We carried out a review of the data available to us about Desire Care - Burton on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Desire Care - Burton, you can give feedback on this service.
Desire Care – Burton is a home care service providing personal and care support to people who live in their own homes. At the time of our inspection the service supported 100 people.
People’s experience of using this service and what we found
We have made a recommendation in relation to COVID-19 testing guidance.
Governance systems were effective in monitoring and mitigating risks to people. Improvements had been made to care plans which were detailed and person-centred.
Staff wore appropriate Personal Protective Equipment (PPE) to reduce the risk of cross contamination and infection.
Relatives told us they felt people were safe, staff generally arrived on time, and two carers arrived when this was identified as a need. Relatives also told us they felt the service was well managed.
There were enough suitably trained staff available to support people safely. Recruitment files showed all pre-employment checks had been made to ensure only staff who were suitable to work with people were employed.
Staff administered medicines as prescribed and recorded this accurately in peoples MARS (Medication Administration Records) which were regularly audited to ensure concerns could be identified and addressed promptly.
We saw partnership working between different professionals and health organisations in people’s care folders.
For more information, please read the detailed findings section of this report. If you are reading this as a separate summary, the full report can be found on the Care Quality Commission (CQC) website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 23 April 2021). At our last inspection we found a breach of the regulations in relation to quality monitoring systems. The provider completed an action plan after the last inspection. At this inspection we found improvements had been made and the provider was no longer in breach of this regulation.
Why we inspected
We carried out an announced inspection of this service on 17 March 2022.
We undertook this focused inspection to check if the provider had made improvements and if they were now meeting the legal requirements. This report only covers our findings in relation to the key questions safe and well-led.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed following this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Desire Care - Burton on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Desire Care Burton is a domiciliary care agency providing personal care to 56 people at the time of the inspection. The service supports younger or older adults with dementia and people with physical disabilities, sensory impairments or a learning disability.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.
People’s experience of using this service and what we found
Quality monitoring systems were in place, however some of these were not fully embedded into the service and were not effective at identifying trends and improving outcomes for people using the service.
Care plans did not always reflect peoples’ care needs, although staff knew how to support people and knew their preferences well.
People told us they felt safe with the staff that supported them, and staff knew how to recognise signs of abuse and how to report any issues.
People were supported by trained staff who had been recruited safely. People were supported to receive their medicines as prescribed. People were supported in line with government guidance around COVID-19.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 19 November 2020) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.
Why we inspected
We carried out an announced focussed inspection of this service on 5 February 2021.We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Desire Care on our website at www.cqc.org.uk.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
physical disabilities or sensory impairments.
Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.
People’s experience of using this service and what we found
There were limited quality monitoring systems in place and improvements were required to ensure records were up to date and to demonstrate how people’s views were captured and used to influence the development of the service.
We found numerous records had gaps in information or were not up to date, this including people’s care records. The provider did update some of these records during the inspection, but we were not assured that they would have identified these gaps through their own quality monitoring systems.
In addition, the provider had not notified CQC of allegations of abuse that had been raised against the service, as required by the law. The provider had worked with the local safeguarding team in addressing these allegations at the time they arose.
Despite identification of areas where the service needed to improve, people told us they were protected from potential risks as staff had a good awareness of what these were and how to mitigate them.
People were satisfied with the arrangements for management of their medicines.
People said staff took appropraite precautions to protect them against the risk of infection.
People were supported by enough staff, who were caring and had developed good relationships with a group of staff they knew well.
Checks of staff when employed were completed they were safe to work with people who used the service, although the provider needed to ensure records of these checks were more organised and easily accessible.
People felt able to share their views with the provider and staff and people felt if they raise any concerns the provider would do what they could to put things right
Staff told us they felt well supported by their managers and they said were approachable.
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 (report published 12 October 2017)
Why we inspected
We received concerns in relation to the management of people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from Good to Requires improvement. This is based on the findings at this inspection.
We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Desire Care – Burton on our website at www.cqc.org.uk.
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 have identified breaches in relation to good governance and notification (to CQC) of other incidents, namely any allegations of abuse whilst staff are delivering personal care.
Please see the action we have told the provider to take at the end of this report.
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 provider was also the registered manager in the service. 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.
On our last inspection in September 2016, we rated the service as Requires Improvement as we found medication audits had not identified where there were potential errors and action had not been taken to review medicine procedures. Formal systems for staff supervision were not completed to ensure staff development and completion of the care certificate were needed. On this inspection we found improvements had been made in these areas. Further improvements were still needed to ensure systems in place to assess and monitor the quality of care to drive improvements within the service. This included where people’s care had been changed and ensuring all information was reviewed to demonstrate how people were supported to manage any complex behaviour.
People felt safe when they received care. Staff understood how to recognise potential harm and protect people from abuse and knew how to report concerns. Recruitment checks were made to confirm staff were of good character to work with people and sufficient staff were available to meet people's support needs.
People had capacity to make decisions about their own care and staff sought their consent before providing care and support. Staff had effective supervision and their work was reviewed through regular checks on their performance and appraisals. People received an agreed level of staff support at a time they wanted it. People were happy with how the staff supported them and were helped to take their medicine as prescribed.
There was a small team of staff who had the skills to meet their needs. People knew who was delivering their support and the provider was flexible and responsive to changes in people’s needs. People received kind and compassionate care and were supported to maintain their dignity, independence and privacy.
People chose how support was delivered and were positive about the way staff treated them. Staff listened to people’s views and people knew how to make a complaint or raise concerns.
Desire provides domiciliary care for people who live in their own home in Burton upon Trent, Derby and Birmingham. At the time of our inspection, ten people were receiving personal care support from the provider.
The provider was also the registered manager in the service. 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 provider did not have systems in place to assess and monitor the quality of care to drive improvements within the service. Where people’s care had been changed, the provider had not ensured reviews had taken place and the records were not changed to reflect people’s current support. Medication audits had not identified where there were potential errors and action had not been taken to review medicine procedures. Formal systems on staff supervision were not completed to ensure staff development and completion of the care certificate. Quality audits within the registered office had not been carried out to ensure the premises were safe.
When staff started working in the service the provider had not completed all the necessary recruitment to confirm staff were of good character to work with people.
Risks to people had been identified and staff understood how to support people to reduce risk and protect them from potential harm and without restricting their rights. However, the support plans did not always include this information.
People told us they felt safe when being supported by staff and staff knew how to protect people if they suspected they were at risk of abuse or harm. Staff understood how to recognise potential harm and protect people from abuse and knew how to report concerns.
People had capacity to make decisions about their own care and their consent was sought before staff provided any care and support. People were supported in such a way as to retain as much control and independence over their lives as they wanted. There was a small team of staff who worked flexibly to enable people to choose when they wanted to be supported.
People were positive about the way staff treated them and said staff were kind and compassionate. People felt comfortable raising any issues or concerns and there were arrangements in place to deal with people's complaints.
People were happy with the staff and felt they were treated in a caring and kind way. People told us staff knew them well. People were encouraged to be independent and their privacy and dignity was upheld in their homes. When people needed support with mealtimes or access to health professionals it was provided for them.
We found breaches 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.