Archived: DAC Essex

Updated 30 November 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 was carried out by two inspectors and two Experts 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 houses and flats. Since the last inspection, a reablement service was being provided to people for up to six weeks after leaving hospital.

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.

Notice of inspection

We gave the service five days’ notice as we needed to obtain people’s names and addresses to write to them about being contacted during the inspection to share their views with us.

Inspection activity started on 2 October 2019 and ended on 30 October 2019. We visited the office location on 10 October 2019.

What we did before the inspection

We reviewed previous reports and notifications that are held on the CQC database. Notifications are important events that the service must let the CQC know about by law. We also reviewed safeguarding alerts, information received from the local authority and information provided to us by staff and people who used the service and their family members. We used all this information to plan our 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 used all of this information to plan our inspection.

During the inspection

We spoke with 19 people who used the service and eight of their family members about their experience of the care provided. We spoke with eight members of staff including the registered manager, group operations manager, care manager, office administrator and four care staff.

We reviewed a range of records. This included eleven people’s care records and daily notes of care provided. We looked at four staff files in relation to their recruitment. Due to a lack of records maintained, we were unable to review any induction, supervision, medicines management and overall governance monitoring.

After the inspection

We continued to seek clarification from the provider to validate evidence found. They sent us information which we used as part of this report.

Updated 30 November 2019

About the service

DAC Essex is a domiciliary care service providing long term personal care and short term reablement to older and younger people in their own homes. The service supported approximately 170 people at the time of the inspection.

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

People told us that they were not always safe and were not provided with a high-quality service that met their needs, wishes and preferences. Missed and late calls meant that people were being left unsafe and without care. Risk assessments did not provide assurances that people were receiving safe care. Risks to people’s safety had not been reviewed or care plans updated with their up to date needs. The recruitment process and checks on the safe employment of staff were not robust or completed in line with the law. People were being cared for by staff who had not always been recruited safely. People’s medicines were not always given at the time prescribed due to missed and or late calls. The lack of available information, regular audits and analysis of errors meant that we could not be assured that people received their medicines safely to manage their physical and/or mental health needs.

The service had not learnt from incidents, concerns and investigations to make improvements to the service for people using it and staff working within it. Staff were not provided with appropriate induction, training, supervision and support to carry out their role effectively. The service could not demonstrate that new staff had the necessary skills and training in the core subject’s necessary for a care worker to understand their role. We were not assured that people were being cared for by staff who were fully trained and supported. People were not always supported to have enough food and drink. The poor rota arrangements meant that people had calls too close together or too far apart which resulted in people not having their meals at a time that was convenient for them.

Though people using the service and their family members said staff were caring and kind and they had built up good relationships with them, our findings did not suggest a consistent caring service or a service that was always respectful and treated people with dignity. The assessment of people needs was not robust, reviewed or adequately recorded. Whilst people contributed to how they wanted their care arranged, the care plans did not contain up to date information about people’s needs or circumstances for staff to understand their changing needs. Care was not provided in a responsive way as people did not receive their care and support when they needed it. People’s concerns were not always responded to and used to improve the service. People knew how to make a complaint but felt that they were not listened to or responded to appropriately when they had concerns about their care.

There was not a clear vision, strategy or support system to deliver high quality care. The culture was not inclusive or person centred and the management unclear of their responsibilities. Quality assurance processes were not in place for the safety of the service and records management were disorganised. People and staff were not involved in the development of the service and their views not listened to.

People consented and made decisions about their day to day care provision and their capacity to make those decisions was assessed and discussed with them, their representatives and family members. Staff supported people in the least restrictive way possible and in their best interests. However, people were not supported to have maximum choice and control of their lives due to the lack of organisational systems in place to manage the service. Staff worked with other organisations to provide additional care and support to people. People were supported to access healthcare services and referrals were made in a timely way to ensure people received information and treatment. People were supported at the end of their life and staff worked well with professionals to ensure people’s end of life care was well managed and comfortable.

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 16 January 2019).

Why we inspected

The inspection was prompted in part due to concerns received from members of the public, staff and the local authority about risks to people’s health and safety, late and missed calls and staffing issues. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the relevant key questions sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We found eight breaches of the Health and Social Care Act 2008 in relation to person-centred care, safe care and treatment, meeting nutritional and hydration needs, receiving and acting on complaints, good governance, staffing, fit and proper persons employed and duty of candour.

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

The overall rating for this service is Inadequate and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.