All inspections: Direct Health (Leicester)

This inspection took place on 19 February 2016.

Direct Health (Leicester) is a domiciliary care service providing care and support to people living in their own homes. The office is based in Leicester and the service currently provides care and support to people living in Leicester, Leicestershire and Coventry including older people and younger adults with physical disabilities, learning disabilities, and mental health needs. At the time of our inspection there were 100 people using the service.

The service had a registered manager. This 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 using the service and relatives said the staff were caring and treated people with kindness and compassion. Staff valued the people using the service and took an interest in their lives, families, hobbies and interests. This helped them to build up relationships of trust with the people they supported.

People told us they were encouraged to make decisions about their care and support. Staff supported them to be independent and offered them choices at every opportunity. Staff were made aware of people’s specific instructions on how they wanted their personal care given. This helped to ensure that people were supported in a personalised and dignified way.

People told us they felt safe using the service and trusted the staff. Staff were trained in safeguarding (protecting people who use care service from abuse) and knew what to do if they had concerns about the well-being of any of the people using the service. If people were at risk in any areas of their lives staff were aware of this and knew how to help reduce the risk and keep people safe.

The staff team was multicultural reflecting Leicester’s population and some staff members were multilingual, speaking a range of local languages including Gujarati, Punjabi, and French. The service employed both male and female staff so if a person using the service wanted a staff member of a particular gender this could usually be accommodated.

Staff encouraged people to eat healthily. Particular diets, including halal, low cholesterol, and diabetic were catered for. If people needed encouragement to eat staff provided this and assisted people with their hydration, offering them frequent drinks. Staff were knowledgeable about people’s health care needs and knew when to alert health care professionals if they had any concerns.

Staff were safely recruited to help ensure they were suitable to work in a care environment. There were enough staff employed to meet people’s needs. If people needed two staff at a time to assist them they were provided. Staff were trained to administer medicines safely and people said they did this.

Most people using the service and relatives said staff were usually on time and stayed for the time they were supposed to. Some people thought there had been an improvement in staff time-keeping. However a minority of people said there were still issues with the timeliness of calls. The registered manager agreed to address this.

People using the service and relatives said they thought that overall Direct Health (Leicester) provided a good service. They told us they were frequently asked for their views and that staff and management listened to them and acted on what they said. Results of surveys and questionnaires showed that the majority of respondents were satisfied with the service they received.

Since we last inspected there had been a number of positive changes made to the service. These included better staff retention and an improvement to the timeliness of calls. The registered manager and staff had been nominated for The Great British Care Awards (a national celebration of excellence across the care sector) and were attending the finals in May 2016.

We carried out an unannounced comprehensive inspection of this service on 29 July and 1 August 2014. Three breaches of legal requirements were found. This was because the provider had not ensured that the planning and delivery of care met the individual needs of the people who used the service. They did not have an effective system in place to for receiving, handling and responding appropriately to complaints. Nor did they have an effective system in place to monitor the quality of service delivery.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection the 15 May 2015 to check that they had followed their plan and to confirm that they had now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Direct Health (Leicester) on our website at www.cqc.org.uk

Direct Health (Leicester) provides a domiciliary care service to people living in Leicester and Leicestershire. When we visited there were 111 people using the service.

Direct Health (Leicester) is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection a registered manager was not employed at the service. However an acting manager had been appointed and we saw evidence that they had applied to CQC to become the registered manager.

At our focused inspection on the 15 May 2015, we found that the provider had followed their plan which they had told us would be completed by the end of February 2015 and legal requirements had been met.

People using the service and relatives we spoke with said they thought care workers managed risk well. They told us care workers used hoists safely and understood the importance of health and safety in general.

Risk assessments had been re-written and improved. They identified areas of risk had provided care workers with the information they needed to keep people safe. They were individual to the people using the service and took into account their specific circumstances and surroundings.

Some improvements were needed to the provider’s safeguarding policy and to information in the service users' guide about safeguarding. The management team said they would make these improvements.

People using the service and relatives said they thought there had been some improvement with regard to the timeliness of calls. However others told us there were still occasions when care workers arrived too late or too early. Records showed that overall there had been a substantial improvement in the timeliness of calls.

People using the service and relatives said complaints were better managed since our last inspection. They said staff had responded promptly and taken appropriate action when concerns were raised. Records confirmed this.

Changes and improvements had been made to the way the agency was managed. People using the service and relatives said this had had a positive impact and they felt better supported as a result. A new quality audit system was in place and people were involved in the monitoring of the service. Records of a recent customer survey showed an increased satisfaction with the service provided.

Some people using the service and relatives said they would like the agency to further improve its communication so they always knew which care workers were coming to support them. The management team said they would take action to address this.

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This inspection was announced. This meant staff at the agency knew we were coming a few days before our visit.

Direct Health (Leicester) provides a domiciliary care service to people living in Leicester and Leicestershire. When we visited there were 140 people using the service.

Direct Health (Leicester) is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. At the time of our inspection a registered manager was not employed at the service.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and to report on what we find. Staff at the agency understood their responsibilities under this legislation.

Care workers knew how to look after people safely and what to do if they had any concerns about their well-being. There were systems in place to protect people from the risk of harm. These covered staff recruitment, health and safety, and the environment. Some risk assessments were in need of improvement. Some people expressed concerns about the high turnover of care workers at the agency and the effect it had on their care.

Prior to our inspection some people raised concerns with us about how the agency managed medication. They told us medication had been delayed because people’s calls had not always been on time, and on one occasion wrongly administered. When we visited the agency had taken action in response to these concerns including auditing records and re-training care workers.

Care workers were caring and knowledgeable about the people they supported. They treated them with dignity and respected their privacy. People’s health care needs were assessed and care workers made aware of these in plans of care. They supported people to be healthy, and alerted health care professionals if they had any concerns.

The agency was not responsive to people’s needs because people told us, and records showed that calls were often over 15 minutes late or early. This had a negative effect on some people’s care as it meant their needs weren’t met in a timely fashion. This is a breach of Regulation 9 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People had access to the agency’s complaints procedure and knew how to make complaints. However these had not always been recorded or responded to properly. This was a breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Some people had concerns about how the agency was being managed although a few people thought there had been recent improvements.

Records showed that although there were arrangements in place to assess and monitor the quality of the service the results had not always been acted on. This was a breach of Regulation 10 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found a total of three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

During this inspection we spoke with eight people who received support from Direct Health (Leicester). We telephoned four people who lived in their own homes in Leicester and Loughborough and we met four others who lived at Danbury Gardens extra care scheme.

People who used the service told us that they were satisfied with the support they received. One person commented, 'I am quite pleased, they do everything I need.' They also told us that they found the service to be reliable. One of the people we spoke with said, 'I get regular staff and they come at regular times.'

Arrangements relating to administering and recording medication had improved. People told us that they were satisfied with these arrangements. One of them said, 'They always check my tablets first and make sure I take them. Then they write it down in the folder. They are very careful about it all.'

We spoke with people using the service and their representatives on both days of our inspection. We spoke with four people using the community service and several people using the extra care scheme at Danbury Gardens.

Everyone we spoke with was satisfied with the care they received from Direct Health. They told us care workers always arrived on time, or they were contacted if there was going to be a delay. One person commented: 'I am so well looked after. I count my blessings; the care is excellent.'

One of the people we spoke with had help with medicines. They told us care workers explained what medicines they were giving them. We saw that some medication records were not completed properly and care workers did not report to managers when colleagues had made errors.

Two of the people we spoke with knew that managers did spot checks to check the quality of service they were receiving. We found the provider had systems for assessing and monitoring the quality of the service. The provider was taking steps to improve these systems to ensure all staff understood their roles and responsibilities in relation to delivering a high quality service.

All of the people we spoke with told us care workers routinely recorded the support they had given. We found the provider was checking the quality and accuracy of all records. Records were usually stored securely and they could be located promptly by care workers.

We spoke with four people using the service. Two people told us they were satisfied with the care they received. One commented: 'I've heard one or two complaints but I haven't had any.' Another said of the staff: 'I think they're all lovely.' The other two people we spoke with told us that care workers did not always do everything they should do at the planned times. From the examples they gave, we saw that their physical care needs were being met, but they did not feel their views and concerns were properly considered by all staff.

We found the provider had taken some action to improve people's care and welfare, but they had failed to assess people who were at risk of falls.

We spoke with seven people using the service. They told us care workers treated them with respect. One person said: 'When this is working properly, this is the best service you can get. The care team they've got now are the best they've had.' People told us they were involved in decisions about their care and they attended regular reviews to discuss the support provided.

Two people were dissatisfied with the service. One commented: 'It's got worse... Sometimes you don't get your time ' if you're supposed to get quarter of an hour, you might only get five minutes. They've done the job but that's not the point.' Most people we spoke with thought there had been recent improvements in the service. Comments included: 'It took a long time to sort out, but things are running smoothly.' and 'We'd be sorry to lose them. Things took a while to get sorted. I'm quite pleased with how things are going.'

We did not speak to people using the service about protecting them from abuse. One family member told us they were confident that care workers would identify any potential abuse and report it appropriately. We found that care workers were aware of reporting procedures and had been trained in safeguarding vulnerable adults. Managers did not know how to identify when an incident should be investigated as potential abuse and were not aware of the requirement to report such incidents to the Care Quality Commission.

Direct Health (Leicester) provides a service to people living at Danbury Gardens as part of an Extra Care scheme. We inspected Danbury Gardens because the local authority had reported concerns to us about the care provided there by Direct Health (Leicester).

People using the service told us they were happy with the service. They thought particularly highly of the care workers. One person said of themselves and their care worker, 'We're a team.' We saw that care workers were competent and treated people with dignity. Some people told us that one group of care workers did not always respond well to their requests for support. People told us they made decisions about their care and that care workers took their wishes into account. We saw that care records did not always show how people were supported to be involved in decisions about their care, especially if they needed help to express their views. Care workers and the provider worked with other organisations and professionals such as the housing association that owned the building and district nurses, to ensure people received safe effective care.

One person using the service told us she had recently reported a concern to the provider. We saw records that showed the provider was taking appropriate action. However, when we looked at the person's care records, we saw that a similar incident had been reported before. The provider had not identified this, so they were not trying to find out why the action taken following the previous incident had failed to prevent a reoccurrence. This meant systems to keep people safe from abuse were ineffective.

People told us the agency delivered a good service and they were satisfied with the care they received. One person said, 'The carers are skilled and know what they're doing.' Another told us, 'The care is very good and I have had no problems at all with the agency.' A relative said, 'The care is exactly what my relative needs and I am very happy with it.'

People told us they knew who to speak to if they had any concerns about the agency. One person said, 'We are told to ring the office if anything goes wrong. I have the number if I need it.' A relative said, 'If there was ever a problem I would ring the office but I've not had to do that yet.'

One person said they thought the agency responded well if concerns were raised. They told us, 'If I have a complaint I ring the office and speak to the manager. She is always helpful and tries to sort things our.'

People said they liked the staff team. One person told us, 'All the carers have a good attitude and are very friendly. They don't have much time when they're here but they do chat to me as they go about their work.' A relative said, 'Our main carer is fantastic and brilliant with my relative. We think the world of him. If he's away they send other carers and to be fair they are all good.'

Some people were happy with staff timekeeping and reliability. One person told us, 'They come to us every morning and they are pretty reliable. If they are ever going to be late they ring to let us know.' However another person said that on one occasion no-one turned up to care for them. They said, 'The agency phoned up to tell me and then they sent someone else so it wasn't too bad but I would have liked more notice.

People told us they preferred to have regular carers. One person said, 'I prefer regular carers. There's nothing worse than someone who hasn't been before and I have to tell them where everything is.' A relative told us, 'We do have regular carers which is good because it's better when it's people you know.'

Archived: Direct Health (Leicester)

All Inspections

19 February 2016

During a routine inspection

15 May 2015

During an inspection looking at part of the service

29 July and 1 August 2014

During a routine inspection

30 October 2013

During an inspection in response to concerns

16, 17 May 2013

During a routine inspection

28 February 2013

During an inspection looking at part of the service

8 January 2013

During an inspection looking at part of the service

30 August 2012

During an inspection in response to concerns

28 October 2011

During an inspection in response to concerns