Dennyson Care Limited

Dennyson Care limited is a domiciliary care agency based in the London Borough of Redbridge. The service provides personal care to adults living in their own homes. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

At the time of our inspection, the service was providing personal care to approximately 82 people.

CQC only inspects where people receive personal care.

People's experience of using this service and what we found:

While the provider had sent us some notifications, they had not always sent us all relevant notifications in a timely manner, as they are required to do.

The registered manager did not have a programme to regularly assess care worker’s competency to manage medicines. There was therefore a risk that people might not always be protected against the risks associated with medicines. The provider did not always monitor care calls in real time to ensure people always receive their calls at the time planned and agreed with them.

The provider’s quality assurance systems had not identified the above shortfalls so the necessary improvements could be made.

There were processes in place to safeguard people from abuse and guidance for staff to follow to keep people safe from harm. Risk assessments were completed and reviewed. Staff wore appropriate Personal Protective Equipment (PPE) such as face masks and disposable gloves and aprons to protect people from the risk of cross infection.

People's care needs were assessed and reviewed. Staff completed training to know how to care for people effectively. Staff told us they were supported by the registered manager to perform in their roles. There was a procedure for reporting incidents and accidents in the service and learning lessons from them to prevent re-occurrence. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and relatives told us staff were kind and caring. They praised the caring and inclusive nature of the service. People's privacy, dignity and independence were respected and promoted. People and relatives were actively involved in their care planning and delivery.

People received care that was responsive to their needs and preferences. People's communication needs were assessed and met.

People achieved good outcomes from their care. People, relatives, and staff all spoke highly of the support they received from the management team. The registered manager and nominated individual maintained oversight of people's care. The management team also took on caring roles, this ensured they built and maintained a close relationship with people and their relatives.

The provider promoted a positive culture and person-centred service. Feedback from people and relatives was received. There were quality assurance systems in place for the provider to continuously improve the service.

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

Rating at last inspection

The last rating for this service was good (published 7 June 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Enforcement and Recommendations

We have identified a breach of regulation in relation to good governance.

We have made recommendations for the provider to improve the way they assessed staff competency to support people with their medicines and around effective systems to monitor care calls.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The service is based in the London Borough of Redbridge and provided personal care to adults living in their own homes. At the time of our inspection, the service provided personal care to 90 people.

People’s experience of using this service:

The provider had made improvements to the service following our last inspection. People were safe and there were procedures to protect them from abuse. Risks associated with people’s needs were assessed more thoroughly.

Staff treated people with dignity and respected their privacy.

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’s independence was promoted.

Staff provided care to people in their own homes and arrived at times that suited people.

People were provided their prescribed medicines and they were supported with their nutritional needs by staff.

People had access to health care professionals, such as GPs when required. They received care and support from staff who were kind and compassionate.

Staff were recruited safely and were supported with training and supervisions for their development. They maintained positive relationships with the people they supported. They understood people’s needs, preferences and what was important to them.

Care plans were person centred and detailed people’s support needs. People and relatives were supported with complaints they wished to make. They were able to provide their feedback about the service.

Staff felt supported by the management team and told us there was a positive culture.

The registered manager carried out audits and checks to ensure staff provided a good standard of care. They were committed to making continual improvements. Learning took place from incidents to help improve the service.

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

Rating at last inspection:

At the last inspection on 24 April 2018, the service was rated ‘Requires Improvement’ (report published 22 June 2018).

Previous breaches:

At the last inspection we found breaches in relation to ensuring safe care and treatment to people and good governance of the service. We asked the provider to complete an action plan to show what they would do to improve and by when. At this inspection we found improvements had been made and the provider is no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Dennyson Care is based in Ilford, Essex. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults.

Not everyone using Dennyson Care receives regulated activity; the 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.

At the time of our inspection, 50 people were using the service, who received personal care. The provider employed 25 care staff.

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 care homes, 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 inspection, we found people did not always receive safe care. Specific risks to people were not always included in risk assessments to help staff identify and mitigate the risks to ensure the safety of the person and the staff. This meant that the provider did not always assess, monitor and mitigate risks associated with the service to ensure people received safe care at all times.

The registered manager was committed to developing the service, although further improvements were required with quality assurance systems as this had not identified the shortfalls we found at the inspection. This would ensure people received a safe service.

People were protected from abuse. Staff understood procedures to follow in order to safeguard people from potential abuse.

The provider had sufficient numbers of staff available to provide care and support to people. Staff had been recruited following pre-employment checks such as criminal background checks, to ensure staff were suitable to work with people safely. Staff received an induction, relevant training and were able to shadow experienced staff in order for them to carry out their roles effectively.

When required, staff prompted people to take their medicines and recorded this in Medicine Administration Records (MAR). Staff had been trained on how to manage medicines safely.

The provider was compliant with the Mental Capacity Act 2005 (MCA) and staff understood the principles of the Act.

Staff told us that they received support and guidance from the registered manager and other senior staff. They received regular supervision and could approach the management team with any concerns they had. People's care and support needs were assessed and reviewed regularly.

The provider worked with health professionals if there were concerns about people's health. People were registered with health care professionals, such as GPs and staff contacted them in emergencies.

People were supported to have their nutritional and hydration requirements met by staff, who provided them with meals and drinks of their choice, when this was requested.

People were listened to by staff and were involved in their care and support planning. They were treated with dignity and respect when personal care was provided to them.

Care plans provided staff with information about each person’s individual preferences.

Complaints about the service were responded to appropriately as set out in the provider's complaints procedures.

The provider had introduced an online call monitoring system to help manage and improve the service.

The management team carried out monitoring checks on staff providing care in people’s homes. This ensured staff followed the correct procedures and people received the care they had been assessed for.

Feedback was received from people and relatives to check they were satisfied with the service. The management team ensured lessons were learned following serious incidents.

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.