About the serviceDAS Care Limited is a domiciliary care service that provides personal care and support to people living in their own homes. The service was supporting 17 people with personal care at the time of our inspection.
People’s experience of using this service and what we found
At the beginning of our inspection activity the provider provided us with inconsistent information. This related to the amount of people receiving personal care and the amount of staff who were actively working for the service. This was difficult for the provider to verify.
We had to liaise with the local authority to determine the amount of people that were receiving commissioned care.
People were at risk of poor care and support because there were no governance systems in place to monitor the quality of the service. No audits were being carried out. This meant that the provider had failed to identify and address the issues we found during our inspection of the service.
Although there were enough staff employed to care for people, the provider was unable to demonstrate that staff had been recruited safely. Relatives said their loved ones felt safe with staff and advised that a regular team of staff would visit who knew them well.
No induction for new employees was taking place and not all staff had received essential training. Staff had not received competency assessments or supervisions to ensure they had the required skills to provide safe care and support to people. In most cases staff’s previous work experience in other care settings had been relied upon.
People’s medicines were not managed safely. Some people did not have medicines records even though staff were prompting their medication and no medication risk assessments were in place. The provider was unaware that this paperwork needed to be completed.
Risk management of people’s care required improvement. Not all risks were assessed and those that were did not contain the information staff needed to provide safe care.
Staff were not taking part in the governments COVID-19 testing programme for domiciliary care workers.
A safeguarding concern relating to a person living with dementia had not been reported to the relevant authorities without delay and the provider had limited knowledge of safeguarding processes. A review of this person’s care had not taken place to ensure that it was suitable and safe.
People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There were no mental capacity assessments or best interest decisions in place, and staff and management had limited knowledge of the principles of the Mental Capacity Act 2005 (MCA).
Despite our finding’s relatives felt listened to and were involved in decisions about their family members care and support. Relatives confirmed their loved one’s dignity was maintained, and staff were able to describe how they promoted people’s independence and respected their right to privacy. However, we found that care plans were not person-centred and did not outline individual preferences and wishes on how people would like to be supported or any information about their life history.
Relatives felt able to raise concerns with the management team if they had any and were positive about the care their loved ones received. However, the provider had not set up a system to identify, record and respond to any concerns or complaints.
Staff told us that they enjoyed working for the company and that they felt supported by the manager. The service worked with other professionals to support people with complex health needs to remain living in the community. Feedback received about the provider’s professional manner was positive.
The provider responded positively to our findings, welcomed our inspection and planned to make improvements in the future.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 29/01/2020 and this is the first inspection.
Why we inspected
This was a planned inspection based on the date of registration.
Enforcement
We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to safe recruitment of staff, safeguarding service users from abuse, staff competency and training, safe care and treatment people receive, care that is not person-centred, consent to care, no system in place to identify and manage complaints and the overall management oversight of the service at this inspection.
We took action to impose conditions on the providers registration to prevent them taking on new or increases in care packages until improvements have been made. The provider is also required to give regular updates on progress towards these improvements.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
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 of their 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.