Archived: Dale Care Limited

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.

We last inspected Dale Care on 11 February 2014, at which time it was meeting all our regulatory standards.

Dale Care is a domiciliary care provider based in Crook providing personal care to people in their own homes in the Durham, Stockton-on-Tees and Gateshead areas. The service mostly provides support to older people but is also registered to provide personal care to children and younger adults. At the time of our inspection the service provided personal care to approximately 1,250 people.

The service had a registered manager in place. A registered manager is a person who has registered with the CQC 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 registered manager had extensive experience of working in health and social care.

We found people’s medicines were not always administered in a safe and proper manner and the service did not always learn from mistakes made.

We found there were adequate numbers of staff to ensure people’s needs were met safely, although we found a number of instances of delayed or missed calls. We found people sometimes had to wait for care staff to arrive and this was a source of anxiety and risk.

Pre-employment checks of staff ensured the service reduced the risk of unsuitable people working with vulnerable adults. Safeguarding policies and procedures were sound and taken seriously by all staff we spoke with.

We found the service had a range of risk assessments in place to ensure people were protected against risks such as those presented by the environment and their mobility. We saw these risk assessments were regularly reviewed.

We found infection control procedures were in place and people were protected against the risk of acquired infections.

There were supervision and appraisal processes in place. All staff we spoke with confirmed they were well supported.

People who used the service, relatives and external healthcare professionals expressed confidence in the ability of staff to ensure people were protected from abuse.

We found the majority of staff were trained in core areas such as safeguarding, moving and handling, first aid, as well as training specific to the individual needs of people using the service, for example dementia and PEG feed training. We found however that some staff had not received training specific to the needs of people they were providing care to, such as dementia awareness training and Mental Capacity Act (MCA) training.

We found staff had a good knowledge of people’s likes, dislikes and preferences.

We found care plans to be sufficiently detailed to give members of staff relevant information when providing care to people who used the service. We saw professional advice was incorporated into care planning and delivery, and that people’s consent had been sought prior to care being delivered.

People’s changing needs were met through liaison with a range of external health and social care professionals and we saw these interactions were documented on the service’s computer system.

People we spoke with and relatives told us they knew how to make a complaint if they needed to, and to whom. We saw the registered provider made the complaints policy prominent and accessible in various formats. We saw complaints were not always responded to as well as they could be, with responses sometimes defensive rather than open and transparent when errors had been made.

The registered provider did not always notify CQC of relevant incidents, particularly where medicines errors were repeated and put people who used the service at risk of harm.

Staff and the majority of people who used the service we spoke with were positive about the support they received from the registered manager and we found the registered manager and office staff to have a good corporate oversight of the organisation, as well as knowledge of people who used the service.

We saw the registered manager had in place a range of audits to identify areas of concerning practice although these did not always identify patterns and drive service improvement. There was a consensus of opinion from all professionals we spoke with that the service could improve the way it learned from mistakes and make improvements to the service people received.

We found the service to be in breach of four of the regulations. You can read more about the action we told the provider to take at the back of the full version of the report.

We saw the provider had a process in place for seeking consent for care and treatment. People we spoke with, including relatives and carers of people who used the service, told us they were involved in decisions about their care. People said the care staff always asked first before they provided them with care. The responses we received on the questionnaires we sent out showed people felt they had been given sufficient information about the care and support the provider could offer before they started to use the service.

We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People told us they were mainly happy with the care and support they received from Dale Care Limited. They said they were looked after very well by the staff who came to care for them. The people who responded to our questionnaires were also generally happy with the care and support provided by the agency. Comments included "My care workers are really good and I could not manage without them"; "I have no problems they are excellent in the care they deliver"; "They enable my relative to remain in (their) own home. They are kind and respectful to my relative and (they) would struggle without them. The week day carers especially have become good friends!" and "(My relative's) main, regular carer is very is tune with my relative's needs." Everybody who responded to our questionnaires said they felt safe when care workers visited them, their relatives or friends.

The provider may find it useful to note that some of the people we spoke with were not as satisfied with the care and support received at weekends, compared to that received through the week. This was also commented on by a small number of the people who responded to our questionnaires. We mentioned these issues to the director of social care who expressed their disappointment and said they would look to resolve these issues.

People were protected from the risk of infection because appropriate guidance had been followed. We saw the provider had an infection control policy in place and saw evidence to confirm staff had completed infection control training.

People we spoke with were complimentary about the staff employed by the provider to give care and support to them. They said they had no complaints and felt the staff looked after them very well.

People who responded to our questionnaires were also largely happy with the staff who provided them or their relatives and friends with care and support. Comments included "Care workers very good and helpful", "My main care worker is excellent; no job is too big or small for (them). (They) treat me with respect & dignity all the time" and "They (the care staff) are very friendly and accommodating."

The staff we spoke with said they completed regular training and updates in the required areas to ensure their skills were up to date with current practice. The records we viewed supported this.

All of the staff we spoke with told us they felt well supported in their roles by the provider and their line managers. Comments made by the staff included 'I know I can always ring them (the office) and they'll be there for me', 'There's lots of support here for me' and 'I'm happy in the job.'

People told us they were generally happy with the service and knew how to contact one of the managers if they had any concerns. People who responded to our questionnaires also indicated their satisfaction with the services provided. They also reported that generally when a complaint had been made to the provider, they were happy with the outcome and action taken. This meant people who used the service and their representatives were asked for their views about their care and they were acted upon.