DORZ Care Services Limited

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture. This is the first assessment for this service. This key question has been rated requires improvement. This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance at the service.

This service scored 39 (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 have a shared vision, strategy and culture based on transparency, equity, equality and human rights, diversity and inclusion, and engagement. There was a failure to demonstrate a positive culture that was focussed on learning and improvement. The provider had not always understood the need to complete assessments to provide staff with accurate guidance on their responsibilities when they were working in collaboration with care partners and family. Systems were not effective in identifying shortfalls and making changes to improve the service. There was a failure to understand how risks could be managed. The provider took action in response to concerns identified at this inspection regarding failures in risk management and medicines and was in the process of being supported by the local authority quality team. The providers website did not accurately reflect their registration. For example, CQC identified they had cited themselves as specialising in supporting people with a learning disability and autism. DORZ care services is not at the time of assessment registered to support people with a learning disability or autistic people. Following our feedback the provider took prompt action to remove reference to this from their website.

Not all leaders understood the context in which the provider delivered care, treatment and support. Leaders did not always have the skills, knowledge, experience and credibility to lead effectively, or they did not always do so with integrity, openness and honesty. The provider did not evidence they were a capable leader due to their lack of knowledge in respect of regulations and responsibilities. They did not lead by example to promote an inclusive culture and failed to assess the quality of care people were receiving. The provider ignored the need to robustly assess people's health needs, care records that were shared with staff were inadequate and did not equip staff to provide a high quality and safe service. For example, a staff member told us the provider had told staff to sign for medicines administration even if a family member had given it. They queried this instruction and were told the manager needed to know. The staff member confirmed this would not be in line with nationally recognised medicine practices. The provider demonstrated a lack of knowledge of the priorities of the quality of service by failing to understand, acknowledge and facilitate the important safety aspects of care delivery, such as the management of risk, effective and safe care planning and the training needs that care staff required to effectively carry out their role. They told us they had recently employed a care manager to support the management of the service. However, it was not at the time of assessment clear how their involvement drove improvement. Feedback from staff was positive on the approachability and support from the provider. Although feedback from care staff was positive, there was a lack of awareness, and concern, from staff on the absence of risk information and guidance around people’s health conditions which left people at significant risk of harm.

The provider generally fostered a positive culture where people felt they could speak up and their voice would be heard. Staff spoke highly of the provider and the support they received; however, records of staff meetings did not show how the provider invited staff to contribute or raise concerns or suggestions.. Following our feedback the provider took action to ensure records of meetingsreflected staff contribution to discussion and actions.

The provider valued diversity in their workforce. They worked towards an inclusive and fair culture by improving equality and equity for people who worked for them. Systems and programmes were in place to support staff inclusion and needs. The provider had recruited a diverse workforce. Some, but not all staff, had completed training in equality and diversity. One staff member described being supported to progress in their role and described how they had completed training to support them with this goal.

The provider did not have clear responsibilities, roles, systems of accountability and good governance. They did not act on the best information about risk, performance and outcomes, or share this securely with others when appropriate. There was a lack of clear and effective governance. Management systems were not effective in identifying shortfalls in the quality and safety of the service. The provider’s systems had failed to identify multiple concerns identified at this inspection, such as the failure to assess, review and manage risks to people, including risks of falls, risks associated with people’s health and well-being and medicines. The provider was unclear and unaware of their regulatory responsibilities and failed to ensure that care and support needs were effectively risk assessed particularly where support was shared with family and other care providers. There was a failure to understand the impact and importance of assessing people’s risks in full and ensuring that staff has access to important information and guidance around health care conditions and risks in order to safely and effectively undertake their role.
The provider did not always demonstrate good oversight of the service. Systems for monitoring people’s health care were not robust. The provider could not provide an assessment regarding risks concerning a person’s SaLT (Speech and Language) guidance. This meant they were not clear about the level of risk. There were no risk assessments or care plans in place to provide guidance for staff in how to support this person safely and in the way the person preferred.
Quality assurance systems were poor. The registered manager had quality assurance checks in place although the consistency and effectiveness of these was poor. Audits had failed to identify the issues and concerns identified in this report, such as risk assessments, medicines, staff training needs and regulatory requirements. For example, the provider amended their staff training matrix 3 times during our assessment as a result of CQC identifying discrepancies with details of the staff they employed.
Audits of medicine administration were not effective. A monthly audit did not provide enough detail to give assurance and had not identified concerns where people had been assessed as requiring time specific medicines. Audits had not identified shortfalls including the lack of PRN protocols or details of arrangements when staff were responsible for administering medicines in collaboration with people and their relatives.

The provider did not always understand their duty to collaborate and work in partnership, so services worked seamlessly for people. They did not always share information and learning with partners or collaborate for improvement. Systems for monitoring quality were not robust. Before this inspection the local authority raised concerns about the provider’s understanding of quality processes including staff training and medicine arrangements. At the time of assessment, the provider was actively working with stakeholders to make improvements to the quality of the service. There had not been sufficient time to provide assurance of improvements being made at the time of assessment

The provider did not focus on continuous learning, innovation and improvement across the organisation and local system. They did not encourage creative ways of delivering equality of experience, outcome and quality of life for people. They did not actively contribute to safe, effective practice and research.
The leadership of the service did not demonstrate a good understanding of how some improvements needed to be implemented. During and following the assessment, we discussed our serious concerns about the lack of risk management around people’s healthcare conditions with the provider. Although the regulatory and legal requirements were discussed and reiterated with the provider, there was a lack of understanding that assessment and management of all risks to people they supported should be considered and incorporated into their support plans and assessments.
The provider failed to show an understanding and focus on the learning and development of staff to ensure that they had the training and skills to support people’s needs safely and effectively. They were unable to demonstrate how new staff were inducted in line with the Care Certificate Standards or that they had received training in line with regulation for people with a learning disability and autistic people. Following our feedback the provider ensured staff completed accredited training.
The provider’s systems failed to identify shortfalls and support learning to make improvements. Care plans and risk assessment records were not always detailed or completed, there was a lack of analysis to identify shortfalls in the quality of information or guidance available to staff.