Archived: Direct Health (Chesterfield)

Is the service safe?

We saw the provider had made some improvements in obtaining people's consent to care since our previous inspection visit in July and August 2013 but that there was still the potential for for decisions made on people's behalf not to be in their best interests.

People we spoke with told us they felt safe when receiving care. One person told us 'They always treat me properly'. Staff we spoke with were knowledgeable about the types of abuse that could occur and what the reporting procedures were. Their training in safeguarding people was up to date.

The service had improved its medication procedures and we saw people's medication was dealt with safely.

Is the service effective?

Most people and their relatives that we spoke with us told us they were satisfied with the service they received and several told us it had improved in the last six months. One person told us there had been definite improvements since December 2013, another said the timekeeping was better and two others were cautiously optimistic about the current service, with one relative saying 'It's moving in the right direction'.

We found care records had improved and they now gave clear guidance to staff on how to provide the necessary support to people and that staff received relevant training to be able to support people properly.

Our observation and feedback from people and their families found there was an insufficient number of staff to cover staff absences and this meant the service provided had been unreliable and inconsistent for some people.

Is the service caring?

People we spoke with praised the care workers and one said 'They're very good' and another told us 'I'm satisfied with everything'.

Is the service responsive?

In response to people's concerns, most people told us they received a courteous response from the manager. One person said 'This manager is the most hopeful we've had'.

Is the service well led?

People told us they could air their views and were asked for feedback about the service. They told us the manager was approachable and that they felt listened to. One person told us 'They're obliging'. We saw there was a clear complaints procedure and that formal complaints were properly addressed.

People we spoke with told us they were generally satisfied with the care and support they received. One person said that most staff understood their needs, particularly their regular staff, 'They're really good, they know what to do.' A relative told us, 'The ones we have coming in (staff) are some of the best. They have to be experienced to understand (person's name) needs.'

However, we found that care was not always planned and delivered to meet the individual needs of people using the service or to ensure their welfare and safety. We found gaps, lack of detail and inaccuracies in the care plans and risk assessments we looked at. This meant that people were at risk of receiving inappropriate or unsafe care.

We found that although people's needs were assessed, that care was not being planned and delivered in a way that ensured people's needs were met. We saw that some aspects of people's care, including where there was a risk of harm, were not included in their care plans. We saw that people's medicines were also not being administered and recorded in a way that protected them for risk.

We found that staff were not aware of the correct way to report any concerns about abuse or neglect. We also found that the provider did not always take appropriate action to ensure people were safe from abuse.

We saw that staffing levels were generally adequate at the service and that new care staff were being recruited. People receiving care told us that although there were sometimes shortages, this had been improved.

Staff we spoke with said they were trained in most areas but required more knowledge and support to meet the specific needs of people receiving care. This included training in dementia, mental health difficulties and supporting people who could become aggressive.

We found that some quality monitoring systems were in place, but these were not fully ensuring that people were protected from receiving unsafe or inappropriate care.

People told us that there were not always enough staff to provide their care and that sometimes staff had not turned up or were late. We also found that where a person needed two staff to provide their care, only one person sometimes came to help them. We found that although new staff were being recruited that the provider was not taking appropriate steps to ensure there were enough staff to meet people's needs.

We found that although people's needs were assessed and care plans were written about their support some important information was missing. We saw that there was not always enough guidance for staff about people's health needs and other risks that could affect them to ensure people's safety and welfare.

We found that appropriate arrangements were not in place for recording the administration of people's medication. This was because records were incomplete and systems in place did not fully ensure that people received their medication as prescribed.