Archived: Direct Health (Leicester)

Updated 12 December 2018

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 and to look at the overall quality of the service and provide a rating for the service under the Care Act 2014.

Direct Health (Leicester) provides personal care for people living in their own homes. This inspection took place on 10 and 11 July 2018. The provider was given 48 hours’ notice because the location provides a personal care service and we needed to be sure that someone would be in. 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 care service.

We looked at the information we held about the service, which included ‘notifications’. Notifications are changes, events or incidents that the provider must tell us about.

The provider completed a Provider Information Return. This is information we require providers to send us a least once annually to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed the provider’s statement of purpose. A statement of purpose is a document which includes the services aims and objectives.

We contacted commissioners for health and social care, responsible for funding some of the people who used the service and asked them for their views about the agency. No information of concern was held about the current provision of personal care to people using the service.

During the inspection we spoke with seven people who use the service, five relatives, the care services director, the quality compliance manager, the registered manager, and three care staff members employed by the service.

We looked in detail at the care and support provided to four people who used the service, including their care records, audits on the running of the service, staff training, three staff recruitment records and policies of the service.

Updated 12 December 2018

The inspection took place on 10 and 11 July 2018.

Direct Health Leicester is a ‘domiciliary care service.’ People receive personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates the care provided, and this was looked at during this inspection. The service provides personal care for older people and younger adults. This was the first inspection of the service. It was a comprehensive inspection. The quality compliance manager stated that 67 people were receiving a personal care service at the time of the inspection.

The inspection was announced because we wanted to make sure that the registered manager was available to conduct the inspection. The registered manager was returning to work after special leave so the inspection was mainly carried out with the care services director and the quality compliance manager.

A registered manager was in post. This is a condition of the registration of the service. 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 and associated Regulations about how the service is run.

We identified concerns about a number of issues. Three requirement notices have been issued due to breaches of regulations in relation to the service not meeting requirements of safe care and treatment, person centred care and good governance.

Staffing was not always in place to always provide people with a safe personal care they needed. Risk assessments were not always comprehensively in place to protect people from risks to their health and welfare.

Policies set out that when a safeguarding incident occurred management needed to take appropriate action by referring to the relevant safeguarding agency. However, some incidents had not been reported to us at the time the service had been aware of them, as legally required.

Staff understood their responsibilities under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) to allow, as much as possible, people to have effective choices about how they lived their lives. Staff had asked people’s consent when they provided personal care. A capacity assessment was in place to assess whether any restrictions on choice were needed in the person’s best interests.

Staff had largely received training to ensure they had skills and knowledge to meet people's needs, though training on some other relevant issues had not yet been provided.

People and relatives told us that most staff were friendly, kind, positive and caring, though some staff rushed people when providing personal care. Some said they had not been involved in making decisions about how and what personal care was needed to meet any identified needs.

Care plans did not always contain detailed information individual to the people using the service, to ensure that their needs were met. Care plans were not always available to people and staff, which meant a risk that people’s individual care needs would not be met.

People and relatives were not always confident that concerns had been followed up. They were not always satisfied with how the service was run.

Some staff members said they had not been fully supported in their work by management.

Management had not carried out comprehensive audits in order to check that the service was meeting people's needs and to ensure people were provided with a quality service.

Staff recruitment checks were in place to protect people from receiving personal care from unsuitable staff.

Most people and their relatives told us that they thought staff provided safe personal care when they were with them. If personal care is not delivered at assessed critical times, then people’s safety cannot be guaranteed.

Staff had been trained in safeguarding (protecting people from abuse) and understood their responsibilities in this area.

People and relatives told us that medicines had been supplied so that people could take their medicine safely.