Business Box

Updated 5 December 2023

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 Health and Social Care Act 2008.

Inspection team

The inspection team consisted of 1 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.

Service and service type

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

Notice of inspection

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

Inspection activity started on 13 November 2023 and ended on 16 November 2023. We visited the location's office on 13 and 16 November 2023.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with 5 relatives about the experience of the care provided. We spoke with the manager in person, and 3 members of staff by telephone.

We reviewed a range of records. This included 3 people's care records. We looked at 3 staff files in relation to recruitment. A variety of records relating to the management of the service, including quality monitoring, policies and procedures, and the staff training matrix.

Updated 5 December 2023

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

About the service

D R & C Private Home Care Limited is a domiciliary care service providing personal care. The service provides support for children 0 – 18 years, younger adults, people with a learning disability and autistic people, physical disabilities, people with mental health needs, older people and people living with dementia. At the time of our inspection there were 6 people using the service. 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 and what we found

Right Support: People were placed at potential risk of harm as staff training practices were not robust. Staff references from current or previous employers were not always sought. Staff shortages meant the manager and sometimes people’s relatives were providing support and care.

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. People’s individual care and support needs and any known risk had been assessed and planned for. Staff understood people’s individual care needs and associated risks. People where required were supported with their medicines. Accidents and incidents were reviewed.

Right Care: People’s relatives were positive about the care and support provided to their family member and were involved in discussions and decisions about the care and support. Relatives were positive about the quality of the care, which was provided by a small team of staff, who knew the person well. Staff were introduced to people, and worked alongside experienced staff or the person’s relatives so they could get to know people and gain their trust and confidence.

Right Culture: Systems and practices for oversight and governance of the service were insufficient to monitor the quality and safety of the service provided. The system of auditing had failed to identify improvements were need in the recruitment and training of staff. People’s views as to the quality of the service were sought, however the focus of feedback was limited to the person’s package of care, and did not provide opportunities to seek people’s views in order to shape and develop the service.

Relatives spoke positively of the service their relative received, and the person centred care provided. Relatives and staff spoke positively of the manager, and were aware of the challenges brought about due to insufficient staffing, and the action being taken by the manager to recruit 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 3 May 2018).

Why we inspected

We undertook this focused inspection as part of a random selection of services rated good and outstanding.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for D R & C Private Home Care Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to the oversight and monitoring of the service, staff shortages, and insufficient staff training.

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

We have made a recommendation that the provider reviews and updates the staff recruitment policy to meet the requirements set out in law so as to support safer recruitment practices and decisions.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.