We carried out a review of the data available to us about Direct Source Healthcare Ltd on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Direct Source Healthcare Ltd, you can give feedback on this service.
People’s experience of using this service and what we found
We found all required staff recruitment checks had not been completed on staff, before they delivered people's care. We made a recommendation to support good recruitment practice.
People were protected from harm and abuse through the knowledge of staff and management. Risks to people's safety were identified, assessed and appropriate action was taken to keep people safe. Staff followed infection control procedures to protect people. People's medicines were safely managed.
Quality assurance systems were in operation with the aim of improving the service in response to people's needs. The registered manager and senior staff were visible and approachable for people using the service, their representatives and staff.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 16 September 2020)
Why we inspected
We received concerns in relation to staff recruitment as a result, we undertook a focused inspection to review the key questions of safe and well-led only.
We have found evidence that the provider needs to make improvements. Please see the safe section of this full report.
We found no evidence during this inspection that people were at risk of harm from this concern. The provider agreed to make improvements to their staff recruitment procedures.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Direct Source Healthcare on our website at www.cqc.org.uk.
Recommendations
We made a recommendation about staff recruitment processes.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Direct Source Limited provides domiciliary care and support for people living in their own homes. At the time of our inspection there were 25 people who were receiving personal care. The service provided care for people with long term health conditions, older people, people with physical disabilities, people living with dementia and people needing end of life care and support. Care staff provide a service to people who need assistance with aspects of their care including mobility needs, personal hygiene and eating and drinking.
People's experience of using this service and what we found
Since our last inspection, improvements had been made to the managerial oversight and governance of the service. The provider had ensured sufficient checks and systems were in place to enable them to assure themselves that the service was meeting the relevant regulations. The provider now had systems in place which helped them continuously improve, including responding to incidents and accidents.
The service provided sufficient numbers of staff to meet people's needs. People’s relatives told us there was a good level of staff consistency which benefited their loved ones.
People told us they felt safe. Staff had received training to ensure they could recognise the signs of abuse and report them confidently. Risks associated with people's care were managed. Records showed people had risk assessments in place and that these were reviewed regularly. People told us staff supported them safely.
People and their relatives told us they were supported to take their medicines safely. Staff received training to enable them to administer medicines and processes were in place to ensure staff were competent. Accidents and incidents were recorded and reported. Systems were in place to ensure lessons were learnt when things had gone wrong.
Care plans reflected people's individual needs, and ensured staff were provided with care in support in a person-centred way. Records confirmed that people were given the opportunity to express their views regularly and were involved in their care. People were supported with their food and drink where this was part of their agreed care package.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 17 March 2020). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection effective action had been taken to meet the relevant regulation.
Why we inspected
We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met the legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.
Enforcement
We imposed conditions on the provider's registration following our previous comprehensive inspection on 17 April 2018. This required the provider to send us a monthly update of progress made to improve the service. We will discuss with the provider if they wish to apply to remove these conditions.
Follow up
We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Direct Source Limited provides domiciliary care and support for people living in their own homes. At the time of our inspection there were 15 people who were receiving personal care. The service provided care for people with long term health care conditions, older people, people with physical disabilities and people living with dementia. Care staff provide a service to people who need assistance with aspects of their care including mobility needs, personal hygiene and eating and drinking.
People's experience of using this service and what we found
Since our last inspection, improvements had not been made to the managerial oversight and governance of the service. Whilst people and their relatives continued to be satisfied with the staff and care calls undertaken to them, the provider did not have sufficient systems in place to ensure there was effective governance of the service. Some systems of checks and audits took place, but these had failed to identify the shortfalls we found.
The provider had systems in place for the recruitment of staff. We found required checks were completed before staff undertook care calls to people. However, in some cases, checklists to ensure recruitment processes had been followed were either not in place or had not been completed correctly. The oversight of staff recruitment was therefore inconsistent. This meant the service could not be sure the staff recruited were safe to work with people.
The service provided sufficient numbers of staff to meet people's needs. People told us the service they received was generally reliable. We saw feedback from people that stated staff were sometimes late and asked that they be always contacted and kept up to date if staff were not going to attend at the agreed time of the call. The registered managers were aware of this issue and working to make improvements in this area.
People told us they felt safe. Staff had received training to ensure they could recognise the signs of abuse and report them confidently. Risks associated with people's care were managed. Records showed people had risk assessments in place and that these were reviewed regularly. People told us staff supported them safely.
People and their relatives told us they were supported to take their medicines safely. Staff received training to enable them to administer medicines and processes were in place to ensure staff were competent. Accidents and incidents were recorded and reported. Systems to review accidents and incidents were in place to ensure lessons were learnt when things had gone wrong.
Records showed people's needs were assessed prior to using the service. Staff told us they received the training they needed to do their job well. Records confirmed staff were provided with induction and ongoing training. The service worked with people and their relatives to ensure people had access to healthcare services.
People and relatives told us staff were caring and kind. Staff told us they were happy in their roles and enjoyed working with people. 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.
Care plans reflected people's individual needs, and ensured staff were provided with care in support in a person-centred way. Records confirmed that people were given the opportunity to express their views regularly and were involved in their care. People were supported with their food and drink where this was part of their agreed care package.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was requires improvement (published 7 February 2019). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, not enough improvement had not been made or sustained and the provider was still in breach of the relevant regulation.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We have identified a breach in relation to the effectiveness of the provider's governance systems. We imposed conditions on the provider's registration following our previous comprehensive inspection on 17 April 2018. This required the provider to send us a monthly update of progress made to improve the service. We will continue to monitor the service through the provider's monthly reports.
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 alongside the provider and 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.
We last inspected the service in April 2018 and found that the provider was not meeting the requirements of the regulations. We therefore rated the service as ‘Inadequate’ at the previous inspection. We found the provider had not always ensured staff were competent, suitably qualified and skilled to complete their work. There were inadequate and non-existent systems with ineffective leadership to ensure compliance with the legal requirements. All staff employed did not have appropriate security checks in place. Care and treatment was not provided in a safe way and people were not always protected from potential abuse or harm. The provider had not ensured that the care and support people received met their needs and reflected their preferences. People’s complaints were not investigated fully.
Following our inspection in April 2018, the service entered Special Measures.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. We imposed a number of conditions on the registration of the location following our April 2018 inspection to ensure the provider made the required improvements. These included seeking agreement from CQC for any new packages of care and providing us with regular service improvement updates. Following the inspection, we met with the provider discuss the actions they were planning to take to meet the regulations.
During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
At our inspection on 4 and 20 December 2018, there was a registered manager in post. The registered manager was also the provider. They had appointed a manager, who they were supporting through the registration process with CQC. 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.
Following our previous inspection the provider had implemented systems to monitor and improve the quality of service people received. Some of these systems had been used to drive improvements around the management of people’s prescribed medicines. However, some systems had only recently been implemented and therefore more time was needed before we could ascertain the impact they had on driving the quality of the service. Additionally, some systems required additional work to ensure they were effective.
People and their relatives spoke extremely positively about the care they received and how staff cared for them. They felt their views and concerns were responded to. The provider ensured people’s complaints, concerns and views were recorded and acted upon. People felt safe when being assisted by staff and felt staff had the skills and support to meet their needs.
Staff were positive about working for the provider. Staff were being supported to attend and complete training and had access to the support they required. Following our previous inspection the provider had taken action to ensure all staff went through comprehensive checks before they worked with people and that they received training and professional development. Further work, time and consistency was still required in relation to staff training and support.
People’s care and risk assessments had been reviewed, however further work was required to ensure that all plans were reflective of the individual person’s needs and preferences. Care staff understood people’s needs.
People received their care visits as they expected. Care staff arrived when expected and ensured people had their needs met.
We found one repeated breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulation 2009. You can see what actions we told the provider to take at the back of the full version of this report.
Not everyone using Direct Source receives a 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 time of this inspection Direct Source were supporting 28 people. The majority of these people were living in the county of Gloucestershire.
We carried out a comprehensive inspection of this service on 27 April 2018. We carried out this inspection due to concerns raised by the local authority safeguarding team, contracts team and the police. This was Direct Sources’ first inspection since they were registered with the Care Quality Commission (CQC). The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.
There was a registered manager in place. 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.
A potential safeguarding event had been inappropriately managed by the registered manager. Their actions could have put other people who used the service at risk of experiencing harm. The registered manager had not consulted with the appropriate agencies and followed their advice. They had not checked or taken action to ensure that people were safe who received support from Direct Source. Staff also had a limited knowledge about the actions they could take to respond to safeguarding concerns about people potentially experiencing abuse and harm.
Required checks for new staff were not always completed. Staff did not have full employment histories with any gaps in their employment histories identified and explained. Sources of references were not clarified and other security checks were not in place, when staff started working at the service. Concerns raised did not alert the registered manager to review Direct Sources’ recruitment practices.
People did not have full and detailed risk assessments with a detailed accompanying care plan for staff to follow. The service was not identifying all the risks which people faced with a good plan in place to enable staff to respond and manage these risks.
People were not being supported to receive their medicines in a safe way. The registered manager was not checking or responding to concerns when they came to light regarding the administration of people’s medicines.
Staff did not receive a full and practical induction to their job. Training was very limited and often not provided. Staff did not have training in important areas of their work. The registered manager did not have systems to monitor what training staff had received. Staff competency was not being monitored or tested in any robust way. The registered manager did not have firm assurances that staff were competent and able to do their jobs.
The people who were being supported by Direct Source did not have person centred care assessments. People’s assessments did not explore how people wanted to receive their care and live their lives. People did not have meaningful end of life plans in place when they had reached this part of their lives.
The service was not matching people to the staff who would be visiting them, in order to help people to have a more meaningful care experience. Some people had missed and late care visits and the registered manager did not have sufficient systems in place to manage and prevent this from happening again.
The registered manager and provider were not completing regular quality monitoring checks to review the quality of the service and make plans to make improvements. The leadership of the service had not responded in an open and transparent way to concerns raised about people’s safety. The leadership had not considered or were open to the mistakes that had been made and made plans to rectify these mistakes and short comings.
The registered manager was not reporting all the events which they must do by law to us at the Care Quality Commission.
There was a complaints process in place. However, complaints were not processed in a robust evidenced based way.
These issues constituted breaches in the legal requirements of the law. You can see what action we asked the provider to take at the back of the full version of the report.
As a result of the late and missed care visits and the lack of an investigation into these it was unclear if the service had enough staff to meet people’s needs. Given the lack of governance and systems and poor leadership issues, we concluded that these missed and late calls were the result of how staff were organised and monitored.
People told us that staff sought their consent to provide support. However, the service was not routinely gaining people’s permission to share information about them with other agencies such as the local authority.
The service was not seeking the involvement of people, staff, and professional organisations into the development of the support they provided.
People spoke positively about the staff who supported them. They said they felt safe around staff. People also told us that they were treated in a kind way, and their dignity and privacy was promoted by staff. Although, people felt at times they were not always listened to by staff due to staff communication difficulties. This was a language divide which the registered manager had not identified as an issue and had not taken steps to address.
The people we spoke with confirmed staff supported them appropriately with their food and drinks. People felt confident that staff would respond to a change in their health needs.