Archived: Danbury Care

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.

On 29 March 2017 we returned to the service to assess whether improvements had been made. We found insufficient action had been taken to improve and meet the outstanding breaches of Regulation 17 (Good governance) and Regulation 18 (Staffing). In addition, we identified a breach of Regulation 19 (Fit and proper persons). You can see what action we told the provider to take at the back of the full version of the report.

Danbury Care provides a domiciliary care service and is registered to provide personal care to people in their own homes. On the day of our inspection, there were 57 people using the service and 15 care staff supporting them.

A registered manager was in place. 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.

Systems were not in place to oversee the effective quality assurance and management of the service for people who used it and the staff. People were at risk because the provider did not have robust systems in place for the safe recruitment of staff.

Information in people’s care plans and risk assessments were not sufficiently detailed or up to date to understand their needs and to minimise risks to their health and wellbeing. People knew who to make a complaint to at the service and complaints were dealt with verbally but no information was recorded as to the outcome and learning from people’s feedback or views.

Improvements had been made for the training, support and supervision for staff but there was not a programme in place for the training and support of all staff to equip them with the necessary skills and knowledge to work with vulnerable people

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported. People were treated with kindness and respect by staff and their dignity was maintained. Staff gave people choices and supported their independence. People gave their consent to care and support and their rights were respected.

People’s health needs were met as staff liaised well with health and social care professional. People were supported to be able to have their meals as and when they wanted them which met their nutritional needs.

Staff understood people’s needs and caring relationships had developed as staff engaged and involved people in their care arrangements. People were satisfied with the staff who provided their care and support. However, the provider did not demonstrate that they were committed to the delivery of good care for people due to multiple failings within the service.

A registered manager was in place. 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.’

During the inspection, we found that improvement was needed in the way the service was managed and how staff were trained and supported. We found two 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 service did not have robust systems in place for the overall effective management of the service. The provision of mandatory training and supervision of staff was not in place to ensure they had the necessary skills and knowledge in carrying out their roles.

Staff had a good understanding and knowledge of safeguarding procedures and were clear about the actions they would take to protect the people they supported. People’s medicine were administered to them safely and in a timely way. Risks to people’s health and wellbeing were appropriately assessed, managed and reviewed. Care plans were sufficiently detailed and provided an accurate description of people’s care and support needs.

There were sufficient numbers of staff available to meet people’s needs. Appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service.

People were treated with kindness and respect by staff and their dignity was maintained. Staff gave people choices and supported their independence. People gave their consent to care and support and their rights were respected.

People’s health needs were met as staff liaised well with health and social care professionals. People knew who to make a complaint to at the service and complaints were dealt with quickly and appropriately. People were supported to be able to have their meals as and when they wanted them which met their nutritional needs.

Staff understood people’s needs and provided care and support accordingly. Caring relationships had developed and people were fully involved in their care arrangements.