Archived: Direct Health (Kettering)

Updated 16 March 2017

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.

This inspection took place on 19, 20 and 24 January 2017 and was unannounced. The inspection team consisted of one Inspector.

Before the inspection, the provider completed 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 improvements they plan to make.

Before the inspection, we looked at relevant information as to the provider's activities since their registration with the Commission. We reviewed any complaints, safeguarding concerns and intelligence provided to us about the service. We also spoke with local health and social care commissioners to gather feedback about the service.

During our inspection we visited one person’s home and met with one person and their relative. We also spoke with five people who used the service and six relatives on the telephone. We looked at the care records relating to 13 people and the rotas for 25 people.

In total we spoke with 10 members of staff, including three care staff, two co-ordinators, the manager, the area manager, and three people from the corporate provider. We looked at six records in relation to staff recruitment and training, as well as records related to the quality monitoring of the service, complaints, safeguarding and the staff rotas.

Updated 16 March 2017

This unannounced inspection took place over three days on the 19, 20 and 24 January 2017.

Direct Health (Kettering) is registered with the Care Quality Commission (CQC) to provide personal care and delivers a domiciliary care service to people living in their own homes. At the time of the inspection Direct Health (Kettering) was providing care and support to 112 people.

There was not a manager in post registered with CQC however; the provider had recruited a manager who was in the process of submitting an application to CQC to become the 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.

During our inspection in July 2016 we found that there was a systematic failure in all areas of the service and people were not always receiving their planned care. We identified that the provider was in breach of eight Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We placed the service in special measures and imposed conditions on the provider’s registration preventing new packages of care and requiring them to provide monthly reports to CQC. The provider has submitted these reports as required; these have been analysed and indicated that improvements had been made in these areas.

However at this inspection we found that the provider had not provided enough resources to ensure that all the necessary improvements were made and to meet regulatory requirements. Although the provider had placed some additional senior staff in the branch during the last six months and the manager had developed action plans to address the failings in the service, the provider had failed to supply sufficient resources to implement the action plan in a timely way. It is a concern that it took further intervention from CQC before the additional resource was allocated to the service.

We found that most people did not receive care at regular times from staff that knew them. The staff rotas showed that staff were allocated for the convenience of the service and did not always take into account people’s needs or preferences. Staff did not follow the rotas they had been allocated.

There were not enough staff to provide people’s care; the office staff and the manager were often providing care in the evenings and weekends as there were no appropriate contingency plans for unexpected absences. Staff had not received all of the training and supervision they required to carry out their roles. In our last inspection in July 2016 we identified serious concerns with staff knowledge and skills in safeguarding and moving and handling; not all staff had received the required updates or training since our last inspection.

People who used the service and staff did not always have access to on-call staff or the manager during evenings and weekends, as the on-call staff were providing care.

People did not always have risk assessments that reflected their current needs or care plans to mitigate these risks. Staff did not always have clear instructions about the care people required.

People were protected by the manager and staff who understood their roles and responsibilities to safeguard people. The manager raised, responded and investigated safeguarding concerns and kept clear records of concerns that had been raised.

People received their medicines safely. The provider had systems in place to monitor the management of medicines and take action where issues had been identified.

People knew how to complain and the provider had systems in place to manage people’s complaints in a timely way and take action to resolve them.

We identified that the provider was in breach of four of the Regulations of the Health and Social

Care Act 2008 (regulated activities) Regulations 2014 (Part 3).

This service has been in Special Measures for the last six months. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to have made significant improvements within this timeframe. During this inspection the service failed to demonstrate to us that sufficient improvements had been made and remains rated as inadequate in the Safe, Responsive and Well Led domains. Therefore, this service remains in Special Measures.

As not enough improvement has been made within the allotted timeframe, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This could lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.