Archived: Directsupport4ultd

Updated 6 July 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection visit took place on 25 May 2016 and was announced. The provider was given 48 hours’ notice because the service is a small home care agency and we needed to be sure staff would be at the office.

The inspection team consisted of an inspector and an expert-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.

Before the inspection, we asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and what improvements they plan to make. They did not return a PIR and we took this into account when we made the judgements in this report.

Before our inspection visit we spoke with two people who no longer used the service who had contacted the Care Quality Commission to share concerns about their experience of the service. During our inspection we tried to speak by telephone with ten people using the service but they preferred that we spoke with their relatives. We were able to speak with seven relatives. We looked at three people’s care plans and associated records. We reviewed information about the support that staff received through training and appraisal. We looked at three staff recruitment files to see how the provider operated their recruitment procedures and at records associated with the provider’s monitoring of the quality of the service.

We spoke with the acting manager, the operations manager, the director and a care worker.

We contacted the local authority who paid for the care of some of the people using the service. We also contacted Healthwatch who are the local consumer champion for people using adult social care services to see if they had feedback about the service.

Updated 6 July 2016

The inspection visit took place on 25 May 2016. We gave the provider 48 hours’ notice of our inspection visit because the service is a home care agency and the acting manager is often out of the office supporting staff or providing care. We needed to be sure they would be in.

Directsupport4u Ltd is a home care agency supporting people who live in their own homes in central and north Warwickshire. At the time of our inspection 36 people were supported with personal care.

It is a condition of registration that the service has a registered manager. A registered manager is a person who has registered with the Care Quality Commission 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. The service had not had a registered manager since June 2015. The provider told us that two staff were in the process of applying to be registered manager one of who was the current acting manager.

People who used the service were safe when they received care and support, though two people who no longer used the service contacted us before our inspection visit to say they were not comfortable with care workers who were sent to support them. The provider had a recruitment procedure under which all the required pre-employment checks were carried out. Those checks were made with a view to ensuring that only staff suited to work for the service were recruited. However, after recruitment interviews no record was made why people offered positions were considered suitable.

People’s care plans included risk assessments of activities associated with their personal care routines. The risk assessments provided information for care workers that enabled them to support people safely but without restricting people’s independence.

Enough suitably skilled and knowledgeable staff were deployed to meet the needs of the people who used the service. Staff arranging home care visits were knowledgeable about people’s needs. They sought to allocate care workers with the relevant skills and knowledge to support people with particular needs and preferences.

Care workers were trained in how to support people with their medicines. A set of medication administration records we looked at had been retrospectively completed which meant we could not be sure that people had actually received their medicines. Care workers did not always complete medicines administration charts or report gaps in those charts. This meant the provider was not able to check quickly whether a person had taken their medicines.

People were cared for and supported by care workers who had the relevant training and support to understand their needs. Relatives of people who used the service at the time of our inspection were mainly complimentary about the skills of care workers. Care workers were supported through supervision, appraisal and a training plan that was being implemented at the time of our inspection.

The acting manager understood their responsibilities under the Mental Capacity Act (MCA) 2005. A care worker we spoke with had awareness of the MCA. They understood that people had to be presumed to have mental capacity to make decisions about their care and that their capacity could change from day to day.

Care workers either prepared meals for people or supported people to make their meals according to the level of support people required.

Care workers received training to help them understand about medical conditions people lived with. They supported people to access health services when they needed them.

Care workers were caring. People were supported by the same care workers most of the time. Most people received home care visits close to the times they expected. However, the provider was not monitoring how well they were performing against those criteria.

People who used the service were involved in decisions about their care and support. They received the information they needed about the service and about their care and support. People told us they were always treated with dignity and respect, though three people told us that their preference for female care workers was not always met.

People contributed to the assessment of their needs and to reviews of their care plans. People’s care plans were centred on their individual needs. People knew how to raise concerns if they felt they had needed to.

People who used the service, their relatives and staff had opportunities to be involved in the development of the service.

The provider had arrangements for monitoring the quality of the service. However, those arrangements did not monitor how well the service was performing in relation to things that were important to people using the service. Those arrangements were in the process of being improved at the time of our inspection. The acting manager carried out monitoring activities to gather people’s views and experience of the service.