D C Homecare is a domiciliary care agency which provides personal care and domestic support to people in their own homes. The service provides care and domestic support to people who live in the Buckfastleigh, Ashburton and Bovey Tracey areas of Devon. The service is not required to have a registered manager in post as the registered provider manages the service.
This announced inspection took place on 21 and 22 November 2016 and included visits to the office, staff interviews and visits to people in their own homes. At the time of this inspection 19 people were using the service, all but one of whom were receiving support with their personal care needs. Domestic support is not regulated by us, and therefore this inspection only looked at the care and support of those people who received assistance with their personal care. This was the first inspection of the service since it registered with CQC in March 2015.
Prior to this inspection a concern had been raised with us that the service was not obtaining the necessary disclosure and barring (DBS) checks for prospective new staff. We asked the provider for information about the staff employed at the service and whether they had a DBS check completed before they started to care for people unsupervised. The provider confirmed that all staff had a DBS check, but there had been an administrative error which meant there was a delay in obtaining a check for one member of staff. The provider told us they were aware for their responsibility to ensure all staff employed by the service were suitable and safe to work with people who were vulnerable due to their circumstances.
At this inspection we looked at the recruitment files for four staff, including the most recently recruited staff member. All four files included the necessary pre-employment checks including proof of identify, previous employment references and a DBS check.
The provider told us they regularly reviewed and audited the quality of the service, although at the time of the inspection records of these audits were not being maintained. It was therefore not possible to verify of these audits were taking place. The provider said that through continuing to provide care to people, observing staff’s interaction with people, and monitoring the daily care records and medicine administration records they reviewed staff practice and the care people were receiving.
People and staff had been asked to complete a survey which asked for their views about the quality of the service. The results of those completed in September 2016 showed a high level of satisfaction from both people and staff. One person commented, “I am delighted with all the carers, they are friendly and caring people. I couldn’t wish for better care.” The provider was in the process of developing new documents that were easier for staff and people to use. Amongst the documents being developed were the quality monitoring surveys and audits and those used for staff supervisions, appraisals and observations.
People and staff told us the service was managed well. One person said “it’s excellent”. People said they felt safe with the staff when receiving care. They said they had a regular staff team whom they had come to trust and know well. Each person we spoke with told us their care staff were kind and compassionate. Their comments included, “They are wonderful. Every one of the carers is lovely, friendly, helpful, and [the provider] is super” and “I regard them as friends now.”
People told us staff usually attended to them on time and they had never had a missed call. If on occasion staff were going to be late they always received a phone call to notify them. Staff told us they had no concerns over the planning of visits and they were provided with sufficient paid travel time. They said they had enough time to ensure they delivered care safely and visits were not compromised by having to leave early to get to their next person on time.
People and their relatives had no concerns over the care and support they received and they felt able to make a complaint if something was not right. One person told us, ““There’s nothing that needs improving” and another person said, “It couldn’t be better.”
Staff performance was regularly reviewed by the provider and the team leader through direct observation to ensure they were meeting people’s needs respectfully and in the manner people preferred. Staff knew people well and were able to tell us how they supported them. The service was flexible and responsive to changes in people’s needs.
Staff had received training in safeguarding adults and knew how to recognise signs of potential abuse. They understood the necessity to report any concerns to the provider however some staff were unsure who to report concerns to outside of the agency. The provider said they would remind staff of the contact details and process for reporting suspected safeguarding issue to the local authority. All staff said they would to report incidents of theft or physical aggression to the police.
Risks to people’s health and safety had been assessed and were regularly reviewed. Some of this information was written in people’s care plans and some in separate risk assessments completed by health care professionals. The provider acknowledged that staff would benefit from having this information in one document, in people’s care plans, and commenced amending the plans during the inspection. Assessments related to people’s health care and mobility needs, as well as environmental considerations, such as stairs or the safety of kitchen equipment. Staff were given information about how to minimise the chance of harm occurring to people and themselves.
The service supported some people to take their medicines. Care plans provided information about each person’s medicines and when these should be taken. People told us the staff supported them safely and they received their medicines as prescribed.
Staff told us they had the training they needed to carry out their role, including moving and transferring people safely, infection control, first aid, pressure area care and caring for people living with dementia. Staff told us they enjoyed their job and felt supported and valued by the provider. Staff meetings provided opportunities to review the development and continued improvement of the service. Staff told us the provider was very approachable, was keen to hear their views and were always available.
Some of the people receiving a service were living with dementia which might affect their ability to make decisions about their care and support. The provider and the staff had a good awareness of the Mental Capacity Act 2005. Staff said they asked people every day about whether they were happy to receive care and to allow them to make what decisions they could.
The provider told us how proud they were of the care and support they and the staff provided to people. They kept up to date with current issues in the care profession by accessing care related websites and attending external training events. The provider was aware of their responsibilities under the duty of candour, that is, their duty to be honest and open about any accident or incident that had caused, or placed a person at risk of, harm. Systems were in place for the reporting of notifications to Care Quality Commission and incidents that involved people had been reported to us as required.
We have made a recommendation in relation to the service’s quality monitoring processes and its record keeping.