Archived: Direct Health (North Notts)

Updated 28 August 2019

The inspection:

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Act, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team:

The inspection was carried out by one inspector, an assistant inspector and three Expert by Experiences. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type:

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection:

This inspection was announced. We gave the service 48 hours’ notice of the inspection. This was because we needed to be sure that the provider or registered manager would be in the office to support the inspection.

Inspection activity started on 24 July 2019 and ended on 25 July 2019. We visited the office location on 24 and 25 July 2019.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. This included checking incidents the provider must notify us about, such as serious injuries and allegations of abuse. We sought feedback from the local authority, Healthwatch and professionals who work with the service. 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 the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all this information to plan our inspection.

During the inspection

We spoke with 43 people who used the service and nine relatives about their family member’s care. We spoke with three care staff, a care coordinator, an assessor, registered manager, quality compliance manager and care services director.

We reviewed a range of records. This included all or parts of records relating to the care of eight people as well as a range of staff files. We also viewed training and supervision records and records relating to the safety and management of the service.

After the inspection

We asked the manager to provide us with a variety of policies and procedures and additional information. All information was sent within the required timeframe. We used all this information to help form our judgements detailed within this report.

Updated 28 August 2019

Direct Health (North Notts) is a domiciliary care agency providing personal care to 270 people across Nottinghamshire. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service:

People told us they felt safe with staff; however, people raised concerns about the punctuality of staff. Whilst records showed most calls were completed within 30 minutes of the expected time, people still felt staff punctuality was affecting their life and in some cases their safety.

Risks were assessed in key areas. However, whilst assessments for skin integrity were robust, staff did not keep consistent records to ensure this care was completed safely and as planned. Environmental risk assessments were in place, but these did not include reference as to how to make people safe in an emergency.

The provider had ensured that the local authority had been notified of allegations of potential abuse where needed and investigations were carried out thoroughly. The provider had not always ensured the CQC were notified of these incidents.

People’s medicines were managed safely, although some people were concerned that if calls were late they could miss their medicines. The risk of the spread of infection was safely managed. The provider had systems in place to help staff to learn from mistakes.

People received care in line with their assessed needs. Staff training and supervision were largely up to date. People received the support they needed to maintain a healthy diet, although guidance was not in place to support people with appropriate foods for a diabetic diet. People had access to other health and social care agencies where needed.

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 and relatives found the staff to be helpful, kind and caring. People liked the staff and described them as kind and caring. People were treated with dignity when personal care was provided. Independence was encouraged. People felt able to contribute to decisions about their care and staff respected their wishes. People’s records were stored securely to protect their privacy.

People’s care records contained person-centred information including people’s preferences for call times, male or female staff and the level of support they wanted with personal care. Where applicable, people were supported with their hobbies and interests and action was taken by the provider to reduce the risk of social isolation.

Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care plans were in place, although more detailed discussions were needed with people to ensure their rights and wishes were respected.

Some people raised concerns about the quality of communication with office-based staff. Not all statutory notifications had been sent to the CQC when required.

Quality assurance processes were in place; along with feedback from people and staff, these were used to help the service to improve and develop. When people had met the registered manager, they found them to be supportive and approachable. The registered manager had a good understanding of most regulatory requirements of their role

Rating at last inspection and update: The last rating for this service was Requires Improvement (published 19 July 2018). The service remains rated Requires Improvement. This service has been rated Requires Improvement for the last two consecutive inspections.

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of the regulations from the last inspection.

However, we have identified one new breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

More information about this is in the full report and can also be found at www.cqc.org.uk

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

Please see the action we have told the provider to take at the end of this 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.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.