Dignity Direct Homecare Ltd - Sheffield

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meantsome aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safeguarding, managing risks posed to people and managing medicines.

This service scored 53 (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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. Since our last assessment new systems had been introduced to monitor accidents and incidents; however, these were not always effective in identifying learning and driving improvement. For example, weekly incident reviews had not been completed consistently, for reviews which were completed sections intended to capture themes, trends and lessons learned had been left blank. Incidents were not consistently recorded across monitoring systems, resulting in incomplete oversight. For example, safeguarding concerns and medicines-related incidents were not always reflected within incident or complaints records, reducing the provider's ability to identify recurring risks. There was also limited evidence of actions taken and learning following some significant incidents. Whilst incidents had been recorded, records did not always demonstrate robust review, escalation or consideration of wider learning.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services. We could not be assured information shared with partner agencies would be correct and reflect people’s current needs, should they move between services or require external input. Care plans and risk assessments were not consistently accurate, complete or up to date. Records contained discrepancies, conflicting information and missing details relating to areas such as mobility, falls, nutrition, health conditions and skin integrity. Records did not always provide staff with sufficient guidance to manage identified risks safely, and daily records contained information which had not been incorporated into care plans.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately. Whilst we found some improvements had been made to recording systems, and staff told us they felt able to report safeguarding concerns: we found some safeguarding concerns which were not appropriately recorded and actioned. For example, we found a person had reported an allegation of neglect from a family member which had not been appropriately actioned, monitored and reported. Whilst some systems were in place to monitor safeguarding incidents, these did not always identify the number of safeguarding concerns accurately, meaning the provider did not have effective oversight of all incidents and could not monitor any themes and trends effectively.

Staff had received training in relation to safeguarding, and whistle-blowing policies and procedures were in place.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In homecare services, this is done through the court of protection. The service was not always working within the principles of the MCA, people had not always had their capacity assessed in a wide range of decisions about their care, care plans contained conflicting information about people’s capacity to make decisions. We also found the registered manager had little knowledge of their roles and responsibilities in relation to assessing people’s capacity. Staff were trained in relation to the MCA.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Whilst we found no harm to people, improvements were required to records to ensure risks were effectively identified, assessed and managed. Risk assessments and care planning documentation were not always accurate, up to date or reflective of people's current needs. Records contained inconsistencies, omissions and conflicting information relating to areas such as mobility, falls, nutrition, skin integrity, health conditions and the support required to manage risks safely. Known risks were not always supported by clear guidance for staff, and changes in people's needs were not consistently incorporated into care plans and risk assessments.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People were supported in their own homes. Risk assessments were undertaken of people’s properties to ensure they were safe for staff to provide care.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs. We could not be assured people were always supported by staff for their allocated call times. Whilst we found most calls were completed, some calls were significantly late, some were missed and where people required 2 staff, we found some people had not received 2 staff for their allocated time. We also received mixed feedback from people about staff arriving on time and staying for their allocated call times. A person told us, “Sometimes carers are late due to other clients. It happens once a week. I can’t do anything with one hand and so I have to sit and wait. It’s frustrating. I can’t open my NOMAD for medicines. They do stay for the full time and will ring if they are going to be late.” And a relative said, “They (carers) try to adhere to the times that I ask for. If they are a little late by half an hour, then we can cope. They don’t tell us if they are going to be late. Recently no one turned up because of an admin error.”

Staff were recruited safely, all appropriate pre-employment checks were in place and staff received regular training and supervisions, to enable them to effectively carry out their care duties. Staff competencies were assessed to ensure they were adhering to the services policies and procedures. A staff member said, “Before starting employment, the appropriate pre-employment checks were completed, including references, right-to-work checks and a DBS check, in line with the provider's recruitment procedures.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. Staff received infection, prevention and control (IPC) training and were able to tell us how they helped to keep people safe from the risk of infections. IPC policies and procedures were in place, and staff received spot checks to ensure they were adhering to safe IPC practices. However, some people told us staff did not always follow IPC procedures whilst providing support and some people told us staff did not always keep their homes clean and tidy. A person said, “Oh yes, they (staff) put gloves on. They do a good job and keep my place clean.” Whilst a relative said, “I think they do (wear Personal Protective Equipment). They always have aprons and gloves on. Most dispose of them properly. Although 1 staff didn’t take the used pad out of the bin. I don’t think they (staff) wash their hands and still have them (gloves) on when they go.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.Medicines Administration Record’s (MAR’s) were not always consistently completed, we found medicines records for 1 person had not accurately been completed by staff, to evidence if they had received their medicines on the correct days of the week.There was a lack of information on people’s medicines records, such as allergy information. We also found discrepancies between people’s medicines care plans and MAR’s.For example, 1 person’s care plan recorded that they may take too much medication. However, this information was not accurate, as the person was unable to self-administer or independently access their medicines.

We also found a concern relating to a potential overdose which had not been found by the provider, this was found to be a recording concern. We made a safeguarding referral to the local authority about this concern. We received mixed feedback from people about receiving their medicines. 1 person told us, “Some staff, especially at the weekends don’t put my creams on.” Whilst another person said, “They (staff) remind me to take them. There’s no problems with medicines.” Another person also told us staff had not administered enough paracetamol, which they had to clarify with their Dr, to ensure they received enough pain medication.

Where people had ‘as required’ medicines prescribed, protocols were in place to guide staff about how and when these should be administered. Staff had received training and competency assessments.