Archived: DAC Essex

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.

People received a service which was personalised and met their needs. They told us the service enabled them to remain as independent as possible and to live in their own homes.

People were cared for by a consistent team of staff who were skilled and competent in providing care and support. Staff and the registered manager showed a genuine interest and passion to deliver personalised care based on people's likes, wishes and preferences.

Support was planned and delivered in a structured way to ensure people's safety and wellbeing. Staff had access to up to date information about how to support people and communication with health and social care professionals was effective in ensuring people received joined up care.

Systems were in place to audit the quality and delivery of care to people. The service was well led by an experienced and established management team.

More information is in the detailed findings below.

This was the service's first inspection.

About the service: DAC Essex is a domiciliary care agency providing personal care to people in their own homes. At the time of the inspection, 94 people were using the service.

Why we inspected: This was a comprehensive inspection as the service had not been rated before. The overall rating is Good.

Follow up: We will continue to monitor the service through the information we receive.

Please note that the summary section will be used to populate the CQC website. Providers will be asked to share this section with the people who use their service and the staff that work there.