Dementia Care & Support at Home Limited

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.

Dementia Care & Support at Home is a domiciliary care service based in the Swinton area of Salford, Greater Manchester. People using the service receive care and support from staff at home, with packages of care funded by both the local authority and self-funders.

This was the first inspection we had carried out at Dementia Care & Support at Home. This was because the service re-registered with CQC in May 2017 and meant any previous inspections were associated with the old location.

At the time of the inspection there were approximately 42 people using the service, however only 38 were in receipt of a regulated activity which was personal care. Other people using the service were supported with domestic duties such as cooking and cleaning. As such we only focussed on people in receipt of a regulated activity during the inspection.

During this inspection, we found the service to be meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, however have made four recommendations regarding accident and incident monitoring, care plans, medication and staff team meetings.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People told us they felt safe as result of the care and support they received and staff understood their responsibility with regards to safeguarding and how to report concerns.

Staff were recruited safely, with appropriate checks undertaken before staff commenced employment.

Staff told us they felt there were sufficient numbers of staff available to support people and said their weekly rotas were well managed. Some people said staff did not always turn up on time, but said they were contacted by staff from the office to let them know what was going on. People said missed visits were rare, but were again kept informed by staff.

People had individual risk assessments in their care plans and the service maintained and log of any accidents and incidents which had occurred, which detailed any follow up actions taken. Trends analysis of accidents was not routinely undertaken and we have made a recommendation about this in the detailed findings of the report.

People told us they received their medication on time and said staff watched them taking it and gave them a glass of water. We did identify missing signatures on four people’s medication administration records (MAR) we looked at. Medication audits of these MAR had stated there we no gaps in recording. We did note however that staff had recorded in the daily communication log, that people had been given their medication as prescribed. We have made a recommendation about this in the detailed findings of the report.

Staff told us they received enough training, induction, supervision and appraisal to support them in their role.

People told us they received enough to eat and drink. Staff had a good understanding about how to support people, such as ensuring people received plenty of extra fluids during the hot weather.

The people we spoke with told us they were happy with the care and support they received and described staff as kind and caring.

At the time of the inspection the registered manager was in the process of re-writing all care plans within the service. Therefore, staff were using the support plan provided by the local authority, where an overview of each person’s care needs was recorded. We have made a recommendation about this in the detailed findings of the report.

We saw complaints were recorded and detailed any follow up actions required. A service user guide was also in place, informing people how they could express if they were unhappy with the service they received.

People had access and were supported to attend activities for people living with dementia within the local community.

There were systems in place to seek feedback from people using the service through satisfaction surveys.

At the time of the inspection, the registered manager said formal staff meetings were not held and any information to be cascaded was shared via email or by a group text message. We have made a recommendation about this in the detailed findings of the report.