Background to this inspection
Updated
9 July 2019
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
Inspection team
The inspection team consisted of one inspector, one assistant inspector and one Expert-by-Experiences. This is a person who has had personal experience of using or caring for someone who uses this type of care service.
This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. However, at the time of our inspection the registered manager was unavailable due to leave.
Notice of inspection
We gave the service 48 hours’ notice of the inspection. Inspection activity started on 11 June 2019 and ended on 12 June 2019. We visited the office location on 13 and 14 June 2019.
What we did before the inspection
The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report. We reviewed the last inspection report and information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used all of this information to plan our inspection.
During the inspection
We spoke with 15 people who used the service and 14 relatives about their experience of the care provided. We spoke with 16 members of care staff, the care services director, a care coordinator and care assessor. We reviewed a range of records. This included ten people’s care records. We looked at nine staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
9 July 2019
About the service
Direct Health (Nottingham City) is a domiciliary care agency. It provides personal care to people living in their own homes within and around Nottingham City. It provides a service to older and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Direct Health (Nottingham City) 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, 303 people were receiving personal care as part of their care package.
People’s experience of using this service and what we found
Whilst improvements had been made since our last inspection in how people received their care, people were not consistently receiving care that was responsive to their individual needs. People had experienced late calls and missed calls and whilst no person’s safety had been put at risk, improvements were required. Action was being taken provide people with regular staff and for calls to be made within the allocated timeframe.
Staff had received training in safeguarding adults. Allegations or suspicion of abuse were reported and acted upon, where action was required to protect people this was completed. Improvements had been made to the completion of assessments and guidance provided to staff of how to safely provide care. Information was detailed and up to date.
Staff recruitment was ongoing and in areas where recruitment and retention of staff was problematic, no new care packages were being accepted until staffing levels had increased. Robust checks were completed on staff’s suitability to provide care before they commenced their employment.
Where people required support with the administration of medicines, improvements had been made to the guidance provided for staff. Additional checks and monitoring had also been introduced. People were protected from the risk of cross contamination because best practice guidance in infection control practice was followed.
Incidents and accidents were reviewed and analysed for lessons learnt and action was taken and shared with staff to reduce further reoccurrence. 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 support this practice.
Staff received an induction and ongoing training and support. This included opportunities to discuss their work and development needs. Staff practice was monitored. Staff shared information with healthcare professionals to support people with their ongoing care needs. People’s health was monitored, and staff took action if people required urgent assistance. Where people required assistance with nutrition and hydration needs, staff had detailed guidance.
People were complimentary about staff and considered them to be kind and caring. End of life care considered people’s wishes and preferences. Staff provided care that was respectful about people’s privacy and dignity. People’s communication and sensory needs had been met and were understood by staff.
The provider’s complaints procedure had been shared with people and when concerns and complaints had been received these had been responded to. People had opportunities to share their experience about the service. The provider had systems and processes to monitor the service and since the last inspection, improvements had been made to increase oversight and accountability. The provider had an ongoing action plan and the management team showed a commitment to continually improve the service.
Rating at last inspection
The last rating for this service was Requires Improvement (published 29 June 2018). The service has improved to an overall rating of Good. Responsive remains Requires Improvement, further action was required to ensure people received a service that was consistently responsive.
Why we inspected
This was a planned inspection based on the previous rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Direct Health (Nottingham City) on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.