Archived: Dorset Blue Care

At our last inspection in March 2017 we took enforcement action and told the provider to make improvements to staffing, safe care and treatment and governance. We also asked them to tell us how they would improve the processes that protected people from abuse. They wrote and told us they would make immediate changes. We undertook this focussed inspection to check they had followed their plan and to confirm they 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 Dorset Blue Care on our website at www.cqc.org.uk.

The service did not have a 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. A senior manager working in the service had made enquiries about adding this location to their current registration but this had not taken place.

The provider had reconsidered the quality audit systems in place. Following quality audit checks there had been improvements in care planning and risk assessments. People's care records gave staff the guidance they needed to support people safely. Minor improvements identified at the June 2017 inspection had been introduced by the September visit date.

At this inspection we found that there had been improvements with regard to the reviewing of people’s individual care records and risk assessments. One person’s records evidenced that staff knew how to meet their needs but some improvements in the written guidance to staff were required. The manager acknowledged this and made arrangements to update at the time.

The provider had reviewed its staffing levels and established that ‘zero hour ‘ contracts and a IT application had been some of the causes of people having missed visits. As a result of this review staff were offered permanent contracts so that the provider could be clear about the amount of staff available to meet their commitments. The IT application that had caused miss communication between field workers and office staff had been disabled. This meant that field workers could no longer enter onto the IT system they could not attend a visit (thinking that the system informed office staff of this) and would have to contact the office staff directly allowing office staff to organise another worker to attend to the visit. This meant a reduction in missed visits reducing the risks people faced.

Staff felt involved in service developments and identified mangers as approachable and responsive. People and relatives also felt able to talk with senior staff about any concerns and were confident that actions would be taken.

People were supported by staff who understood the risks they faced and knew how to identify and report abuse. Where concerns had been identified these had been responded to appropriately.

People received their medicines safely. Staff understood the need to balance safety with people’s wishes and independence and this was reflected in their guidance and practice.

Dorset Blue Care had been acquired by the You Trust in November 2017 and they became the registered provider in December 2017. The previous registered manager had left the service in February 2017 and a manager from within the provider organisation had applied to add Dorset Blue care to their registration. At the time of the inspection there was not 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.

The service was not safe. People had been put at risk by calls being missed. The senior staff and managers were not aware of all of these incidents and the information had not been shared with other agencies appropriately. People told us that whilst they felt listened to when they spoke with staff across the service they sometimes could not get through to anyone when the office was closed.

Management were committed to making continual improvements to the quality of care people received. They were seeking to create a positive working environment where staff and people felt able to discuss any concerns or ideas openly. There were systems in place to review and monitor the quality of the service people received including feedback from people and staff. These had not been effective in ensuring the quality of care people were receiving from the service.

Staff understood how people made choices about the care they received, and encouraged people to make decisions about their care. Records, however, did not reflect that care was being delivered within the framework of the Mental Capacity Act 2005. We spoke with the registered manager about this and they began to address the omission straight away. We have made a recommendation about the recording of MCA decisions.

Staff were not being deployed effectively to ensure people received their visits as planned. People told us they were not confident that they would receive their calls at the agreed time and records reflected insufficient numbers of staff providing care. Staff were recruited safely and checks were made on their suitability to work with vulnerable adults.

Staff told us they knew how to identify and respond to abuse; including how to contact agencies they should report concerns about people’s care to. An incident of missed care that made a person more vulnerable to harm had not been appropriately reported to other agencies.

People told us they received their medicines and creams safely. There were not safe systems in place to ensure time dependent medicines were administered appropriately. Senior staff told us they would rectify this immediately.

People felt safe. They were protected from harm because staff understood most of the risks they faced and how to reduce these risks. Some risks people faced were not managed effectively and staff had varied understanding about how to mitigate these risks.

People were positive about the care and support they received. They told us staff treated them kindly and with dignity and respect. We saw people were comfortable with staff in their homes. Staff were consistent in their knowledge of the majority of people’s care needs and spoke with confidence about the care they provided to meet those needs. They were motivated to provide the best care they could. Staff kept records about the care they provided. These records were not used to review people’s care experience.

People had access to health care professionals and were supported to maintain their health by staff. Staff understood changes in people’s health and shared the information necessary for people to get the appropriate treatment.

People were confident in the skills of the staff and where staff needed specific training to support people safely this was being provided. Where people had their food and drink prepared by staff they told us this was prepared to their satisfaction. People were left with access to appropriate drinks and food between visits.

We identified concerns related to the systems in place to protect people from abuse, staff deployment, the management of risk and the governance of the service. There were breaches of regulation. You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.