Archived: Direct Health (Sheffield)

The manager of Direct Health (Sheffield) was given 48 hours’ notice of the inspection, because the location provides a domiciliary care service; we needed to be sure that the manager and some care staff would be present to talk with. We also wanted the service to make initial contact with some people, who we had identified we would like to visit, to ask them if we could visit them in their own homes.

Direct Health (Sheffield) is a domiciliary care service. The agency office is based in the Attercliffe area of Sheffield. They are registered to provide personal care to people in their own homes in the Sheffield, Barnsley and Rotherham areas of South Yorkshire. At the time of our inspection the service was providing personal care for approximately 320 people. There were approximately 160 staff employed by the agency and they delivered approximately 2,600 hours of personal care each week.

The service was last inspected on 16 and 17 March 2016 and was found to be in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; Person-centred care, Regulation 12; Safe care and treatment, Regulation 10; Dignity and respect, Regulation 16: Receiving and acting on complaints Regulation 17; Good governance and Regulation 18; Staffing.

The overall rating for the service was 'Inadequate'. At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that enough improvement had been made to take the provider out of special measures.

It is a condition of registration with the Care Quality Commission that the service has 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.

The registered provider appointed a new manager in April 2016 who was in the process of applying for registration as manager of the service at the time of this inspection.

Since the inspection on 16 and 17 March 2016 the registered provider has worked closely with representatives of the local safeguarding authority and contracts and commissioning departments of the local authorities. An embargo on new placements was agreed with CQC and a detailed action plan was developed, implemented, monitored and reviewed. We have also met regularly with the local authority and registered provider to discuss progress and monitor improvements.

At this inspection we found the registered provider had taken significant and effective action to improve the quality and safety of services provided in all areas of service delivery.

Improvements had been made with the safe management of medicines although further improvement was still needed.

People said they felt the service had made some improvements particularly in relation to the times care staff visit. Other people still said their preferred visit times were not being met. Better systems were needed to ensure sufficient numbers of staff were deployed to meet people’s needs at preferred times.

Risk assessments for people who received a service had been updated and were in place in the care files we checked.

Staff were receiving regular supervisions, observation in practice checks and training updates. Some staff had not received an annual appraisal.

People said staff were caring and respected their privacy and dignity.

People's needs had been assessed when they started to use the service and all but one care plan we checked had been reviewed and were up to date.

Some people felt the service had made some improvements. Some people however said they had little confidence in the registered provider and felt they were not listened to and the concerns they raised weren’t acted upon.

Some people, relatives, staff and stakeholders said the new manager was “making a difference” and described them as hard working, approachable and a person who promoted strong care values and was committed to service improvement.

A number of improvements had been made in the management and leadership of staff which had resulted in the provision of safer and effective care for a number of the people who used the service. There was still some room for improvement in a number of areas including medicines management, staff support, effective communication with people and staff, and quality assurance.

Direct Health (Sheffield) is a domiciliary care service. The agency office is based in the Attercliffe area of Sheffield. They are registered to provide personal care to people in their own homes in the Sheffield, Barnsley and Rotherham areas of South Yorkshire. At the time of our inspection the service was providing personal care for approximately 380 people. There were approximately 160 staff employed by the agency. There were approximately 2,800 hours of care provided each week by the service.

The service was last inspected on 25 and 30 June 2014 and was found to be in breach of one of the regulations we inspected at that time. People were not protected against the risks associated with medicines because some people were not supported safely with their medication. The provider sent a report of the actions they would take to meet the legal requirements of this regulation which stated they would be compliant by 8 August 2014. We checked whether this regulation had been met as part of this new approach comprehensive inspection.

It is a condition of registration with the Care Quality Commission that the service has 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. A week before the inspection was due to take place we were informed the registered manager had resigned. The area manager of Direct health (Sheffield) was managing the service on an interim basis.

The provider did not have adequate systems to ensure the safe handling, administration and recording of medicines to keep people safe.

People did not have their needs met by sufficient numbers of deployed staff resulting in missed, short and late visits.

Risk assessments for people who received a service were either missing or incomplete. Risk assessments which were present in the care plans did not provide detailed person specific information to mitigate the risks.

Some staff did not receive regular supervisions, appraisal or training updates.

Some people were not supported to eat sufficient food and drink to ensure they maintained a well-balanced diet due to late or missed calls.

Most people felt most staff were caring and respected their privacy and dignity. However there were examples where this was not the case.

People's needs had been assessed when they started to use the service but a care plan was not in place for one person we visited. We found other care plans had not been reviewed for some time and were not up to date.

Some people felt complaining did not improve the service they received as any concerns they raised weren’t acted upon.

There were some systems in place to assess and monitor the quality of service provided. However these were not effective or acted upon to ensure care provided was adequately monitored, risks were managed safely and the service achieved compliance with the regulations.

We found 10 breaches in six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in; Regulation 9; Person-centred care, Regulation 12; Safe care and treatment, Regulation 10; Dignity and respect, Regulation 16: Receiving and acting on complaints Regulation 17; Good governance and Regulation 18; Staffing.

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 service is 'Inadequate' and the service is therefore in 'Special measures'. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still 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 this service. This will 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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

On the 11 February 2014 we took enforcement action against the provider and issued a warning notice to protect the health, safety and welfare of people using the service. As well as assessing whether improvements had been made in these areas, the focus of the inspection was to answer five key questions; Is the service safe, effective, caring, responsive and well-led?

Over the course of 4 days we visited the services office and spoke to the agency manager, area manager, 2 care coordinators and 4 support staff. We checked records and we spoke with 25 people who used the service and 12 of their relatives. We also visited 5 people in their own homes and spoke with them, and 5 of their relatives about the care and support they received and checked records at their home relating to their personal care.

Below is a summary of what we found. The summary describes what people we spoke with told us, what we observed and the records we looked at.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to promote people's welfare. Staff used risk assessments. There were risk assessments in place with people's planned care. These gave details of how individual risks to a person could be removed or minimised.

Staff were aware of potential environmental risks and said documentation to reflect any changing risks was always updated and communicated to all staff.

We found that one person was not protected against the risks associated with medicines because staff were not administering their medication at the correct times and some medication was not being administered at all. The person's medication chart was not being accurately completed by staff.

Is the service effective?

People and their relatives told us they were actively involved in making decisions about care and support. People's health and care needs were assessed with them and their representatives, and they were involved in writing the support plans. People and their relatives said support plans were up to date and reflected their current needs.

Is the service caring?

People and relatives of people who used the service said they felt their privacy was respected when staff assisted them with care and support .They said, 'staff are always friendly and polite' and 'staff treat him with respect, they always make sure curtains are drawn and he is appropriately covered when they are washing him.'

Care workers we spoke with demonstrated a good understanding of the people's needs and were able to give examples of how they promoted people's independence.

We asked people and their relatives for their opinions about the support provided. Feedback and comments were very positive, for example; 'mums care staff are brilliant', 'staff really know my husband, they are excellent' and 'very happy with my care', 'a good team of carers', 'can't praise the carers enough' and 'the care staff are smashing, beyond description, they are very reliable.'

The majority of people and their relatives we spoke with said that many aspects of the service had improved. They said care workers generally read their care plans and followed the tasks in them. They said their care plans had been reviewed recently by a care coordinator and said that staff were visiting on time and staying the allocated time to provide care and support.

We spoke again with five people and their relatives who we had spoken with or visited during our inspection in February 2014 to ask them how they found the service 'today' compared to the service in February 2014. People said, 'the care staff are more reliable, we have had no missed visits, we are generally happy' , 'I now know which care staff are coming and at what time, I've much more confidence in the agency' and 'the carers who come know what they are doing, things are much better, staff come on time, I'm very happy.'

When speaking with staff it was clear that they had a good knowledge of the person's interests, personality and support needs.

People and their relatives who used the service said their care needs had been recorded and staff provided support in accordance with their wishes.

Is the service responsive?

We saw that the provider had a system in place to monitor incidents. The system was electronic based and was therefore accessible to all the senior management team of Direct Health. We raised two issues of concern with the provider following our visits to people in their own homes. During our office visit at the agency we saw evidence that our concerns had been documented and follow up action had been taken by the provider to address these issues.

We found that a policy and procedure was in place for handling complaints to ensure that any complaint was responded to appropriately.

Relatives and people we spoke with told us they were 'a lot happier' with the service. When we asked them if they did want to raise a concern, or were worried about anything what they would do, they all said they would go to the manager and talk to them. They said, 'I see the manager face to face' and 'I can phone the office with problems, things are better now.'

Is the service well-led?

We looked at a sample of the service's policies and procedures. We found the policies and procedures to be detailed, clearly written and easy to understand. Policies and procedures had been reviewed and updated in line with service requirements.

The service had a quality assurance system. We saw evidence the care coordinator and manager completed monthly audits to ensure systems were in place to promote people's safety. The manager, people and their relatives said support plans daily records and medicine records were checked regularly by the managers as part of the quality assurance measures in place. This helped to ensure people received a safe, good quality service at all times.

People and their relatives said the manager and care coordinators completed 'direct observation' visits in people's homes to observe how staff provided care and support for people who used the service. We saw evidence that the manager and care coordinators also spoke with people at these visits to check that they were happy with the support they had received.

Staff said they were clear about their role and responsibilities and said they were 'much happier' at the agency. They said 'we are supported and there is more consistency in our visits.'

During our inspection visit we looked at the arrangements in place to ensure people experienced effective, safe and appropriate care, treatment and support. To do this we contacted 58 people who used the service or their relatives, we spoke with 28 people that used the service and five relatives. We visited ten people in their homes. We also reviewed records.

Service users told us that care tasks were not completed in accordance with the care plan, there was a lack of continuity of care workers, missed calls, late/early calls, they did not always receive care from a male/female carer in accordance with their preference, some people reported medication errors and some service users said they 'Felt rushed.'

We found evidence at the inspection that people's needs were not assessed and care and treatment was not planned and delivered in line with their individual care plan. The provider was non-compliant with this outcome.

We received mixed messages regarding the quality of the care people had received. Some people and relatives made positive comments about the staff that regularly supported them or their family member. We found evidence at the inspection that improvements had been made. However, we found that some people had experienced a lack of continuity of care to meet their individual needs because people had not received support from regular care staff or at their allocated visit times. The provider was non-compliant with this outcome.

There were no effective quality monitoring systems in place. The provider was non-compliant with this outcome.

There was an effective complaints system available. Comments and complaints people made were responded to appropriately. The provider was compliant with this outcome.

We found evidence at the inspection that people's needs were not assessed and care and treatment was not planned and delivered in line with their individual care plan. The provider was non compliant with this outcome.

People who used the service told us that the care and support they received at Direct Health was satisfactory. One person told us "I have regular carers that I know well. On odd occasions a carer that I didn't know has come, but they wore uniform and had an identity badge'

People who used the service received their medication at the times they needed them and in a safe way.

The provider had sufficient numbers of appropriate staff to enable people to have their health and welfare needs met.

There provider had gaps in addressing complaints and full and complete records were not maintained. The service was non compliant with this outcome area.

People we spoke with told us they were very satisfied with the care and support they received. Comments included: "I'm highly delighted with the care I get. The staff are respectful and polite. They come on time and stay for the allocated time", "The care plan is followed, staff have the skills to give care. I have no complaints" and "Generally staff arrive on time but it would be nice if they called to let me know if they are going to be late."

Evidence showed people's privacy, dignity and independence were respected. We found people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Evidence showed staff had received appropriate professional development, training and supervision.

We found the provider had an effective system to regularly assess and monitor the quality of service that people receive.