Archived: Duty of Care 24-7 Ltd

People’s experience of using this service:

People’s experiences of the service were positive. However, the systems that were in place to ensure and review if the service provided good quality care required improving. Improvements were required to the auditing of the service, to review the quality of care people received. Effective auditing systems were not in place and there were no opportunities for people to review the service they received.

Staff did not know how to report safeguarding concerns to an external agency and improvements were also required to the recruitment procedures of new staff. Whilst training had improved since the last inspection, further improvements were required to ensure staff understood people’s specific care needs, particularly in relation people’s mental health needs.

We found improvements were required to people’s care plans to ensure they provided enough guidance to staff about supporting people with their care and achieving their goals. There were no plans in place to ensure people were given the opportunity to discuss end of life care.

People told us staff treated them well and respected their decisions. People were involved in decisions about their care and staff were knowledgeable about people’s preferences. The service was flexible to meet the changing needs of people that used the service and staff were respectful of people and their needs.

We have made a recommendation for the provider to provide staff with training about the specific mental health care needs of people using the service.

Rating at last inspection: Requires Improvement (published 13 June 2018). At the last inspection, there was a breach of Regulation 18: Staffing of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014 (Part 3). At this inspection we found improvements had been made and the service was no longer in breach of this regulation. However, this is the third inspection that the service has been rated as Requires Improvement and the CQC will be working with the provider to review how the required improvements can be made and sustained.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Enforcement: We found the provider to be in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3), Regulation 17: Good governance.

Follow up: The provider will be instructed to provide an action plan and we will be meeting with the provider to review how they can make the required changes to achieve and sustain a Good rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At this inspection on 2 May 2018, we found the service remained as ‘Requires improvement’.

Duty of care 24-7 Ltd provides support and personal care to people with mental health conditions who live in their own homes in order for them to maintain their independence.

At the time of inspection, only 2 people were receiving personal care. Not everyone using Duty of care 24-7 Ltd received regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided.

Staff did not always receive the appropriate training that was necessary to enable them to carry out the duties they were employed to perform. When staff were inducted in to the service, the process was not robust and did not make sure they were trained in areas such as safeguarding adults and supporting people with mental health conditions. Some of the staff we spoke with did not have the required knowledge of how to report any concerns of abuse. Ongoing training systems provided were not effective in training staff in these areas.

Effective quality audit systems were not in place to ensure that staff training was up to date. The registered manager was aware that not all staff had completed the required training, but had not taken any prompt action to make sure that people received care from staff that were appropriately trained.

You can see what action we told the provider to take at the back of the full version of the report.

The service had a registered manager in post. 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.

People told us they felt safe. People had risk assessments in place to cover any risks that were present within their lives, but also enable them to be as independent as possible. All the staff we spoke with were confident that any concerns they raised would be followed up appropriately by their manager, but they did not always know who to go to should they need to report concerns outside of the service.

Staffing levels were adequate to meet people's current needs.

The staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service. References and security checks were carried out as required.

Staff told us they had the appropriate personal protective equipment to perform their roles safely. People we spoke with told us that staff supported them in a way which prevented the spread of infection.

Staff were well supported by the registered manager, and had one to one supervisions and observations. Staff were happy that they were able to contact the registered manager and speak with him whenever they needed to.

The provider understood their responsibility to comply with the Accessible Information Standard (AIS), which came into force in August 2016. The AIS is a framework that makes it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they are given.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice

People were able to choose the food and drink they wanted and staff supported people with this when required. People could be supported to access health appointments if required. The registered manager and the staff had a good understanding of people’s mental health needs, and knew when to access the support of other health professionals.

Staff treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. People told us they were happy with the way that staff spoke to them, and provided their care in a respectful and dignified manner.

People were involved in their own care planning and were able to contribute to the way in which they were supported. Care planning was personalised and mentioned people’s likes and dislikes, so that staff understood their needs fully. People told us they felt in control of their care and were listened to by staff.

The service had a complaints procedure in place to ensure that people and their families were able to provide feedback about their care and to help the service make improvements where required.

The people we spoke with knew how to use it.

The service worked in partnership with other agencies to ensure quality of care across all levels. Communication was open and honest, and improvements were highlighted and worked upon as required.

The provider was also the registered manager at the time of our inspection. 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.

Staff had the skills and knowledge to provide the care and support people needed but had not always received the level of training needed or undertaken regular formal supervision.

Policies and procedures were not always followed and staff had not always had the opportunity to share best practice and support the provider in the development of the service.

People received care from staff that were friendly, kind and caring; passionate about providing the care and support people needed and wanted to enable them to stay in their own homes.

People had care plans that were personalised to their individual needs and wishes. Records contained detailed information to assist care workers to provide care and support in an individualised manner that respected each person's individual requirements and promoted treating people with dignity.

Staffing levels ensured that people received the support they required safely and at the times they needed. The recruitment practice protected people from being cared for by staff that were unsuitable to work in their home.

Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. People told us that they felt cared for safely in their own home. The provider understood their role in caring for people with limited or no capacity under the Mental Capacity Act 2005.

The provider was closely involved in the day to day running of the agency and continually monitored the quality of the service provided. Staff and people were confident that issues would be addressed and that any concerns they had would be listened to and acted upon.