Archived: Direct Health (Doncaster)

Updated 29 April 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 checked 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 took place on the 16 March 2016 and was announced. The provider was given short notice of the visit to the office in line with our current methodology for inspecting domiciliary care agencies. The inspection team consisted of one adult social care 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 our inspection, we reviewed all the information we held about the home. We spoke with the local authority and Healthwatch Rotherham to gain further information about the service. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England.

We spoke with nine people who used the service, and eight relatives of people who used the service.

We spoke with six care workers, a care co-ordinator, the manager and the transitional manager. Other members of the management team were present on the day of inspection to support the manager. We looked at documentation relating to people who used the service, staff and the management of the service. We looked at six people’s care and support records, including the plans of their care. We also looked at six staff files. We saw the systems used to manage people’s medication, including the storage and records kept. We also looked at the quality assurance systems to check if they were robust and identified areas for improvement.

Updated 29 April 2016

The inspection took place on 16 March 2016 and was announced. We gave the service 48 hours notice in line with our current methodology about inspecting domiciliary care agencies. The service was registered with the Care Quality Commission in July 2015. This was the first inspection of the service.

Direct Health (Doncaster) provides personal care to people living in their own homes. At the time of our inspection there were 96 people using the service.

At the time of our inspection the service did not have a registered manager in post. 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 appointed a manager who was in the process of applying to be registered with the Care Quality Commission.

We saw the service had appropriate procedures in place to ensure people received their medicines safely. However, this was not always followed through in practice. We saw a selection of medication administration records (MAR) sheets and found some gaps in recording.

The service had a policy in place for safeguarding people from abuse as well as local authority procedures and practice guidance. The safeguarding policy included the types of abuse and how to recognise and report abuse. We saw that staff had received training in this area and knew what to do if they suspected abuse.

We saw care plans contained information about risks associated with people’s care. However, these contained limited information about how to keep the person safe. Some risks were not identified.

A lot of people we spoke with told us that they felt the service was short staffed and there was a high turnover of staff. The service had experienced a lot of occasions where calls to people in the community had been missed. This was an issue that the manager was currently trying to address. The process in place was to meet with any staff who missed a call for whatever reason.

The service had arrangements in place for recruiting staff, and pre-employment checks were carried out prior to commencing work.

People were supported to have their assessed needs, preferences and choices met by staff who had the necessary skills and knowledge. We looked at records in relation to staff training and found training took place on a frequent basis. Staff we spoke with told us they felt the training they received had given them confidence to carry out their role effectively.

We found the service to be meeting the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with had a good knowledge of this and said they would speak to the registered manager if they needed any further advice.

People were supported to eat and drink sufficiently to maintain a balanced diet. We spoke with people who used the service and looked at their care plans. We found care plans identified the support people required during mealtimes.

People were supported to maintain good health, have access to healthcare services and received ongoing healthcare support. We looked at people’s records and found they had received support from healthcare professionals when required.

We spoke with care workers who gave evidence that they clearly understood the needs of people they were supporting, and they were able to understand how individuals wanted to be supported. All of the staff that were interviewed by us had a very good understanding of the individual needs of the people who used the service and also of how they chose to have their care delivered.

We spoke with people who used the service and their relatives and they were aware they had a care plan. However, people told us they had not been involved in any reviews to ensure the plan was still correct. We looked at care plans belonging to people and found they were not very organised. Some contained paperwork relating to the company who previously provided the support to people. This was confusing as it was not clear what parts of the documentation were relevant and which were no longer required. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service had a complaints system in place. We saw evidence that concerns had been dealt with effectively. However, when we spoke with people and their relatives they told us they had raised concerns and were not satisfied with the response.

We saw various audits had taken place to make sure policies and procedures were being followed. However, it was not clear what had been done to address any shortfalls. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People we spoke with felt the service lacked leadership and felt communication was a problem. One relative said, “There is a lack of communication from the office and this shows a lack of leadership.” People told us how they received a rota advising them of who would be attending their calls, but this changed frequently and they were not informed of the update.

Staff we spoke with felt the service was well led and the manager was approachable and listened to them.