Archived: Dale Care Limited

Updated 5 August 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.

The inspection took place on 19, 20, 21 and 22 June 2017 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

The inspection team consisted of two adult social care inspectors and eight experts by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who used this type of care service. The experts in this case had experience in caring for older people, people living with dementia, people with physical disabilities and people with mental health needs.

Before our inspection we reviewed all the information we held about the service. We examined the previous action plan sent to CQC by the provider and notifications received by the CQC. Notifications are changes, events or incidents that the provider is legally obliged to send us within the required timescales. We spoke with four staff from local authority commissioning and safeguarding teams. We spoke with the local Healthwatch. Healthwatch are a consumer group who champion the rights of people using healthcare services. We also contacted two health and social care professionals.

We asked the provider to complete a Provider Information Return (PIR). This is a document wherein the provider is required to give some key information about the service, what the service does well, the challenges it faces and any improvements they plan to make. This document had been completed and we used this information to inform our inspection.

During the inspection we reviewed ten people’s care information, looked at a range of staff records, policies, procedures, auditing, rota information, survey information and IT systems. We spoke with 75 people who used the service and 24 relatives. We visited three people in their homes. We also spoke with 15 members of staff: the regional director, the registered manager, the operations manager, the leader of the triage team, a member of the complaints/QA team, two care co-ordinators and eight care staff.

Updated 5 August 2017

The inspection took place on 19, 20, 21 and 22 June 2017 and was announced. This meant we gave the provider 48 hours’ notice of our intended visit to ensure someone would be available in the office to meet us.

The service was last inspected by CQC in May 2016, at which time the service was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Health and Social Care Act 2008 (Registration) Regulations 2014. During that inspection we found the provider did not ensure the proper and safe management of medicines. Additionally they had not notified CQC of alleged instances of abuse by way of medicines errors. The provider had failed to ensure there was an accurate, complete and contemporaneous record in respect of each service user. There were insufficient numbers of staff deployed to meet people’s needs through the implementation of an effective rota system. We also found that not all staff had received the appropriate training.

At this inspection we found improvements had been made and the provider had completed each of the improvement actions necessary. Robust systems were in place to investigate and analyse medicines errors, as well as systems to learn from these errors. Records had been improved and of the records we reviewed we found they were accurate and up to date. Training of staff had been addressed and improvements had been made. In addition to the above we also found that CQC had been notified of all relevant events as required.

Dale Care is a domiciliary care provider based in Crook providing personal care to people in their own homes in County Durham, Gateshead, Newcastle and surrounding areas. There were approximately 1,300 people using the service at the time of our inspection.

The service had a registered manager in place. 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.

We found medicines administration was supported by robust medicines and disciplinary policies. Where mistakes were made, appropriate support and investigations took place, as well as notifications to the appropriate agencies.

People who used the service felt safe and relatives had confidence in the ability of staff to keep people safe. Staff had received safeguarding training in safeguarding and understood their responsibilities. There was an out-of-hours phone line in case of unforeseen circumstances and people did not report they had experienced any missed calls recently.

Risks were assessed by an area supervisor when someone first started using the service, and reviewed thereafter. Pre-employment checks, including Disclosure and Barring Service checks, were in place.

There were sufficient numbers of staff on duty to meet the needs of people who used the service, although the planning of individual staff rotas still required improvement to ensure people received a better continuity of care.

New staff received a seven-day induction, as well as shadowing opportunities. The provider agreed shadowing practices could be further improved but we found mandatory training covered a range of core topics, such as: safeguarding, infection control, dementia awareness, first aid and nutrition. The registered manager and training manager ensured staff completed refresher training.

Staff liaised regularly with external healthcare professionals and ensured their advice was incorporated into care planning.

Staff were supported through annual appraisals and a number of supervisions throughout the year – the timings of these were not always consistent and the provider had recently introduced a new supervision format for staff. Initial feedback regarding this was positive.

People who used the service and relatives consistently told us staff were caring, patient and upheld people’s dignity. People confirmed staff encouraged them to retain their independence on a day-to-day basis.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People told us they were encouraged to contribute to their own care planning and review, and felt partners in the process.

People who used the service and external professionals told us staff were accommodating to people’s changing needs and preferences.

People who used the service knew how to complain, and who to. This information was shared with people in a welcome pack. Complaints were thoroughly investigated and responses given, whilst a quality assurance and complaints team had been set up to help the provider learn from mistakes.

The registered manager, regional director and care staff were described in positive terms by people who used the service and relatives. We found leadership of the service to be an effective balance of experience and trialling new ideas. Auditing and quality assurance systems were in place to enable the provider to identify trends.

The culture of the service was in line with the goals of the statement of purpose, meaning people who used the service were supported to maintain their independence from care staff who demonstrated a good understanding of people’s needs and individualities.