Archived: Direct Health (Nottingham)

Direct Health (Nottingham) is a domiciliary care agency. It provides personal care to people living in their own homes within and around Nottingham. 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) 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, 120 people were receiving personal care as part of their care package.

People’s experience of using this service and what we found

Improvements had been made in how care was provided. This included people receiving advanced notice of the staff who would be supporting them. Improvements were ongoing in people being provided with a regular core group of staff. Some people had experienced late or missed calls, However, this had reduced and action was being taken to make further improvements.

Improvements had been made to how risks were assessed, monitored and managed. Staff had detailed guidance of how to mitigate risks. Improvements had also been made in how people were supported with their prescribed medicines.

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. Incidents were reviewed to consider if action was required to reduce further risks.

Staff recruitment was ongoing and at the time of the inspection, sufficient staff were deployed to meet people's care needs. Robust checks were completed on staff’s suitability to provide care before they commenced their employment.

People were protected from the risk of cross contamination because best practice guidance in infection control practice was followed.

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.

Staff received an induction and ongoing training and support. This included opportunities to discuss their work and development needs. Staff had spot checks completed to review their practice to ensure standards were maintained.

People were supported with their health care needs. Staff monitored people's health and care needs and shared information with healthcare professionals when required. Where people required assistance with nutrition and hydration needs, staff had detailed guidance of the support people required.

People were complimentary about staff and considered them to be kind and caring. End of life care considered people’s wishes and preferences, however, additional detailed guidance for staff was required. People received care and support that respected their privacy and dignity. People’s communication and sensory needs were assessed, but inconsistently recorded in the guidance for staff.

The providers' 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 senior managers had oversight and staff were accountable. 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 27 July 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.

For more details, please see the full report which is on the CQC 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.

This service is a domiciliary care agency. It provides personal care to people living in their own homes within and around Beeston, Kimberley, Eastwood and Stapleford in 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 (Nottingham) 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, 139 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 assessments of people’s needs lacked detail in some places. A person had experienced a change of need, increasing their risks, but their risk assessment and associated care plans had not been updated in a timely manner. Risks associated with the environment had been assessed and information recorded to inform staff of how to manage known risks.

Shortfalls were identified in the management of medicines; best practice guidance was not always followed. People had experienced late and missed calls and action was being taken to make improvements. Safe staff recruitment checks were in place and followed.

Staff had received training in infection control and food hygiene and followed best practice guidance to reduce the risks associated with cross contamination.

Staff were aware of their responsibilities to protect people from avoidable harm and abuse. Accidents and incidents were recorded, reviewed and monitored and the management team had taken action in response to make improvements to the service.

People had an assessment of their diverse needs and best practice guidance and legislation was used to ensure people did not experience any form of discrimination.

Staff received an induction, ongoing training and support, this included competency checks on their performance, knowledge and understanding.

People’s nutritional needs had been assessed and planned for and where people required support with meal preparation, their choices and preferences were respected and acted upon.

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.

Overall, staff were kind and caring in their 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. The registered manager had responded to complaints in line with the provider’s procedures and changes had been made to improve people’s experience of the service.

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

The provider had systems and processes in place to regularly review the quality and safety of the service people received. An action plan was in place that identified the shortfalls identified during this inspection.

We found one breach 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.