Archived: Direct Health (Nottingham)

Updated 10 September 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. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

The inspection team consisted of one inspector, one assistant inspector and two Experts-by-Experience. An Expert-by-Experience is a person who has had personal experience of using or caring for someone who uses this type of care service.

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

We gave the service 48 hours’ notice of the inspection. Inspection activity started on 29 July 2019 and ended on 30 July 2019, this is when we contacted people who used the service for their experience and spoke with some staff. We visited the office location on 14 and 15 August 2019 and met with the management team and spoke with staff.

What we did before the inspection

We reviewed any notifications we had received from the service (events which happened in the service that the provider is required to tell us about). We reviewed the last inspection report. We also sought information from external agencies such as the local authority. We invited external professionals to share their experience of the service and received feedback from one social care professional. We also asked Healthwatch Nottingham for any information they had about 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.

During the inspection

We spoke with 20 people who used the service and four relatives about their experience of the care provided. We spoke with the registered manager, care service director, a care coordinator, an assessor, a medication compliance coordinator and 11 care workers. We reviewed a range of records. This included twelve people’s care records. We looked at ten staff files in relation to recruitment and staff supervision. We reviewed a variety of records relating to the management of the service, including staff training, audits and checks.

Updated 10 September 2019

About the service

Direct Health (Nottingham) is a domiciliary care agency. It provides personal care to people living in their own homes within and around Nottingham. It provides a service to older and younger adults living with a range of health conditions and needs, to live independently in the community. Not everyone using Direct Health (Nottingham) receives regulated activity; 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 time of our inspection, 120 people were receiving personal care as part of their care package.

People’s experience of using this service and what we found

Improvements had been made in how care was provided. This included people receiving advanced notice of the staff who would be supporting them. Improvements were ongoing in people being provided with a regular core group of staff. Some people had experienced late or missed calls, However, this had reduced and action was being taken to make further improvements.

Improvements had been made to how risks were assessed, monitored and managed. Staff had detailed guidance of how to mitigate risks. Improvements had also been made in how people were supported with their prescribed medicines.

Staff had received training in safeguarding adults. Allegations or suspicion of abuse were reported and acted upon, where action was required to protect people this was completed. Incidents were reviewed to consider if action was required to reduce further risks.

Staff recruitment was ongoing and at the time of the inspection, sufficient staff were deployed to meet people's care needs. Robust checks were completed on staff’s suitability to provide care before they commenced their employment.

People were protected from the risk of cross contamination because best practice guidance in infection control practice was followed.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff received an induction and ongoing training and support. This included opportunities to discuss their work and development needs. Staff had spot checks completed to review their practice to ensure standards were maintained.

People were supported with their health care needs. Staff monitored people's health and care needs and shared information with healthcare professionals when required. Where people required assistance with nutrition and hydration needs, staff had detailed guidance of the support people required.

People were complimentary about staff and considered them to be kind and caring. End of life care considered people’s wishes and preferences, however, additional detailed guidance for staff was required. People received care and support that respected their privacy and dignity. People’s communication and sensory needs were assessed, but inconsistently recorded in the guidance for staff.

The providers' complaints procedure had been shared with people and when concerns and complaints had been received, these had been responded to. People had opportunities to share their experience about the service.

The provider had systems and processes to monitor the service and senior managers had oversight and staff were accountable. The provider had an ongoing action plan and the management team showed a commitment to continually improve the service.

Rating at last inspection

The last rating for this service was Requires Improvement (published 27 July 2018). The service has improved to an overall rating of Good. Responsive remains Requires Improvement, further action was required to ensure people received a service that was consistently responsive.

Why we inspected

This was a planned inspection based on the previous rating.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.