Archived: Direct Line Consultancy Services

Updated 8 December 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

We gave the service 24 hours’ notice of the inspection visit because we needed to be sure someone would be in the office to give us access to the records. The inspection was completed by one inspector.

Before the inspection we reviewed information we already held about the service in the form of the last inspection report, the action plan the provider sent to us telling us how they would address our previous concerns and notifications that had been submitted to us. Notifications are information about incidents and events providers are required to tell us about by law.

During the inspection we spoke with two parents of children who received a service and four members of staff including the office administrator, the office apprentice and two care workers. After the inspection we spoke with a social worker and a member of the commissioning team. During the inspection we reviewed the care files of three children receiving personal care, including assessments, risk assessments, care plans and records of care. We reviewed four staff files including recruitment, training and supervision records. We reviewed various documents, policies and audit records relevant to the management of the service.

Updated 8 December 2018

This inspection took place on 10 July 2018 and was announced. At the last inspection in November 2017 we identified breaches of seven regulations.

We asked the provider to take action to address our concerns about fit and proper persons employed, receiving and acting on complaints and safeguarding service users. We took enforcement action and issued warning notices requiring the provider to meet regulations regarding good governance, safe care and treatment, staffing and person-centred care.

The provider had taken very limited steps and had only addressed our concerns about complaints. Following this inspection in July 2018 we continue to have significant concerns about person centred care, safe care and treatment, good governance, staffing, and fit and proper persons employed.

Direct Line Consultancy Services is a domiciliary care agency. It provides personal care to children living in their family homes in the community. Although registered to provide a service to older adults, younger disabled adults and children, the service was only providing care to children at the time of our inspection. Not everyone using Direct Line Consultancy Services receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection the provider told us they were supporting three children with personal care. After the inspection the local authority told us an additional four packages had been commissioned to include personal care.

There was a registered manager in post, although he was not present during the 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.

The provider had failed to address our previous concerns about the lack of detail in care plans and risk assessments. There was insufficient information to ensure care workers could provide safe care and treatment to children in a way that reflected their preferences. Children receiving care had complex healthcare needs including physical and neurological disabilities but there was no recorded joint working with other professionals. There was also a lack of information about how to respond to health related emergencies which meant children were at risk of harm. It was not always clear whether the provider had taken appropriate action to safeguard children from harm.

Parents told us they were unhappy with staff who had only received online training working with their children. Staff had not received the training they needed to meet children’s needs. Recruitment records were not complete and did not show robust recruitment processes had been followed.

The provider collected information about children’s religious beliefs and cultural background but did not consider if this affected how children wished to receive care. Care workers did not feel the provider was sensitive to the religious and cultural background of families they supported.

Care plans were reviewed regularly, and families were asked to provide feedback on their experience. However, key information was not recorded and changes in circumstances were not captured in the care plans.

Families told us they had developed trusting and positive relationships with named care workers, but they did not trust the provider to supply consistently skilled care workers. Families chose to go without care when their regular care workers were not available.

The audit and quality assurance systems in place had failed to identify and address issues with the quality and safety of the service. The response of the provider did not demonstrate they understood the seriousness of the issues or that the lack of information within files put children at risk of harm.

Families told us staff arrived on time and stayed the full duration of scheduled visits. The provider had taken action to ensure complaints were responded to appropriately. Families told us they knew how to make complaints.

During this inspection we identified continued breaches of five regulations regarding person-centred care, safe care and treatment, staffing, fit and proper persons employed and good governance. Full information about our regulatory response is added to reports once all appeals and representations have been exhausted.

The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘special measures.’

Services in special measures will be kept under review, and if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review, and if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvement when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.