Das Care Limited

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At our last assessment, the provider was in breach of legal regulation regarding people’s safe care and treatment. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and learning.

Relatives reported that they felt confident raising concerns, complaints and compliments. The provider was described as having excellent, timely and consistent communication, which was highly valued by people. Relatives said any issues they raised were addressed promptly, with appropriate actions taken to resolve concerns.

A member of staff told us incidents were recorded on the electronic care planning system, which immediately notified the registered manager. They explained that people’s immediate safety would be prioritised and medical advice sought where required. Staff were regularly reminded to report any concerns about abuse, neglect or unsafe practice without delay. Information about safety and good practice was shared through staff meetings and a secure staff communication group, where staff were encouraged to share knowledge, ask questions and support one another.

Staff meetings also provided opportunities for learning and reflection. Agenda items included service user feedback, positive risk-taking, and the timely reporting of incidents and near misses. Although records of regular service user check-ins were not available, the provider advised there had been no incidents in the previous 12 months. Historical incident and accident records demonstrated clear reporting processes, actions taken, and lessons learned.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

We were unable to obtain direct feedback from people or their relatives regarding safe systems, pathways and transitions.

However, records demonstrated effective partnership working and clear processes for coordinating care with some external healthcare professionals. For example, 1 person received clinical oversight from district nurses for catheter management. The provider confirmed they worked alongside district nurses, occupational therapists, and GPs to help ensure people's health needs and safety were met and care remained coordinated.

Staff described working closely with healthcare professionals and confirmed they communicated any changes in people's health to relevant professionals to ensure timely intervention and review.

The provider gave an example of supporting a previous client to transition from receiving care at home to a permanent care setting. They described the process, which included liaising with the new provider to discuss the persons care needs and, with the agreement of the person and their family, sharing relevant care records to support a smooth and safe transition.

The provider worked with people to understand what being safe meant to them and the best way to achieve that. They had concentrated on protecting their right to live in safety, free from abuse, and discrimination. However, improvements were required to safeguarding processes.

The provider had a safeguarding policy in place which outlined safeguarding responsibilities, including the requirement for care workers to remain up to date with safeguarding training. However, the provider had not maintained effective oversight of mandatory staff training. Records showed that only 4 of 8 staff had completed safeguarding training.

Whilst staff were able to describe the safeguarding reporting process and stated they had completed training; the provider could not demonstrate that safeguarding training was current or completed within required timescales. Although no harm had occurred, this increased the risk of safeguarding concerns not being recognised, reported, or acted upon appropriately.

A review of care records identified that consent to care documentation for 2 people was out of date. Both records were last signed in March 2022, with no evidence of review or renewal. While no evidence was identified that people had received care contrary to their wishes or had experienced harm, the provider could not demonstrate that consent arrangements remained current. This created a risk that care may not be delivered in accordance with people's current wishes or lawful consent arrangements, which could lead to people receiving inappropriate care and increase the risk of safeguarding concerns.

The provider demonstrated an understanding of when safeguarding referrals should be made and the appropriate agencies to notify. At the time of the assessment, there had been no safeguarding concerns requiring referral to the local authority or notification to CQC within the previous 12 months.

People and their relatives did not raise any safeguarding concerns or any other concerns about safety.

Following our final assessment feedback, the provider advised that corrective action had been taken to ensure people's consent to care records had been reviewed and updated where required.

The provider did not always work well with people to understand and manage risks.

At our previous assessment, we found concerns relating to how people’s risks were assessed, planned for, and reflected in the care they received. This assessment found similar concerns remained.

The provider had systems in place to assess people's needs before care commenced and to develop care plans and risk assessments using an electronic care planning system. Initial assessments identified a range of risks and captured information about people's care and support needs. However, risk management processes were not always robust. Although risk-related information was available, it was often repeated across different sections of care records and was not consistently supported by clear, standalone risk assessments. This reduced the effectiveness of the provider's overall risk management arrangements.

We found all risk assessments reviewed within the electronic care planning system had been rated as 'low risk'. However, additional environmental risk assessments for the same people, held outside the system, identified some risks as medium or high, raising concerns about the accuracy of risk evaluations.

Known risks were not always assessed appropriately. For example, 1 person with a health condition known to increase the risk of falls did not have a falls risk assessment in place. The same person also required support with catheter care did not have a dedicated catheter care plan or risk assessment, despite this being required by the provider's own policy. In addition, some risk assessments lacked sufficient detail to guide staff, such as information about triggers and appropriate interventions for a person experiencing low mood and anxiety. Care plans and risk assessments did not always clearly reflect people's desired outcomes or provide robust guidance to support safe, person-centred care.

For 1 person living with dementia and experiencing confusion, there was no specific cognition care plan in place. As a result, staff lacked clear guidance on how to support the person’s cognitive needs, promote their safety, and maintain their independence.

A staff member told us, “Care plans provide information about risks and how to manage them safely.” However, our review of care records found that this was not always the case.

We saw examples of staff involving people in decisions about how risks were managed. A relative told us, “They have a hoist for [person] and the first time they used it; [person] didn’t like it at all. The staff talked to [person] throughout the hoisting explaining what they were doing and why.” This demonstrated staff took steps to involve people in decisions about their care and support and explain how risks were being managed.

The provider informed us that, following final assessment feedback, people's care plans and risk assessments were reviewed and updated as required.

The provider did not always detect and control potential risks in the care environment effectively.

At our previous assessment, we identified concerns about the provider's arrangements for assessing and managing fire risks within people's homes. We found similar concerns during this assessment.

A review of environmental risk assessments identified inconsistencies in risk scoring. Two separate environmental risk assessments relating to the same person were in place, with 1 assessing the level of risk as low and another assessing the level of risk as medium. The conflicting assessments did not provide a clear indication of the level of risk or the control measures required, creating the potential for staff to have differing understandings of the risks present within the home environment.

A review of fire safety arrangements identified gaps in the assessment of known risks. The person receiving care was recorded as a smoker; however, the fire risk assessment did not adequately address behaviours that could increase the risk of fire when care staff were present, including smoking by the person or visitors. The assessment also lacked sufficient detail regarding the safe management of flammable products and did not provide guidance on the laundering of clothing and bedding contaminated with prescribed topical creams. These gaps reduced assurance that fire risks had been fully assessed and appropriately mitigated.

A review of risk assessments for 2 people receiving care identified a lack of clear reporting arrangements in relation to equipment failure and malfunction. While staff were instructed to report concerns immediately, the assessments did not specify who concerns should be reported to or the action required if equipment was faulty. People’s homes had been assessed for safety prior to care commencing, and equipment checks were completed monthly to identify any faults or damage. However, these records were not formally linked to moving and handling risk assessments, and there was no guidance for staff on the action required if equipment was found to be faulty. The provider told us that, in most cases, relatives arranged for repairs or replacement equipment; however, staff would support people to safely transfer out of bed where this was needed to enable repairs to be carried out. In addition, separate risk assessments were in place for equipment failure and equipment malfunction, despite covering similar risks. This created the potential for duplication, inconsistency, and confusion. This could lead to delays in reporting, inconsistent staff responses, and the potential continued use of unsafe equipment.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

At our previous assessment, we identified concerns relating to safe recruitment practices and the recording of staff training. We found similar concerns during this assessment, indicating sufficient improvements had not been made.

The provider had not always followed safe recruitment practices, as gaps in staff employment history were not consistently explored. For 1 staff member, a reference from a previous care employer was requested but not obtained. Although the provided stated they had attempted to follow this up using the contact details provided, these efforts were not documented within the recruitment file.

The provider had no oversight of staff training, and not all staff members had completed the essential training required to provide safe and effective care. The provider failed to maintain an up-to-date staff training record following the introduction of a new training provider. Although an updated training matrix record was submitted the day before final feedback, including all members of staff, several mandatory training modules remained outstanding. As a result, it was unclear whether staff had received the necessary training and knowledge to deliver person-centred care.

At the start of our assessment, we found that only 4 of the 9 staff members had completed specialist learning disability training. This was discussed with the registered manager, who subsequently confirmed that all staff had now completed the essential training. Although the service is not currently providing specialist learning disability support, having trained staff would ensure they are equipped to meet people’s needs should this support be required in the future.

Checks to assess staff competency in areas such as safeguarding, mental capacity act (MCA), communication, person centred care, moving and handling, medication administration and infection prevention and control (IPC) were reviewed. However, accurate, complete and up-to-date staff records were not consistently maintained.

Discrepancies were also found between supervision matrixes and individual staff records, reducing assurance that staff competency, supervision and performance were being effectively monitored and recorded.

However, there were sufficient staff on duty to meet people’s needs. The provider conducted ‘spot checks’ during care calls, which provided an opportunity to assess staff conduct and identify any concerns with their work.

One member of staff with 2 years’ previous care experience said they received a comprehensive induction, including 5 days of shadowing, mandatory training, practical moving and handling training, and a medication administration competency assessment. Another staff member said, “When I joined, the provider completed pre-employment checks, including a Disclosure and Barring Service (DBS) check, references and an interview before starting the role.”

The provider assessed and managed the risk of infection.

The provider had an IPC policy which outlined the provider’s expectations and arrangements for maintaining safe infection control practices. Supplies of personal protective equipment (PPE) were observed in the office, and staff told us they could access PPE when needed.

Staff told us infection prevention and control practices were closely monitored, including hand hygiene and the correct use of PPE. The management team carried out spot checks while staff were providing care in people’s homes to ensure procedures were followed. One staff member told us, “In the event of an outbreak, I would report it to management, follow public health guidance, and take the appropriate action to keep people safe.”

The provider did not always make sure that medicines were safe and met people’s needs, capacities and preferences.

At our previous assessment, we identified concerns relating to medicine management. We found limited improvement had been made since our previous assessment and similar concerns remained.

A review of medicines management records identified significant inconsistencies and gaps in documentation. Care records stated that staff were responsible for applying prescribed topical creams, and daily notes recorded that these had been administered; following support to wash. However, there was no medication administration record (MAR) chart or other appropriate recording system in place for prescribed topical medicines. The provider advised that staff did not administer these creams and that family members applied over-the-counter moisturisers, which contradicted both the care plans and daily records. This indicated inaccurate and inconsistent record keeping and a failure to maintain robust medicines management arrangements.

A review of electronic medication administration records (eMARs) identified omissions and discrepancies, including administration times that did not correspond with scheduled staff visits and the absence of essential medication information. This was not in line with the provider’s Administration of Medicines policy and procedure and increased the risk of unsafe and ineffective medicines management.

However, 1 relative stated their loved one relied on the service stating,” [person] still needs constant reassurance, this one is best, they help and reassure [person], they administer the tablets to make sure they are taken.