Darethealthcare UK Limited

Darethealthcare UK Limited provides personal care and support services to older adults living in their own homes within the London Borough of Bromley and its surrounding areas. At the time of our inspection there were approximately 34 people using the service. The service had 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 and associated Regulations about how the service is run.

Assessments and care plans were in place to support people where risks to their health and wellbeing had been identified. There were appropriate safeguarding procedures in place. Recruitment checks took place before staff started work and there was enough staff to meet people’s needs. The registered manager and staff had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and received training relevant to the needs of people using the service. Care plans detailed people’s nutritional and support needs. People were supported to access health and social care professionals when they needed them.

People were provided with information about the service. People said staff were kind and caring and their privacy and dignity was maintained. People were consulted about their care and care plans were in place that provided information for staff on how to support people safely and appropriately. People were aware of the complaints procedure. There were systems in place to monitor the quality of the service provided to people. The provider took into account the views of people using the service. Staff said they enjoyed working at the service and they received good support. There was an out of hours on call system in operation that ensured management support was available to people and staff when required.

Following the inspection, we imposed conditions on the provider requiring them to carry out risk assessments, including assessments on the risks associated with medicines for all people using the service. We also required the provider to send us monthly audit reports of people’s care files and medicines records. Additionally, we served a warning notice on the provider and registered manager requiring them to comply with the regulations.

We undertook this comprehensive inspection on 25 and 30 August 2016 to check that the provider had met the requirements of the enforcement action and requirement notices we took, and to rate the service.

Darethealthcare UK Limited is a domiciliary care provider located in the London Borough of Bromley providing care and support to 33 people across Bromley and the surrounding areas. There was a registered manager in post at the time of our inspection. 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 comprehensive inspection of 25 and 30 August 2016 we found that the provider had taken appropriate action to ensure compliance with the regulations.

Medicines were safely managed. People's records contained a complete list of their prescribed medicines and included appropriate guidance on how to support people safely. Risks to people had been assessed and reviewed, with appropriate risk management plans in place to mitigate future risks. The provider had procedures and policies relating to safeguarding people from harm which were accessible to staff. Staff demonstrated an understanding of types of abuse to look out for and knew how to raise safeguarding concerns. The provider had taken appropriate action to ensure recruitment files contained appropriate pre-employment checks. There were sufficient staff deployed to meet people’s needs.

Staff received regular supervision and these were scheduled across the year. Staff were up to date with mandatory training requirements as identified by the provider. They understood their responsibilities in line with the Mental Capacity Act 2005 (MCA), and the manager acted according to this legislation. People were sufficiently supported with their food and drink requirements and to access healthcare services where necessary.

People told us that they felt staff were caring, and that their privacy and dignity was respected. Care plans were person centred and regularly reviewed. People were consulted about their care and support needs. Concerns and complaints were investigated and responded to in a timely and appropriate manner.

Quality assurance systems were in place to monitor and improve the quality of the service. The provider had made appropriate notifications to the CQC since the last inspection, and the registered manager understood when notifications should be made. People’s views were sought on the running of the service.

The service had 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 and associated Regulations about how the service is run.

During our inspection we found breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of medicines, risk assessments, staff supervision appraisals and training and staff recruitment practices.

Risks to people had not always been identified or properly assessed, and action had not always been taken to manage risks safely. Risk assessments had not been regularly updated. Medicines were not safely managed by the service because records relating to the management of medicines were often not fully complete.

The provider did not operate effective systems to monitor and mitigate risks to people because issues were not identified at audit, and they had failed to find concerns we identified at inspection.

Staff did not always receive appropriate training or supervision as is necessary to enable them to carry out the duties they are employed to perform.

CQC is currently considering appropriate regulatory responses to address these above breaches in legal requirements. We will report on this at a later date.

There was also a breach of regulations as appropriate pre-employment checks were not always in place, including photographic identification prior to them commencing work. You can see the action we have asked the provider to take in respect of this breach of regulations at the back of this report.

People said they felt safe and staff treated them well. The service had appropriate safeguarding adults procedures in place and staff had a clear understanding of these procedures. There was a whistle-blowing procedure available and staff said they would use it if they needed to.

The manager had a good understanding of the Mental Capacity Act 2005 and acted according to this legislation. Staff had completed an induction when they started work and they were up to date with their training. People had access to health care professionals when they needed them.

People said they were treated with dignity and respect, and felt that staff were caring. People were supported to maintain a balanced diet, and had access to health care professionals when required.

The provider had a complaints procedure in place, and people felt their complaints would be dealt with effectively. Staff felt well supported by management, and the provider regularly conducted telephone and paper surveys which showed people were happy with the service.

We found that people and their relatives were involved in making decisions about their care and support needs. Each person using the service had a care and support plan in place to ensure that their needs were met. The provider had appropriate policies and procedures in place to safeguard vulnerable adults. Appropriate checks were undertaken before staff began work. We found that the provider had systems in place to regularly monitor the quality of the service that people received.

All the people we spoke with told us they were involved in the planning of their care and had been asked for their views. People told us they felt able to call the agency's office if they had any concerns about the care and support provided. People also told us staff completed their tasks on time when delivering care and support planned for them.

We found that people were able to express their views and were involved in making decisions about their care and support needs. We also found that the provider had policies and procedures in place to ensure vulnerable adults were protected from abuse and staff had appropriate access to these policies.

We found that staff understood people's care needs and knew how to support them. Support was in place to ensure that staff received adequate training and supervision and to ensure they were appropriately supported to do their job effectively. The provider had systems in place to assess and monitor the quality of the service people received.