Domiciliary Care Services (UK) Limited

Domiciliary Care Services (UK) Limited is a domiciliary care service providing personal care to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of our inspection there were 52 people receiving the regulated activity of personal care.

People’s experience of using this service and what we found

Medicines were not always managed safely. People's risk assessments and care plans were not always detailed. We found no evidence anyone had been harmed but this had put some people at risk of potential harm. There were quality assurance systems in place. However, not all the provider's audits were effective. The provider had not previously identified the issues we found.

People’s care plans were not always person-centred however, people were positive about the support they received from staff. We have recommended the provider reviews documentation to ensure it is person-centred. Staff worked in partnership with other organisations and services to provide people's care and support. There were systems and processes in place to safeguard people from the risk of abuse. People and relatives told us they/their family member were safe being supported by staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s ability to consent to care was considered, however records detailing how a person’s capacity was assessed were not clear. We have recommended the provider reviews their processes for recording how capacity was assessed.

Feedback was gathered through surveys and meetings. Staff felt supported and valued. People told us staff supported them with dignity and respect. Feedback from people and their families about the service was mostly complimentary.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 23 August 2019).

Why we inspected

We inspected this service due to the length of time since the previous inspection.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Domiciliary Care Services (UK) Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

We have made recommendations that the provider reviews their recording processes to ensure records are person-centred and also reflect how a person's mental capacity is assessed.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Domiciliary Care Service, Knighton Road is a domiciliary care service. The service provides personal care to people living in their own homes. At the time of the inspection there were 80 older adults using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

A family member told us, “From the outset I have been involved with the care package. I would recommend this company 100%, without a doubt. They do what you expect them to do.”

People’s safety was promoted by staff who followed guidance on how to reduce potential risk. This included the use of equipment to support people moving around their home. People were supported by sufficient numbers of staff who had undergone a robust recruitment process. People were supported with their medicines. Staff training in key safety areas promoted people’s safety, which included staff knowledge and understanding of reporting potential safeguarding concerns, and following infection control procedures.

People’s needs and expectations of care were assessed, which included assessing people’s needs based on their cultural diversity and communication needs. Assessments were used to develop a package of care, to support the person at home. People’s needs were met by staff who had the necessary skills and knowledge, which included staff’s ability to communicate with people in their preferred language. Staff were supported through ongoing training and supervision to enable them to provide good quality care. Staff promoted people’s health by supporting them to take their medicine, and by liaising with health care professionals when required.

People were supported to have maximum choice and control of their life and staff supported them in the least restrict way possible and in their best interests; the policies and systems in the service supported this practice.

People and their family members spoke favourably about staff, and the positive and supportive relationships that had developed. They told us how they were supported by a core team of staff who had a caring and compassionate nature. They said staff considered their privacy, dignity and independence.

People and family members were involved in the development of care plans, which enabled staff to provide the care and support each person had agreed was appropriate to them. People’s views about their care were regularly sought, and changes made to people’s packages of care, where people’s needs changed. People were confident to raise concerns should they arise.

The management team were aware of their role and responsibilities in meeting their legal obligations. Systems to monitor the quality of the service were in place, and used to develop the service and drive improvement. The provider worked with key stakeholders to facilitate good quality care for people, by accessing training and shaping the provision of domiciliary care. They worked with key organisations to keep up to date with good practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published, 7 February 2017)

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.

Domiciliary Care Services (UK) Limited is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were 88 people using the service. People's packages of care varied dependent upon their needs. There were 33 staff employed who provided people’s care.

The previous comprehensive inspection of 4 January 2016 found improvements were needed and a breach in the regulations. The focused inspection of 3 November 2016 found the service to be compliant with the regulations.

The service had a registered manager. 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.

People’s safety and welfare was promoted by staff that understood and had received training on their role in protecting people from potential harm and abuse. Safety and welfare was further promoted through the assessment and on-going review of potential risks to people. Where risks had been identified measures had been put into place to reduce their likelihood, which were recorded within people’s records and understood and implemented by staff.

Staff upon their recruitment had their application and references validated and were checked as to their suitability to work with people, which enabled the provider to make an informed decision as to their employment. Staff underwent a period of induction and training, which included their being introduced to people whose care and support they would provide. Training provided to staff and staff understanding of their role and responsibilities meant people were supported appropriately with all aspects of their care, which included support with their medicines.

Staff understood the importance of seeking people’s consent prior to providing care and support. Staff were aware of people’s rights to make decisions and were able to tell us how they encouraged people to express their opinions on their care and support. Staff liaised with a range of health care professionals and kept in contact with people’s family members where they had concerns about people’s health.

The open and inclusive approach showed by staff from the service to people meant those using the service and family members had confidence in contacting staff at the service, knowing they would be listened to. This had a positive impact on people. For example, staff from the service were able to provide information and liaise with other agencies to ensure people’s needs were met. The service provided was flexible to meet people’s individual needs and people spoke positively about the attitude and approach of all staff.

The provider had acquired and continued to implement a quality audit system, which assisted them in determining whether they provided quality care and support to people within their own home.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now meet legal requirements. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Knighton Road on our website at www.cqc.org.uk.

The provider submitted an action plan following the inspection of January 2016 advising us of the action they would take to address the breach of regulations identified by the 4 April 2016.

Knighton Road is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were 87 people using the service. The provider employed 61 staff to provide personal care and support.

This inspection took place on the 3 November 2016 and was announced.

A registered manager is 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.

There were effective systems in place to support communication between the registered manager and staff, to ensure staff had access to up to date information so that any changes in people’s needs was understood by all. Members of the management team carried out audits on documentation completed by staff to ensure that records were of a good quality.

The system to appraise and supervise staff had undergone improvement to enable the provider to determine whether the support and care provided by staff was of a good standard. The appraisal and supervision of staff was regularly assessed and improvements if identified were monitored through on going staff appraisal.

The local authority through their commissioning team had found the service to be complaint when assessed against their quality assurance framework.

The provider had acquired and implemented a quality tool kit, which assisted them in determining whether they provided quality care and support to people within their own home. The outcome of people’s views once collated was shared with them and included any actions undertaken to bring about improvement. To further support the commitment of the provider in keeping people informed, the provider circulates a newsletter to people, providing them with information, such as the training staff received so that people could be confident and reassured as to the knowledge of staff in meeting their needs.

Domiciliary Care Services (UK) Limited is registered to provide personal care and support for people living within their own homes. At the time of our inspection there were 98 people using the service.

Domiciliary Care Services (UK) Limited 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 2008 and associated Regulations about how the service is run.

People we spoke with and information we received through questionnaires showed that people felt safe when receiving care and support from staff. People told us this was because staff were friendly and helpful. Staff had a good understanding of their role in reporting potential abuse and were aware of the types of abuse people were at risk of.

Potential risks to people’s safety were assessed and plans to minimise risk were developed, however these were not always sufficiently detailed to provide clear information for staff as to how risk was to be reduced. Staff we spoke with were aware of potential risks with regards to the people they supported and told us how they reduced risk through the use of equipment to safely move people within their home.

People we spoke with and information we received through questionnaires stated that staff arrived on time to provide people’s care and support and that staff completed the tasks they were commissioned for.

People told us that where they needed support with their medicine this was provided by staff. We found there were sufficient staff to provide people’s care and keep them safe and that staff had received training to enable them to meet people’s needs safely.

People we spoke with and information we received through questionnaires showed that people were supported by a consistent group of staff and that in a majority of cases people using the service had been introduced to staff to ensure they were compatible. People told us that individual requirements were met, which included receiving care from staff who spoke their first language and had an awareness of their cultural and religious beliefs.

People using the service and staff told us that ‘spot checks’ were carried out to ensure the care being provided was reflective of people’s plans of care and that staff interacted with people well. However we found that the information recorded about these checks to be very limited and did not provide a record to evidence the assessment and outcome of staff’s competency.

People we spoke with told us that staff sought their views about their care and support and listened to them. Staff told us that they always sought people’s views to ensure that the care they provide is as they wished it to be.

Where people require support with nutritional needs this is provided, which includes the preparation of drinks and meals. People’s plans of care provide information for staff as to the support people need, which ensures people have access to food and drink throughout the day when required.

Staff we spoke with were aware of their role in dealing with unexpected situations, which included arriving at someone’s home to find them unwell. Staff were clear of their role in contacting emergency services where appropriate, seeking guidance from managerial staff and supporting people to access health care.

People we spoke with and information we received through questionnaires recorded that people found staff to be kind and caring. They told us they were supported by a consistent group of staff which meant positive relationships had been developed. People stated that their privacy and dignity was promoted and we found staff were able to provide practical examples of how they promoted people’s dignity.

People told us that staff’s ability to communicate with them in their first language was positive. However a minority of people did express concerns that on occasion’s staff spoke in their first language, which excluded them as they did not understand what was being said.

People’s plans of care provided an overview as to the care and support people required which had been developed from their initial assessment. The style and content of people’s plans of care was currently under review. A quality assurance audit carried out by representatives of the local authority who commission packages of care for people had identified improvements were needed to ensure people’s plans of care were person centred and were developed with the involvement of the person or their representative.

Information we received through questionnaires showed that a majority of people who used the service felt they were involved in the service they received. However people we spoke with felt involved in their care but did not always have knowledge of their plans of care and other information written about them and was kept within their home.

People we spoke with and information gathered from our questionnaires showed that people were confident to raise concerns with staff about their care and that they had confidence that any concerns would be listened to and acted upon.

We found there was not an effective system in place to asses, monitor and improve the quality and safety of the service and to identify where improvements were needed. This meant the provider had not identified areas for improvement and therefore did not have a plan of action to bring about improvement with a view to continually improving the service provided.

The registered manager acknowledged that improvements were needed in some areas, many of which had been brought to the attention of the provider by the quality assurance monitoring visit carried out by representatives of the local authority who commission packages of care for people.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.

We found people's care plans and records provided information which enabled staff to provide the care and support each person required. Staff told us that where they noted changes to the health or welfare of people they reported these to a member of the management team who then liaised with people's relatives or health and social care professionals where appropriate to ensure peoples care packages were reviewed in order that they received the care they needed.

Staff we spoke with told us they had regular access to training and that they were supported by the management team through supervision, one to one 'spot checks' and meetings. The supporting of staff was part of the providers' quality assurance system, which included speaking with people who used the service and seeking their views.

People's comments included: - 'They really are good. I'm very happy with them, if anything happens it gets sorted and the manager is very approachable.' 'Both the carers and office staff are very friendly and organised.' 'They're generally speaking on time and they always provide the care and support that's in my care plan.'

We spoke with four members of staff and found staff had a good understanding of the needs of people they cared for and told us that they found the manager of the service to be supportive. They told us they had access to regular training which enabled them to care for people well.

We found that whilst the service kept records well they had not notified the Care Quality Commission of changes to their management structure which they are legally required to do.