Archived: Direct Health (North Notts)

People’s experience of using this service:

People told us they felt safe with staff; however, people raised concerns about the punctuality of staff. Whilst records showed most calls were completed within 30 minutes of the expected time, people still felt staff punctuality was affecting their life and in some cases their safety.

Risks were assessed in key areas. However, whilst assessments for skin integrity were robust, staff did not keep consistent records to ensure this care was completed safely and as planned. Environmental risk assessments were in place, but these did not include reference as to how to make people safe in an emergency.

The provider had ensured that the local authority had been notified of allegations of potential abuse where needed and investigations were carried out thoroughly. The provider had not always ensured the CQC were notified of these incidents.

People’s medicines were managed safely, although some people were concerned that if calls were late they could miss their medicines. The risk of the spread of infection was safely managed. The provider had systems in place to help staff to learn from mistakes.

People received care in line with their assessed needs. Staff training and supervision were largely up to date. People received the support they needed to maintain a healthy diet, although guidance was not in place to support people with appropriate foods for a diabetic diet. People had access to other health and social care agencies where needed.

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 and relatives found the staff to be helpful, kind and caring. People liked the staff and described them as kind and caring. People were treated with dignity when personal care was provided. Independence was encouraged. People felt able to contribute to decisions about their care and staff respected their wishes. People’s records were stored securely to protect their privacy.

People’s care records contained person-centred information including people’s preferences for call times, male or female staff and the level of support they wanted with personal care. Where applicable, people were supported with their hobbies and interests and action was taken by the provider to reduce the risk of social isolation.

Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care plans were in place, although more detailed discussions were needed with people to ensure their rights and wishes were respected.

Some people raised concerns about the quality of communication with office-based staff. Not all statutory notifications had been sent to the CQC when required.

Quality assurance processes were in place; along with feedback from people and staff, these were used to help the service to improve and develop. When people had met the registered manager, they found them to be supportive and approachable. The registered manager had a good understanding of most regulatory requirements of their role

Rating at last inspection and update: The last rating for this service was Requires Improvement (published 19 July 2018). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations from the last inspection.

However, we have identified one new breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

More information about this is in the full report and can also be found at www.cqc.org.uk

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This service is a domiciliary care agency. It provides personal care to people living in their own homes within and around Ashfield and Mansfield in North Nottinghamshire. It provides a service to older adults and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Direct Health (North Notts) receives 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.

At the time of our inspection, 278 people were receiving personal care as part of their care package.

There was a registered manager at the service. 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.

Risks associated with people’s needs showed information provided to staff to manage known risks varied in detail or had not been completed. Risks associated with the environment had been assessed and information recorded to inform staff.

Shortfalls were identified in the management of medicines; best practice guidance was not always followed. Improvements were required in the deployment of staff. Some people had experienced missed and late calls and weekends were identified to be the most likely times this occurred. Safe staff recruitment checks were in place and followed.

Staff had received training in infection control and food hygiene.

People’s nutritional needs had been assessed but these needs were not always sufficiently supported and effectively managed.

People had an assessment of their needs and care plans were developed to instruct staff of how to support people. When people’s needs changed, this was not effectively managed and people experienced a delay in their needs being reviewed.

Staff were aware of their responsibilities to protect people from avoidable harm and abuse. Accidents and incidents were recorded, reviewed and monitored and action was taken to share any learning. Staff received an induction and ongoing training and support.

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 healthcare needs were monitored and action was taken when changes occurred such as informing the person’s relatives and representatives or health and social care professionals.

Staff treated people with respect and kindness, they were caring and compassionate in their care and approach. Independence was promoted and privacy and dignity respected. People had access to information about independent advocacy services.

People knew how to raise a concern or make a complaint. Whilst some people had experienced a positive outcome to a complaint, others were less confident to raise any complaints.

People received opportunities to share their feedback about the service. The provider and registered manager had met their registration regulatory requirements.

The provider had systems and processes in place to regularly review the quality and safety of the service people received, but these had not identified the shortfalls identified during this inspection.

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.