Archived: Direct Health (Crewe)

announced.

At the time of our inspection Direct Health (Crewe) provided a home care service to people in Crewe, Sandbach, Alsager, and Congleton areas. It is part of the Direct Health Group, which operate a number of agencies around the country. The service is registered with the Care Quality Commission (Commission) to provide the regulated activity personal care. Information provided by the manager indicated that the service was providing personal care for 49 people in total.

A registered manager is a person who has registered with the 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. At the time of the inspection a manager was in post who was applying to be registered with the Commission. Since the inspection the manager has successfully completed her application and is now registered.

This comprehensive inspection of the service was a follow up to previous comprehensive inspections in December 2015 and January, June and July 2016 where we found that the provider was not meeting all the requirements for a service of this type and was awarded an overall rating of inadequate. We took enforcement action in line with our enforcement procedures and put the service in special measures. As a result of this inspection this service is no longer in special measures.

During this inspection, we found that the provider was meeting all the required regulations.

During this inspection we found that significant improvements had been made regarding how the service was provided. We spoke with 40% of all people using the service, or their representatives and received predominantly positive feedback. Comments included, “They (staff) are well trained and know what they are doing”, “They are excellent, a well managed service, I know who is coming and when so I am happy” and “Overall they are very good.”

People told us that they felt safe and we found that staff understood their responsibilities to report any suspicions of abuse or poor treatment.

People told us that their care calls were never missed, and that staff always arrived to support them as expected.

All new employees were appropriately checked through robust recruitment processes.

Staff were skilled and knowledgeable. We found that staff completed an induction prior to starting work in the service and received regular and on-going training. Staff told us that they felt supported, they received regular supervision and appraisals.

People received personalised care and the service was responsive to people's changing needs. Assessments and care plans were in place. They provided sufficient information and were regularly reviewed.

The service had a complaints policy and procedure. Records showed that in general the service responded to concerns and complaints and learnt from the issues raised.

At the time of our inspection Direct Health (Crewe) provided a home care service to people in Crewe, Sandbach, Alsager, and Congleton areas. It is part of the Direct Health Group, which operate a number of agencies around the country. The service is registered with the Care Quality Commission (Commission) to provide the regulated activity personal care. Information provided by the manager indicated that the service was providing personal care for 54 people in total.

Following our last inspection in December 2015 and January 2016 the previous registered manager for the service resigned. The provider appointed a new manager in April 2016 who was in the process of applying for registration as manager of the services at the time of this inspection. A registered manager is a person who has registered with the 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 current manager became registered with the commission on the 25 September 2015.

This comprehensive inspection of the service was a follow up to a previous comprehensive inspection in December 2015 and January 2016 where we found that the provider was not meeting all the requirements for a service of this type and was awarded an overall rating of inadequate. We took enforcement action in line with our enforcement procedures and put the service in special measures.

The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The provider took action to improve the quality and safety of services provided. Working closely with representatives of the local safeguarding authority and Cheshire East Councils Commissioning Manager an embargo on new placements was agreed and a detailed action plan was developed, implemented, monitored and reviewed. On the 24 June 2016 representatives of Cheshire East Council told the Commission that they had found that the provider had taken all required action to ensure the safety and welfare of the people who used the service and that the action plan had been completed.

On this inspection we also found that the provider had taken effective action to improve the quality and safety of services provided in all areas of service delivery. There was still some room for improvement in a number of areas including risk assessment, monitoring and review, consent to care, continuity of care and quality assurance. However the new manager demonstrated that they had the required skills, knowledge and aptitude to secure all required improvements and to ensure that they are sustained.

People who used the service expressed satisfaction and spoke very highly of the new manager and staff. For example, one person described the service they received as “excellent”. They said: “Everything has improved; they came out and re-did everything. I feel safe now. The new manager is very good; I’m not fobbed off any more. Overall I am very happy with the service they provided.” Most of the other people spoken with expressed similar views other than a small number of people who were dissatisfied because care staff either came too early or too late to provide care which had upset their daily routines and did not meet their needs.

We could see that the safety of people who used the service was taken very seriously and the new manager and staff were well aware of their responsibility to protect people’s health and wellbeing. All the people spoken with told us that they had positive relationships with their care workers.

We could see that the new manager was very committed to continuous improvement and this was reflected in the feedback forms we saw during the inspection and the comments we received from people. The new manager welcomed both positive and negative comments and treated both as opportunities for improvement of service delivery.

The care staff team presented as confident and competent care workers who were motivated to provide care that met people’s needs and ensured their safety and wellbeing. All staff were unanimous in their praise for the new manager. They told us that that they were fully supported by the new manager, who listened to them, took their views seriously and involved them in service improvement.

At the time of our inspection Direct Health (Crewe) provided a home care service to people in Crewe, Sandbach, Alsager, and Congleton areas. It is part of the Direct Health Group, which operate a number of agencies around the country. The service is registered with the Care Quality Commission (Commission) to provide the regulated activity personal care. Information provided by the manager indicated that the service was providing personal care for 59 people in total.

The service has a registered manager. A registered manager is a person who has registered with the 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 current manager became registered with the commission on the 25 September 2015.

This is the second comprehensive inspection of this service we have undertaken in 2015. Our last inspection of the service February and March 2015 was a follow up to a previous comprehensive inspection in July 2014 where we found that the provider was not meeting all the requirements for a service of this type and was awarded an overall rating of inadequate. We took enforcement action following our inspection in July 2014 and served warning notices on assessing and monitoring the quality of service provided, care and welfare of people who use service, safeguarding people who use services from abuse and staffing. On our follow up inspection in February and March 2015 we found that the provider had made some improvements but the people who used the service were still not receiving safe and appropriate care. We again awarded the service an overall rating of inadequate and extended the date by which the regulations must be met in respect of person centred care, good governance and safeguarding service users from abuse and improper treatment to 1 September 2015. We also told the provider that the services recruitment processes needed to be improved to ensure that fit and proper persons were employed.

On this inspection we found that the provider had taken effective action to improve recruitment processes. However, the warning notices we had served on person centred care, good governance and safeguarding service users from abuse and improper treatment were not met because people who used the service were still at risk of receiving unsafe and ineffective care.

Whilst some people told us that their needs were met and they were happy with the care they received, we found evidence that others had not received safe and effective care and continued to be at risk of their needs not being met.

The service was not well led. Since our last inspection a new manager had been appointed and registered with the Commission but although they were caring in approach they presented with insufficient knowledge, skill and aptitude to ensure the wellbeing of the people who used the service.

We found that an allegation of abuse highlighted at our last inspection had still not been investigated; and concerns raised by staff and visiting professionals had not always been responded to effectively. This meant that managers and staff were not learning from past events, or taking effective corrective action to improve the service.

Although some people told us they felt safe, we found that management and staff had not always taken effective action to protect vulnerable people from neglect.

We identified further breaches of the relevant regulations in respect of person-centred care, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, receiving and acting on complaints, good governance, and duty of candour. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by the Commission. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

This information was provided by people described as whistle-blowers. 'Whistleblowing' is when a worker reports suspected wrongdoing at work and feels they need to tell an organisation outside of the workplace about it. Officially this is called 'making a disclosure in the public interest'. The Care Quality Commission is one of the organisations prescribed for such disclosures. We did not know the identity of any of these informants and in some instances we did not know the identity of the people who used the service who they were telling us about.

Prior to our inspection we contacted the 'Whistle blower's Friend' at Direct Health. This is a designated manager made available from the Direct Health company headquarters if staff have concerns. This manager told us that they were aware of some current difficulties and that the former manager had resigned with effect from January 2014. During our inspection we visited the offices of the provider and talked to the Area Manager as well as the newly appointed Manager of the Direct Health (Crewe) branch. We also talked to two members of staff who were working at the offices.

We looked at records relating to the care of five people who used the service and spoke with three relatives. We also looked at staff rotas and lists of visits made to provide care as well as other records. We saw that the care provided did not always match what had been identified as required by the person who used the service. Relatives told us that there had been missed calls and that they had not always been informed about these. They had complained to the provider and felt that their complaints had not always been treated seriously. Other records showed that there had been complaints of missed calls but these were not logged by the provider.

We talked to the officers of the local authorities which commissioned care from Direct Health (Crewe) including those responsible for safeguarding. 'Safeguarding' means taking steps to make sure that people who use services do not suffer abuse and responding properly if there are any allegations or suspicions of abuse.

Standards we looked at took account of the care and welfare of people using the service and what they experienced. We looked at how complaints were managed and responded to. We also looked at what quality assurance systems the agency used to monitor and develop its service provision.

People we spoke with were generally positive about the service they received. One person told us, 'It is a good service for me. If anything, they could do with getting the visiting times right'. Another person said, 'Staff do a very good job. Always pleasant and cheerful'. We spoke with a member of the staff team, they told us they had worked for the service for some time. They told us it was well managed. They felt supported and they liked the work they undertook. Another member of staff was attending an induction programme. They told us they thought the induction programme was providing them with the knowledge and skills to carry out their roles.

We checked that Direct Health (Crewe) had made arrangements to safeguard people who used the service and checked how they recruited staff. We were satisfied that the provider met the essential standards in both of these activities.

We spoke with sixteen people who used the service and five relatives of people of used the service. We met the newly appointed manager, care staff and reviewed three care plans and other documentation such as staff supervision and training records during the course of the visit.

All the people we spoke with said that they would recommend the agency to others. One person told us that staff were: "Very good' and said: 'I wouldn't be without them, the staff I have are all smashing and very kind and caring." Another person said: "I've no complaints at all, they arrive pretty much when expected, they wear a uniform and are very professional.' A relative told us: "They are excellent, we have a regular group of staff and they are good humoured and kind."

We found improvements were needed in the care plan documentation we reviewed. The care plans ensure information is available to assist staff to provide appropriate care and support according to their assessed care needs.

We met with three people who used the service in their own homes. We also spoke with three family members of people who used the service. As part of our inspection, we reviewed the records held in the branch office in Crewe Cheshire and in people's homes.

People who used the service told us they were 'satisfied' and 'very happy' with the service they received and found the staff 'pleasant' 'kind' and 'supportive.' People who used the service and their family members all told us that they were happy with the care and support provided by the staff.

During the course of the inspection we found that staff had not received regular supervision sessions and that some documentation in respect of people's care plan reviews and risk assessments were not always up to date.