DORZ Care Services Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them. Assessments were not completed consistently and sometimes provided confusing and contradictory information. Some people had not received an up-to-date written assessment prior to starting support with DORZ care services and as a result the provider failed to demonstrate guidance for staff was available or reflected the support the person required. A relative told us how their loved one required support preparing food and needed drinks thickened due to health risks. This was not detailed in care plans or risk assessments and the lack of guidance for staff resulted in increased risk of harm. We fed back our concerns to the provider and were not assured they understood their responsibility to complete detailed assessments to ensure staff had sufficient information to always provide effective support.
Whilst we have identified shortfalls in the assessment process people and relatives provided consistently positive feedback about how they had been involved in care planning. One relative told us, “I was involved in all that. I am the main carer 24/7. Dorz went through all of that with us."
 

The provider generally planned and delivered people’s care and treatment with them, including what was important and mattered to them. There were significant shortfalls with detail within care plans and assessment which resulted in potential increased risk for people and this was not always in line with legislation and current evidence-based good practice and standards. The provider had failed to use care assessment tools to assess risk and to ensure people’s needs were reflected and understood. For example, the provider had failed to risk assess or complete Waterlow assessments to calculate and determine the risk of skin integrity breakdown. One person, who had a history of skin integrity concerns was not assessed using tools such as the Waterlow assessment base tool to determine the risk factors associated with their skin integrity. However, the provider and staff consistently told us how people’s needs and what was important to them was central to how staff supported them. This was confirmed by people and their family members, comments included, “Dorz kept us informed when she was trying to find us a regular carer.” And, “Dorz is brilliant and of course we involve (person) with it."

The provider did not always work well across teams and services to support people. For some people Dorz care services shared people’s support with other care providers and relatives and had not always fully considered their responsibilities to manage risks or provide guidance for staff within those arrangements. During the assessment process CQC raised a number of concerns about the absence of risk assessment and guidance for staff in relation to the health conditions of people. The provider and manager had failed to demonstrate an understanding of their regulatory responsibilities to ensure risk management processes worked effectively when they worked in collaboration with stakeholders. However, people received relevant support from health and social care professionals this included staff supporting visits from health care professionals when this was agreed as part of the persons package of support. One health care professional spoke positively about communication, “(Dorz care services) contact the clinic if they have concerns regarding the patient”.

The provider did not always support people to manage their health and wellbeing to maximise their independence, choice and control. The lack of detailed risk assessments and failure to use health monitoring tools effectively such as fluid records not considering a persons recommended daily intake, increased the risk of staff not identifying changes to a person’s health condition or actions to take. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support. Relatives told us staff let them know if there were changes in their loved one health conditions for them to arrange medical appointments. Some people were supported with meal planning and preparation and staff had recorded choices people had made.

The provider did not always routinely monitor people’s care and treatment to continuously improve it. People’s care records lacked important information and as a result there were shortfalls in ensuring monitoring was in place or always effective. During the assessment process CQC had identified concerns with details around people’s care and treatment. For one person the manager told us, “We ensure [persons] care plan is regularly reviewed and updated to reflect any changes in medication, risk or other clinical needs. This helps us ensure that the care plan remains relevant”. However, we found the provider had not identified the need to update these areas prior to CQCs assessment. We were assured they took prompt action as a result of the risks being identified. Records confirmed staff monitored people on a day to day basis and where needed, referrals to healthcare professionals were made.

The provider did not always formally assess people’s capacity to consent to care tasks. People’s care plans did not always include details of the person’s capacity to consent or Mental Capacity Assessments (MCA) which would provide assurance the person had received appropriate support with specific decision making. Whilst care records provided some information about how to support a person if they expressed confusion or distress which included appropriate redirection techniques; the lack of available guidance for staff increased potential risk of harm and that people would receive inconsistent responses from different care staff. People and relatives confirmed staff sought consent when providing support. Comments from relatives included, “They explain what they are doing and ask if it is ok”. And, “They will ask [loved one]”. Staff confirmed they supported people to make informed choices and demonstrated an understanding of the MCA process. One told us, “I assume capacity unless it has been determined otherwise”.