Business Box

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.

Linda Deazle t/a D R & C Private Home Care is a domiciliary service providing personal care to people living in their own homes. The service caters for older people and younger adults with needs relating to dementia, learning disabilities, mental health, and physical disabilities. At the time of our inspection they were seven people using the service.

The service has a registered manager. This 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.

People told us they felt safe using the service because staff assisted them with their personal care in a safe way and relatives said staff looked after their family members safely and well. Staff knew how to minimise risk to people, for example, by reassuring them if they became distressed and checking on their physical well-being.

There were enough staff employed to meet people’s needs. If people needed assistance to take their medicines staff provided this. The staff had a caring and compassionate approach to the people they supported. People said they usually had regular staff which helped them build relationships of trust with them.

People said the staff were well-trained and staff said they were satisfied with the training they’d received. Staff were trained in the Mental Capacity Act (2005) during their induction and sought people’s consent before providing them with care and support.

If people needed support with eating and drinking staff prepared food for them and/or prompted them to have their meals. Staff supported people with their healthcare needs and if they had concerns about a person’s health they alerted relatives and healthcare professionals as necessary.

People told us their calls were mostly on time and if staff were delayed for any reason they were informed of this. People had personalised care plans which set out how they wanted their care and support provided. Staff knew people’s aims, for example, to stay in their own homes, and supported people to achieve these.

People told us they thought the service was well-managed and they could contact the office staff when they needed to. The registered manager knew all the people using the service and was knowledgeable about their needs. Staff told us they were well-supported by the registered manager. The service had a caring culture and people were valued and given emotional support where necessary.

People had the opportunity to comment on the service through questionnaires. They told us if they had any concerns they would speak to the registered manager and were confident she would address these positively. The registered manager carried out monthly audits of people’s care packages to help ensure they received a good standard of care and support.

Linda Deazle Agency provides personal care for people living in their own homes. On the day of the inspection the registered manager informed us that there were seven people receiving personal care from the service.

A registered manager was 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 and associated Regulations about how the service is run. The provider is the registered manager.

People and relatives we spoke with said they thought the agency ensured that people received safe personal care. Staff had been trained in safeguarding (protecting people from abuse) and staff understood their responsibilities in this area.

Risk assessments were not fully in place to protect people from risks to their health and welfare. Staff recruitment checks were not comprehensively in place to protect people from receiving personal care from unsuitable staff. People told us they had received personal care at agreed times to promote their health and welfare.

We saw that medicines were, in the main, supplied safely and on time, to protect people’s health needs though more information was needed to evidence this had always been carried out.

Staff had training to ensure they had the skills and knowledge to be able to meet people's needs.

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 choice about how they lived their lives but did not have an awareness of their responsibility to assess people's mental capacity.

Staff had awareness of people's health care needs and were in a position to refer to health care professionals if needed though this had not always been carried out.

People and their relatives we spoke with told us that staff were friendly, kind, positive and caring.

People, or their relatives, were involved in making decisions about how they wanted their personal care to be provided.

Care plans were individual to the people using the service to ensure that people's individual needs could be met.

People or their relatives told us they would tell staff or management if they had any concerns and were confident any issues would be properly followed up.

People and their relatives were satisfied with how the service was run by the management. Staff felt they were fully supported in their work by management staff.

Management carried out audits and checks to try to ensure the service was meeting people's needs, though this system needed strengthening to identify issues to improve the quality of service to people.