improvements in management oversight. The process had started, and improvements were being implemented.
People’s care records contained guidance for staff on how to support them. The care records had been reviewed regularly and had relevant risk assessments in place. Complaints were responded to in line with the provider’s complaints policy a copy of which was given to people with other information on the service.
Rating at last inspection and update: The last rating for this service was requires improvement (published 18 December 2020). At this inspection the service had improved to good.
Why we inspected
The inspection was prompted in part due to concerns received about pressure area care. A decision was made for us to inspect and examine those risks.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe sections of this full report.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service:
People told us they felt safe with staff, however there were mixed reviews regarding wearing appropriate PPE as some people told us that staff wore full PPE and others didn’t.
Medicines were not always managed safely. There was a process in place to check MAR charts when they were returned to the office, however, this was not always effective and mistakes in handwritten entries had been missed.
Quality assurance processes were in place, however, these were not always effective in monitoring and managing the service. The provider was unsure of when notifications should be submitted to the Care Quality Commission. We found that some incidents we reviewed on our visit should have been notified through the provider portal. At our last inspection we recommended that the provider looked at the guidance for reporting notifiable incidents.
Staff training was up to date and staff received supervision of their practice, training was carried out by eLearning and staff received practical training on moving and handling on induction. People had access to health professionals when they needed specialist assistance, or their health needs changed.
Management of the service was not consistent in all areas. Managers had responsibilities for specialist areas, but it was not clear how the registered manager had clear oversight of the service.
People’s care records contained guidance for staff on how to support them. The care records had been reviewed since our last inspection and had relevant risk assessments in place. Complaints were responded to in line with the provider’s complaints policy a copy of which was given to people with other information on the service.
Rating at last inspection and update: The last rating for this service was requires improvement (published 8 October 2019). At this inspection the service had remained the same.
Why we inspected
This was a focussed inspection due to concerns about the service within quality monitoring and management oversight.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
People’s experience of using this service:
Risk assessments associated with people’s care were in place; however, they were not always sufficiently detailed to provide staff with the guidance needed to reduce the risk to people’s health and safety. Environmental risk assessments were in place, but these did not include how to make people safe in an emergency.
People told us they felt safe with staff; however, some raised concerns about staff punctuality. The provider ensured the local authority were notified of any concerns about people’s safety. People’s medicines were managed safely. The risk of the spread of infection was safely managed. The provider had systems in place to help staff to learn from mistakes.
Quality assurance processes were in place; however, these were not always effective in highlighting and addressing the concerns we have raised during this inspection. The registered manager and registered person had limited knowledge of the regulatory requirement to report safeguarding concerns to the CQC. People’s views were requested and used to improve the quality of the service provided. Some people felt office-based staff did not always communicate effectively with them. When people had met or spoken with the registered manager, they found her to be supportive and approachable.
We have recommended that the provider reviews the CQC guidance for the reporting of notifiable incidents and ensures these processes are understood and followed by the registered manager.
People received care in line with their assessed needs. Most staff training was up to date and staff received supervision of their practice. 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 support this practice. People received the support they needed to maintain a healthy diet. People had access to other health and social care agencies where needed.
People and relatives found the staff to be kind and caring. People felt they were treated with dignity and respect, especially when personal care was provided. People were encouraged to do as much for themselves as possible. People were able to make decisions about their care and they felt staff acted on and respected their wishes. People’s records were stored securely to protect their privacy.
People’s care records contained guidance for staff on how to support them in their preferred way. However, some records were more detailed than others. People were provided with information in formats they could understand, this reduced the risk of people being discriminated against because of a disability or sensory impairment. Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care was to be discussed with people during reviews of their care.
Rating at last inspection and update: The last rating for this service was Good (published 16 January 2017). The service’s rating has now changed to Requires Improvement.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
We inspected this service on 19 December 2016.This was an announced inspection and we telephoned the week prior to our inspection in order to arrange home visits and telephone interviews with people. The service provides care in people’s homes to older people and people with debilitating illness and long term conditions such as dementia. The service is available in the east side of Derby. The organisation is a family run business. The members have split the responsibilities of the roles, one member is the registered manager and the other member the responsible individual. Both are involved in the running of the business and both were present at the inspection. At the time of the inspection 250 people were being supported by the service. Our last inspection took place in 2014 and at that time the provider was compliant with the areas we inspected.
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.
We had not received notifications relating to aspects of the service. Some people’s care folders did not have all the paperwork relevant to the care needs for that person within the home.
Staff rated the service as a good place to work and people we spoke with would all recommend the service. The staff told us they felt supported by the manager and they had received ongoing supervision.
The staff had received training in a range of areas to enable them to carry out their role and had been given the opportunity to access further training. New employees received the relevant checks to ensure they were safe to work with people and they were provided with an induction to support their role.
People felt safe and the staff knew how to report any concerns to ensure people were protected from harm. When concerns had been raised we saw these had been addressed. Risk assessments had been completed for the environment and specific needs. The assessments identified guidance and ways to reduce any identified risk.
There were sufficient staff to support people’s needs and people told us they received support from a regular group of staff which they found reassuring. Where people required support with their medicine this was completely safely and in line with the appropriate training and guidance.
People were given choices and supported to make decisions. Healthcare professionals had been contacted when requested to support people’s health and wellbeing. Some people received support with food preparation, when this happened people were given choices on their meal.
People told us staff treated them with kindness and compassion. Their dignity was respected in aspects of the care they received. We saw the service was responsive and provided a flexible approach to support people’s care needs and any changing situations.
The provider and manager completed a range of audits to use to maintain the quality of the service or to make improvements. The provider worked with the local authority to provide commissioned care. Any complaints which had been received had been responded to. People and staff were asked their opinion on the service and we saw that they had been responded to continue to make improvements.
People told us they were happy with the service they received, and felt that their needs were being met. Comments received from people included 'I have never had a bad carer; all staff score 11 out of 10, the service is great, I can't fault them, my main carers are excellent and I have good relationships with the staff; I enjoy their visits'.
People also said that staff respected their privacy, dignity and independence.
We found that the service was flexible and centred around individual needs and preferences. People usually received care and support from regular staff that were aware of their needs and preferences. Although on occasions certain individuals did not receive care from regular staff.
Relatives told us they were generally happy with the care their family member received, and felt involved in decisions about their care and treatment.
Arrangements were in place to ensure that peoples' medicines were handled properly. People told us that they received them at the times they needed them.
People felt listened to and able to raise any concerns about the service with staff. We found that the service was generally well managed, and that clear lines of responsibility were in place.
Arrangements were in place to ensure that staff received appropriate induction training and supervision, although staff had yet to receive an appraisal of their work.
We found that the provider had made the following improvements to the service.
Procedures were in place to protect people against the risk of abuse, and to ensure that staff understand and respond appropriately if abuse is alleged or suspected.
Recruitment procedures have been strengthened to ensure that people are cared for by suitably qualified, skilled and experienced staff.
Staff were receiving appropriate support and training to enable them to meet peoples' needs, although staff had yet to receive an appraisal of their work.
People told us they were happy with the care and service they received. People found the service to be reliable as they received the help they needed at their preferred times. People said that they usually received care from regular staff who knew their needs. One person told us 'the staff do a great job; I could not cope without them. They do everything I ask them to do'. A further person told us ' I have good relationships with the staff and my main carer is wonderful'.
People felt listened to and able to express their views and raise any concerns with staff if they were unhappy. People told us that their privacy, dignity and independence was respected.
People said they liked the staff that supported them as they were honest and reliable.
Relatives told us they were happy with the care and support their family member received. One relative told us 'the service has some exceptional staff that have the skills and experience to meet my family member's needs; there is nothing to fault about the care'. Another relative told us 'the care is fabulous and the staff are lovely'.
All three people using the service we spoke with told us that the staff always stayed for the allocated time they were supposed to and completed all the tasks as set out in their care plan before they left. They told us that on the rare occasion that staff were late they received a telephone call to let them know this. In addition, one person told us 'They are always on time and never rushing to leave. They always do what they need to do.' A relative that we spoke to told us 'The staff always staff for their allotted time. There has been the odd mix up, but when I've phoned the office and they've sorted it straight away.'
One person using the service were supported by staff to take their medicines and they told us that staff gave the appropriate support and gave them their medicines when they were supposed to.