Background to this inspection
Updated
9 November 2021
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
This inspection was carried out by an inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
This service is a domiciliary care agency. It provides personal care to people living in their own homes.
At the time of the inspection, the service did not have a registered manager. This means the provider is legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
The inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure the provider, or a manager would be in the office to support the inspection.
Inspection activity was carried out between 7 and 27 September 2021. We visited the office on 15 September 2021 as part of our site visit. Further inspection activity was completed via telephone and by email, including speaking with people who used the service, relatives and reviewing additional evidence and information sent to us by the provider.
What we did before the inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from professionals who worked with the service, including Salford local authority. 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.
During the inspection
We spoke with six people who used the service and eight relatives about their experience of the care provided. We spoke with five members of staff including the provider, deputy manager and three care staff.
We reviewed a range of records. This included eight people’s care records, a selection of medicine administration records and three staff recruitment files. A variety of other records relating to the management of the service were also considered as part of the inspection.
After the inspection
We continued to seek clarification from the provider to validate evidence found following our site visit.
Updated
9 November 2021
Dementia Care and Support at Home is a domiciliary service which provides personal care to people living in their own houses and flats. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. 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 this inspection the service was supporting approximately 47 people.
People’s experience of using this service and what we found
Some people raised concerns with us about the timeliness of care visits which on occasions, had impacted on the care people received. Some people said staff did not stay for the full length of time for their care visit.
At times, people did not always receive their medication safely due to enough time not always being left between people’s care visits. Appropriate arrangements were not in place when covert medicines were being given to people. Medication Administration Records (MAR), were not always used as needed.
Governance arrangements needed to be improved to ensure the concerns from this inspection were identified and acted upon in a timely way.
We have made three recommendations in the report regarding medication, staffing and good governance.
People felt safe using the service, although some people reported a lack of continuity regarding the staff that delivered their care, which at times could make them feel unsafe. Staff were recruited safely before commencing their employment and any safeguarding concerns were reported to the local authority for further investigation.
People received enough to eat and drink, however one family raised concerns with us about staff not always leaving their relative a drink when they had finished the care visit. Staff told us enough training was available to support them in their roles, with ongoing supervision also provided.
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, although we did identify concerns regarding the use of covert medication.
We received positive feedback from people who used the service and relatives about the care provided. People said they felt treated with dignity, respect and had their independence promoted as required.
People had detailed care plans in place regarding the care and support staff needed to deliver. Complaints were managed appropriately and staff worked closed alongside other health care professionals such as district nurses when people required end of life care.
There were systems in place for people who used the service and staff to provide feedback about their care through surveys and meetings. The staff spoken with during the inspection told us they felt the service was well-led.
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 July 2018). At this inspection, the rating has deteriorated to requires improvement.
Why we inspected
This was a planned inspection based on the previous rating.
The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvements.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Dementia Care and Support at Home on our website at www.cqc.org.uk. You can see what action we have asked the service to take at the end of this report.
Follow up
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.