Archived: Danbury Care

Updated 9 January 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.

The inspection took place on 19 and 31 October 2017 and was carried out by one inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service. The provider was given 24 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone was available to speak with us.

Before the inspection we reviewed information we had received about the service such as notifications. This is information about important events which the provider is required to send us by law. We also looked at information sent to us from other stakeholders, for example the local authority and members of the public.

During our inspection we visited the offices of Danbury Care. We looked at the care records of eight people, training and recruitment records of staff members, and records relating to the management of the service. We visited two people in their own home accompanied by a member of staff. We also met with two relatives and spoke with a further six people receiving care and support from the service and five relatives on the telephone. We spoke with the provider who was also the registered manager, two care co-ordinators and three other members of staff.

Updated 9 January 2018

Danbury Care provides personal care and support to people in their own homes. They were supporting 48 people when we inspected on 19 and 31 October 2017. The provider was given 24 hours' notice of our inspection because the location provides a domiciliary care service and we needed to know that someone would be available.

There was a registered manager in post. The registered manager was also the provider. 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.

At our last inspections in March 2017 we found that the registered provider was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to submit an action plan to tell us how they intended to make the required improvements. At this inspection we checked whether these improvements had been made and found that the provider continued to be in breach of these regulations. Additional multiple breaches of the regulations were also found.

Following our inspection in March 2017 we issued a Warning Notice with a requirement that the provider was required to become compliant with the regulation by 30 May 2017. We also met with the provider to discuss their future plans for the business and the improvements needed.

Despite assurances from the provider that improvements would be made following our previous inspections, there continued to be widespread shortfalls in the way the service was led. There was a lack of managerial oversight and the provider was not pro-active. There were no formal quality assurance systems in place to ensure that the quality of care was consistently assessed, monitored and improved. People were not confident that concerns and complaints would be taken seriously and responded to appropriately.

Procedures for the recruitment of staff were still not robust enough to protect people from the risk of unsuitable staff providing their care. Risk assessments in relation to people’s daily living were either not in place or lacked detail. There were no risk assessments in place relating to people’s specific health conditions. Staff did not have up to date information or guidance in order to protect people from the risk of harm.

Care plans were task focussed and extremely limited in detail. Important information about people was not recorded in their care records. People had initially been involved in the planning of their care but had not been consulted or involved in updates.

Care plans did not record the level of support each person required with their medicines. There was limited monitoring of people’s medicines and how staff recorded these. Medication training was brief and ineffective and the medicines policy continued to be out of date.

There continued to be insufficient systems in place for the induction, training, supervision and appraisal of staff. Training provided was not effective in ensuring staff had the knowledge they needed to provide people with safe and effective care in line with their wishes and preferences.

People told us that staff gave them the opportunity to make decisions for themselves. However management and staff had not received training relating to the Mental Capacity Act and were therefore unware of the need to appropriately assess people’s capacity to make specific decisions.

There was limited information included in people's care plans about their dietary needs and records lacked detail about their preferences. Where appropriate the service had made referrals to health care professionals such as the community nursing team and GP’s.

Concerns remained regarding staffing levels and people regularly experienced late calls. People told us they felt safe whilst receiving care in their homes but the provider had failed to recognise that more robust systems were needed to ensure people were not at risk of abuse, including stronger recruitment procedures and adequate monitoring of care staff.

People told us that staff were kind, caring and considerate. Staff demonstrated empathy, understanding and warmth in their interactions with people. Although frontline staff delivered good care to people, the service overall did not demonstrate that they cared about the people they supported.

At our last two inspections we found that the provider lacked understanding regarding their responsibilities as the registered responsible person in accordance with regulation. It was only through the care and commitment of frontline staff that people had not come to any harm. This continued to be the case and the lack of provider oversight and leadership meant improvements were not being implemented, monitored or sustained. This resulted in continued non-compliance with regulations and put people at risk of unsafe care and treatment.

During this inspection we identified a number of breaches 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to; Ensure that providers found to be providing inadequate care significantly improve. Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made. Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.