Archived: Direct Health (Rochdale)

During this inspection we found that improvements had been made. There was evidence to show that most of the staff had received or updated their training to ensure that safe and effective care could be provided.

' Is the service safe?

' Is the service caring?

' Is the service effective?

' Is the service responsive to people's needs?

' Is the service well led?

Below is a summary of what we found. The summary is based on speaking with people who used the service and with a relative, speaking with the staff and from looking at records.

Is the service safe?

The care records we looked at contained enough information to show how people were to be safely supported and cared for.

Risk assessments in relation to a person's health care needs were in place. Assessments were also completed around risks associated with people's home environment and fire safety.

People told us they felt safe and the staff we spoke with understood how to safeguard the people they supported.

Sufficient staff were employed to ensure consistent care was provided. People told us they nearly always had the same care staff to look after them.

The majority of staff had not received the essential training that is necessary to safely support and care for people.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law to ensure that staff receive the required essential training.

Is the service caring?

People we spoke with were complimentary about the staff. Some of their comments were; 'They are all very good carers, no bother at all, I have no worries about any of them' and 'They are very lovely and very good with me. I am happy with the care'.

Is the service effective?

We saw that every person who used the service had recently had a review of their care undertaken. We were told that it was the policy of the company to undertake a care review formally every 12 months and a 'pop in' check on people's care every six months.

People we spoke with told us that they felt their needs were being met. We were told that staff from the agency came out to see them before they started receiving care and support and discussed their needs and preferences.

Systems were in place to help ensure staff learnt from events such as untoward incidents and complaints.

Is the service responsive?

People we spoke with told us they had a copy of the complaints procedure in their home and knew who to speak to if necessary. They told us they felt confident that if they made a complaint it would be dealt with properly.

Is the service well led?

There were a number of quality assurance systems in place to ensure people were supported safely. Senior staff visited or contacted people who used the service on a regular basis to check if they were satisfied with the care and support provided.

Staff we spoke with were complimentary about the new manager. They told us they felt the manager was approachable and supportive.

Staff received supervision meetings every three months. Supervision meetings help staff discuss their progress and any learning and development needs they may have.

All staff were issued with an employee handbook. This enabled them to have easy access to the policies and procedures necessary to provide safe care and support.

Following this visit the provider sent us an action plan telling us what action they were to take to make the necessary improvements. The provider told us that this would be achieved by the 31 March 2014.

Whilst the action plan had yet to be completed, we carried out this inspection due to further concerns raised with us about the care received by people who used the service.

During this inspection we discussed these concerns with the manager. It was acknowledged that alternative arrangements were needed in relation to the specific care for one person, other people had experienced late or missed visits and that additional staff were needed so the consistency in support could be provided, specifically during the evening and weekends.

Further concerns were identified from our discussions with staff. These too were brought to the manager's attention. We requested that appropriate action was taken and confirmation forwarded to us the following day. This was not provided and a further request was made.

We also discussed the progress being made to address the previous shortfalls identified. We found that progress had been slow. We were told that additional resources had been made available to assist the manager, however staffing arrangements remained unstable.

The manager told us that she was still confident that full compliance would be achieved by the identified date.

Senior management acknowledged that restructuring the service over the previous 12 months had caused significant disruption. We were told steps were being taken to address short falls across the service.

The comments we received from people varied. People made positive comments about some care staff who provided support but also raised concerns about inconsistencies in staffing and standards of care. We found that reviews of people's needs were not completed

.

Although there were policies and procedures in place around safeguarding vulnerable adults, there was not an effective system in place to ensure people were protected from the risk of abuse.

We found there were inadequate numbers of sufficiently experienced staff to provide consistent care. This was particularly problematic on weekends. We found that staff did not receive on-going training and were not adequately supported in their roles.

The provider had recently distributed feedback surveys to people who use the service. Comments received varied. The Provider did not have effective systems in place to monitor the quality of care.

The care records we looked at were incomplete, inaccurate and out of date.

The people we spoke with told us they were happy with the care they received. They told us the staff were pleasant, kind and helpful. They also told us the care staff prompted them when their medicines were due and that they received their medicines in a timely manner.

The people we spoke with told us they were very happy with the staff. They told us the staff rarely arrived late and they were always notified in advance if there were any issues with time keeping. They told us that they had no concerns about the care they received. They told us that if they had any concerns or complaints, they would speak to the registered manager or to social services.