Dresden Care Services Limited

Updated 11 January 2019

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.

This unannounced comprehensive inspection took place on the 10 July 2018. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

We had already asked the provider to complete a Provider Information Return (PIR) earlier in 2017, so we did not ask them to complete this again. A PIR is information we require providers to send us at least once annually to give some key information about the service, what the service does well and improvements they plan to make. We took this information into account when we made the judgements in this report. We also reviewed the information we held about the service. We looked at information received from the local authority commissioners, Healthwatch and the statutory notifications the manager had sent us. Commissioners are people who work to find appropriate care and support services which are paid for by the local authority. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. We used all this information to plan what areas we were going to focus on during our inspection visit.

During our inspection visit, we spoke with eight people who use the services of Dresden Care limited and seven relatives and / or friends. During our visit to the office we spoke with the provider’s representative, one care coordinator and six care staff.

We reviewed five people's care plans and daily records to see how their care and treatment was planned and delivered. We looked at how medicines were managed by checking the Medicine Administration Record (MAR) charts for three people. We checked whether staff were recruited safely, and trained to deliver care and support appropriate to each person's needs. We reviewed the results of the provider's quality monitoring system to see what actions were taken and planned to improve the quality of the service.

Updated 11 January 2019

This inspection took place on 10 July 2018 and was announced. We informed the provider 48 hours in advance of our visit that we would be inspecting. This was to ensure there was somebody at the location to facilitate our inspection. The inspection team consisted of one inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of service.

Dresden Care Limited is registered to provide the regulated activity of personal care. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community. It provides a service to older adults and younger adults. There were 35 people using this service at the time of our inspection.

Not everyone using Dresden Care Limited receives the regulated activity; the Care Quality Commission (CQC) only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

At the last inspection in April 2017, we judged the service as requires improvement in the key questions of safe and well-led and we rated the service Requires Improvement overall. We were concerned because the provider had failed to assess all risks to health and safety and failed to manage medicines. We also had concerns that the provider’s governance system of checks and audits continued to require further improvement.

At this inspection in July 2018 we found some improvements had been made in some of these areas however we still had concerns about the provider's system of checks and audits and also, we had additional concerns. As a result, the service has continued to be rated as Requires Improvement. Despite previous inspections identifying shortfalls in governance systems, we found that insufficient progress or improvement had not been made to the systems and processes to audit and monitor the quality of care provided at Dresden Care Services Limited and to meet the Regulations. We are considering what further action to take.

There was a registered manager in post at the time of the inspection. 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.

People were not consistently protected from potential harm due to the provider failing to recognise, report and notify the appropriate safeguarding authorities of potential safeguarding concerns. Risks to people's health and safety were not sufficiently identified and robust risk management plans were not consistently in place. Incidents had not been analysed to identify trends to help prevent the risk of similar occurrences in future. Systems were in place to ensure staff were suitable to work with people in their own homes. People told us there were enough staff available to meet their individual needs. People received their medicines as prescribed.

Staff had not consistently received observational competency assessments to monitor their practice. For example, moving and handling. People told us that staff sought their permission before providing care and support. However, we identified that the registered provider had not consistently understood their obligations under the Mental Capacity Act (2005). People told us they enjoyed the food prepared for them and they chose what they preferred. People were supported to meet their health care needs, when necessary.

People told us that staff who regularly supported them were kind, polite and respected their privacy. People told us they made decisions about how they wanted their care provided. Staff described people’s likes and dislikes and preferred routines.

Staff were responsive to people’s needs and wishes. Most people received care and support that was flexible and felt their needs were met in the way they preferred. Development was in progress to enable people access to their care plans and to ensure people had the opportunity to receive information in alternative formats.

People and their relatives were satisfied with the service they received however we found that the service was not consistently well led. The systems in place to assure the safety, quality and consistency of the service were not consistently effective. Checks and audits had not been effective at identifying matters that needed to improve. Despite this being brought to the attention of the registered provider at our last inspection; they had not taken timely or sufficient action to improve this aspect of the service. The provider had failed to recognise, report and notify the appropriate safeguarding authorities of potential safeguarding concerns. Staff felt well supported in their roles and a valued member of staff.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.