Dignity Direct Homecare Limited

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 meant some 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 18 in relation to staffing. The provider failed to deploy suitably qualified, competent, skilled and experienced staff to enable them to meet the needs of the service users at all times.

This service scored 50 (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. There were systems and processes in place to manage accidents and incidents. However, we received mixed feedback from people. A relative said, “One of the carers called me and said my (Loved one) was not responding and that they tried to wake and they did call the paramedics to check. My loved one was found okay.” Another relative told us, “We had a health incident about a year ago. One of the carers wasn’t washing my (Loved one) properly and they had poo stuck to them for about 5 days causing sores. We asked that carer didn’t come back, and they haven’t.” A third relative commented, “I mentioned to the office about late visits and carers talking very loudly. But not much has changed.” The provider had not treated these events as incidents and there was a failure to learn from them.

The provider worked with people and healthcare partners to ensure people received continuity of care to meet their needs. Office staff shared relevant information about people’s healthcare needs and sought support from healthcare professionals as and when required for example, hospital, GP, district nurse, pharmacy, speech and language therapists (SALT), and occupational therapist to maintain safe care for them.

The provider did not always work well with people to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives, or protecting their right to live in safety, free from avoidable harm and neglect.

We received a mixed response from people and their relatives. One relative told us, “The service is provided safely. They (Care worker) wash, turn in bed, check they are not wet and put E45 cream on to keep dry skin moist. My loved one is bed bound and has no sores. There are no infections.” Another relative said, “My (Loved one) had a bad back about 7 or 8 weeks ago and they were taken to hospital where they said my (Loved one) was dehydrated. The carers in the week just bring a drink down and leave it there, they don’t encourage my (Loved one) at all.”

Care workers completed safeguarding training, and some were aware about the procedure for whistle blowing and the action to take if they suspected someone had been abused including reporting their concerns to the office. Despite formal training, we found some care workers lacked knowledge and understanding around the training delivered to them. For example, when we asked a care worker if they had read and understood the safeguarding policy and procedures. They replied, “Not sure about what is safeguarding.” When asked about whistleblowing they said, “I don’t understand.” Another care worker failed to understand our questions around safeguarding and required support to translate our questions. A third care worker, when we asked what training they had to keep people safe, for example, safeguarding. The care worker said, “I’m not sure, maybe I have done it.”

The provider had a policy and procedure for safeguarding adults from abuse. However, this was not effective as the care workers did not consistently understand what it meant and how to identify and report concerns of abuse.

The provider had maintained an electronic incidents and accidents log, which showed what steps were taken to keep people safe. However, we were not assured if all incidents and accidents were reported in a timely manner and appropriate actions were taken in this matter. For example, when we asked how do you record incidents or accidents, and how do you escalate safety concerns, one care worker said, “I don’t understand.”

At our last assessment in September 2024 the provider had failed to manage known risks to people safely. This was a breach of Regulation 12. At this assessment, the provider had made the required improvement and there was no longer a breach of Regulation 12.

The provider worked with people to understand and manage risks. Risk assessments and risk management plans were completed for people which included guidance for care workers. One person told us, “Yes, I do think that it’s safe. They (Care worker) get me out of bed, wash me and get my food. They get me safely up and downstairs. My pressure sores stopped after carers got the district nurse.” Senior staff completed risk assessments and risk management plans that included guidance for care workers. For example, about how to manage hoisting and mobility, eating and drinking, choking, catheter care, skin integrity, fire, and skin protectant ointment (creams). Risks were reviewed periodically.

The provider training records showed care workers completed mandatory trainings to manage people’s risks. One person told us, “I think they are well trained, not a problem but if there is an issue then they will ask me, there is always a family member here.” A relative said, “We’ve no trouble with them (Care workers) and are happy with their work. They have used the hoist before in the past, but [family member] doesn’t want to get out of bed anymore. If they notice [family member’s] leg is puffed up, they will tell me, and I call the district nurse.” However, we were not assured, as some of care workers had not shown an understanding of specific subjects in how to keep people safe from avoidable harm, further details described in the sections under safeguarding, safe and effective staffing quality statements.

People's care and support was provided in a safe environment. Senior staff carried out a risk assessment of home environment, including fire, safety of the hoist and mobility equipment and gave guidance for care workers to provide care to people in a safe environment.

At our last assessment in September 2024, the provider failed to operate and monitor an effective system to ensure the effective deployment of staff in accordance with people’s needs. There was a breach of Regulation 18. At this assessment, we found the provider had remained in breach of Regulation 18.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

The provider did not make sure people were supported by skilled and effectively deployed care workers. Systems to ensure people received care calls on time were not always effective or adequate. The provider failed to review, monitor and assess electronic call monitoring data effectively to identify shortfalls or improvements. During the assessment, we analysed the electronic call monitoring (ECM) data for 7651calls for60people from 24 June 2025 to 23 July 2025 and identified failings with regard to late calls, short calls, double handed calls, calls were scheduled in before the completion of previous call, calls logged in at 2 locations simultaneously, calls were manually logged, unlogged calls, no travel time between calls, and call rota. The provider’s oversight and management of the home visits call rota, care delivery notes, and call monitoring system and process were not effective. This meant people were placed at high risk of harm from not receiving their care visits as planned.

We received mixed feedback from people. Their comments included, “The carers aren’t always on time. They can be early or late and can go quickly. Today the lunch visit was early, and the carer went after 10 minutes after changing me and put my food in the microwave.” “They (Care workers) are allocated 45 minutes and half hour on 3 of the visits. They only stay 15 minutes and some of that time they are sitting in the kitchen on their own phones.” “The morning care is good and my (Loved one) has a wash and tea and toast but the other 3 calls the carers don’t do anything and they are only there 5 minutes.” “Sometimes they are late, not very late but the office don’t phone and so now the carers phone me if they are going to be late.” “Timing is better now mostly but about a year ago we had the carers coming in at 5.30 am instead of 7.00 am which was ridiculous. We did complain and they did change the carers which made a difference.”

The provider supported care workers through regular supervision meetings. Training records showed care workers completed training which covered areas such as, health and safety, safeguarding, infection prevention control, moving and handling, fluids and nutrition, medicines administration, dementia, and mental capacity act. However, some care workers did not understand what was safeguarding, whistleblowing, what was meant by consent, what to do following an incident and accident and they did not remember what training they had received. For example, one care worker told us, “Yes, I don’t remember their name.” Therefore, we were not assured the training provided was effective or their understanding checked by the management team.

The provider carried out satisfactory background checks for all care workers before they started working. These included checks on care workers qualifications and relevant experience, their employment history and consideration of any gaps in employment, references, criminal record checks and proof of identification. This reduced the risk of unsuitable staff working with people who used the service. However, we had received feedback from people and relatives relating to concerns about care worker’s ability to communicate effectively with people.

People were protected from the risk of infection. Care workers understood the importance of effective hand washing, using personal protective equipment (PPE) and disposing of waste appropriately. This protected people from infection and cross-contamination.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People received their medicines as prescribed. One relative said, “They (Care workers) do the medication, it’s in a blister pack and it is on reorder from the chemist and carers take out the medicines and put them in a little dish for my loved one to take.” At the last inspection, people did not have risk assessments in place for managing the use of external creams that were flammable. At this inspection, improvements had been made. People, their families, and care workers had been provided with information about the fire risks associated with flammable creams. Where people smoked, additional risk assessments were in place, and control measures had been implemented to reduce the risk of harm. In addition, for people prescribed topical creams and patches, body maps were available to guide care workers on where these should be applied.

Person-centred guidance to support the use of ‘when required’ (PRN) medicines were in place. However, where variable doses were prescribed, there was not always clear instruction for care workers on what dose to administer and when. For example, a person who lacked capacity and had difficulty communicating their needs did not have this reflected in their PRN protocol. Therefore, it was not always clear how care workers determined when to administer a higher or lower dose of pain relief medicines.

Staff received medicines training, and their competency was assessed annually or sooner if required. However, care workers understanding of PRN protocols was poor. For example, when we asked about PRN protocols, 2 care workers told us they were not sure and 2 said they did not know what they were. Therefore, it was not always clear how care workers determined when to administer a higher or lower dose of pain relief medicines, or when to refer to the PRM protocols for guidance, as they did not know what they were.

Medicines audits were carried out regularly and actions identified were implemented. There was a process in place for managing and reporting any errors or incidents involving medicines. Office staff were able to talk through the process that would be followed if this occurred. Medicine incidents would be discussed within the staff at team meetings. However, the concerns found about PRN protocols were not identified during their medicines audits.