Archived: Direct Health (Preston)

Updated 31 January 2017

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

This inspection took place on 17, 18 and 19 January 2017 and was announced. We gave the service 24 hours’ notice of the inspection because it is a domiciliary service and the manager is often out of the office supporting staff or providing care. We needed to be sure that they would be in.

The inspection team consisted of two adult social care inspectors, including the lead inspector for the service. We also had on the inspection team an expert by experience, who had experience of caring for someone who used similar services. We also had a pharmacist inspector who specialised in medicines.

Before the inspection, we had asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. Due to technical problems a PIR was not available and we took this into account when we inspected the service and made the judgements in this report.

Before the inspection we gained feedback from health and social care professionals who visited or worked together with the service. We also reviewed the information we held about the service and the provider. This included safeguarding alerts and statutory notifications sent to us by the registered manager about incidents and events that had occurred at the service. A notification is information about important events which the service is required to send us by law.

During the inspection, we used a number of different methods to help us understand the experiences of people who used the service. We reviewed records of care and management systems used by the service for care delivery. We visited three people in their own homes. We spoke with 12 people, six relatives by telephone, and the chief executive of the service, the interim manager, and the nominated individual for the service, the quality improvement manager, three care co-ordinators, two professionals who had visited the service, and five care staff.

We looked at samples of care records of six people of which four records were pathway tracked.

Pathway tracking is where we look in detail at how people’s needs are assessed and care planned whilst they use the service. We also looked at a variety of records relating to management of the service this included staff duty rosters, four recruitment files, the accident and incident records, policies and procedures, service certificates, minutes of staff meetings, reports from commissioners and the local authority, also quality assurance reports, surveys and action plans, visit duration records and medicine records.

Updated 31 January 2017

We carried out an announced inspection of Direct Health (Preston) on 17, 18 and 19 January 2017.

Direct Health (UK) is a limited company providing domiciliary care throughout the country. Direct Health (Preston) is a local branch situated on the outskirts of Preston City Centre. The agency provides personal care services to support people to live independently in the community.

At the time of our inspection there were 100 people using the service and 49 care workers appointed.

The service did not have a registered manager in post. The last manager left the service following enforcement action having been concluded. An interim manager was providing cover and in the process of applying to be registered to become the registered manager. 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.

At the last inspection on 02 June 2016 we found the provider was in breach of legal requirements of the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014, in respect of staffing, safe care and treatment, dignity and respect, safeguarding service users from abuse and improper treatment and good governance. They sent us an action plan telling us what they were going to do to meet the regulations.

At this inspection, we found significant improvements had been made in respect of all areas except medicine management. We found some improvements had been made in respect of managing people’s medicines safely however, we found some ongoing concerns which demonstrated that the provider needed to make further improvements in this area. You can see what action we told the registered provider to take at the back of the full version of the report.

We saw copies of satisfaction surveys that had been completed by the people. These demonstrated people were satisfied with their care and the staff who supported them.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Staff had received up to date training in safeguarding adults and they showed awareness of signs of abuse and what actions to take if they witnessed someone being ill-treated.

Safeguarding incidents had been investigated and documented, showing the support people were getting after incidents. Staff had sought advice from other health and social care professionals where necessary. There were risk assessments which had been undertaken. Plans to minimise or remove risks had been drawn and reviewed in line with the organisation’s policy. These were robust and covered specific risks around people’s care in a person centred manner.

We found people’s medicines had not been managed safely. This was because the service had not effectively managed the needs of people who required topical creams. We found records relating to medicine administration had not been adequately completed to show whether people had received their medicines. There were a considerable amount of medicine administration errors related to topical creams. However, staff had received regular training and competence checks in safe management of medicines. The medicines administration policy was not robust to provide clear guidance for the administration of topical creams however it was under review.

Lone working and environmental risk assessments were in place to ensure the safety of care staff and people they support. During the inspection we observed staff were visiting to people at the planned and agreed times and there was a significant improvement on ensuring care staff stayed the duration of the visits. Regular monitoring checks had been undertaken and action taken for those staff who had been found to be cutting visits short.

We looked at recruitment processes and found the service had recruitment policies and procedures in place to help ensure safety in the recruitment of staff. These had been followed to ensure staff were recruited safely for the protection and wellbeing of people who used the service.

Records we saw and conversations with staff showed the service had adequate care staff to ensure that people's needs were sufficiently met. The majority of the people and their relatives told us they were happy with the staff and their consistence.

We found care planning was done in line with Mental Capacity Act, 2005. Staff showed awareness of the Mental Capacity Act, 2005 and how to support people who lacked capacity to make particular decisions. They had received mental capacity training.

People using the service had access to healthcare professionals as required to meet their needs. Staff had received mandatory training. Care Certificate induction training was available. Staff competences were checked regularly in various areas of practice including moving and handling, medicine administration and food hygiene. Staff had received supervision through spot checks and supervision meetings at the office. They had also been provided with annual appraisals.

We found that people’s care needs were discussed with care commissioners before they started using the service to ensure the service was able to meet their assessed needs.

Care plans showed how people and their relatives were involved in discussion around their care. People were encouraged to share their opinions on the quality of care and service being provided. We saw surveys had been carried out to seek people’s views and opinions about the care they received.

People’s nutritional needs were met. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Management systems at the service were robust. Senior management had been involved in the day to day management of the service. A new manager had been recruited and oversight had been provided on delegated duties.

Quality assurance systems were in place and various areas of people’s care been audited regularly to identify areas that needed improvement. We found audits had been undertaken of care records, and medicine administration records, however; some audits for previous months did not have action plans to show how shortfalls had been rectified. However we were shown new action plans that had been implemented and were to be used in the future. We were assured that these would ensure that any issues identified in audits will be acted on.

There was a business contingency plan to demonstrate how the provider had planned for unplanned eventualities which may have an impact on the delivery of regulated activities.

Surveys we saw showed people felt they received a good service and spoke highly of their staff. Relatives told us the staff were kind, caring and respectful. Professionals we spoke to confirmed this.

We found the service had a policy on how people could raise complaints about their care and treatment.