Direct Care (Kent)

Direct Care (Kent) is a domiciliary agency providing care and support to people in their own homes. Not everyone who used the service received personal care. The Care Quality Commission (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. At the time of the inspection they were providing personal care to 19 people.

People’s experience of using this service and what we found

People told us, “As far as I’m concerned there is nothing they could do better. They are all marvellous. They encourage me and can pick up if you’re not feeling so grand.”

People were supported by a core staff team that enabled them to form good professional relationships. People we spoke to, and evidence reviewed, supported people had care from regular staff.

Risks to health and safety of people were appropriately assessed. Plans and guidance were in place for staff to mitigate these. Peoples medicines were managed in safe ways and there were clear policies in place to ensure this continued.

The registered managers had completed comprehensive background checks of staff before they started work with a fully supported induction process to ensure staff were confident to support people. Staff received appropriate training and received regular supervisions and appraisals. The registered managers completed unannounced supervisions to ensure care staff were working to their standards.

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 care plans were detailed and person centred. Care plans were regularly reviewed throughout the year and were reviewed if changes in peoples needs were identified.

There was a clear management structure in place at the service and people and staff we spoke with were able to tell us the processes for raising concerns or complaints. Feedback about the registered managers was that they were approachable, fair and reactive to things raised to them.

Rating at last inspection and update

The last rating for this service was requires improvement (published 31 December 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14-15 November 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve Regulation 12 (Safe Care and Treatment), Regulation 17 (Good Governance) and Regulation 18 (Staffing).

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Direct Care (Kent) on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Direct Care (Kent) is a domiciliary care agency. It provides personal care to people living in their own houses and flats. At the time of the inspection 21 people were receiving personal care.

People’s experience of using this service:

People were not supported by effectively deployed staff and their visits were not monitored. The provider failed to ensure care was provided in a safe way, by assessing and mitigating risks to the health and safety of people. The systems and processes to assess, monitor and improve the quality and safety of the service were not wholly effective.

People and their relatives gave us positive feedback about their safety and told us that staff treated them well. Staff administered prescribed medicines to people safely and were protected from the risk of infection. The provider carried out comprehensive background checks of staff before they started work. The provider had a system to manage accidents and incidents.

Staff received support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach the registered manager at any time for support. The registered manager worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their 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.

The assessment of people’s needs had been completed to ensure these could be met by staff. The registered manager worked with other external professionals to ensure people were supported to maintain good health. People were involved in making decisions about their care and support. People were treated with dignity, and their privacy was respected, and supported to be as independent in their care as possible.

People’s care plans reflected their current needs. Staff showed an understanding of equality and diversity. Staff respected people’s choices and preferences. People knew how to make a complaint. The registered manager knew if someone required end-of life care.

Notwithstanding the above, we found there were arrangements in place to assess and monitor the quality of care being provided. There was a management structure at the service. Staff were aware of the roles of the management team. They told us the registered manager was approachable. People and their relatives commented positively about staff and the registered manager. The registered manager had worked in partnership with a range of professionals and acted on their advice.

Rating at last inspection and update

The last rating for this service was good (published 26 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to risk assessment and their management, staff deployment and visit monitoring and effective quality assurance systems at this inspection.

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

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Direct care (Kent) provides care services to people in their own home in Kent and Medway. The care provided was tailored to people’s needs so that people could maintain their health and wellbeing or maintain their independence.

Care was delivered to older people some of whom were living with dementia and younger adults. There were 26 people using the service at the time of our inspection. The care and support people needed ranged from short calls to more intensive support packages requiring two staff.

At the last Care Quality Commission (CQC) inspection in July 2014, the service was rated as Good in all of the domains and had an overall Good rating.

The two providers of the service were also the registered managers. 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.

At this inspection we found the registered managers had consistently monitored the quality of their service to maintain a rating of Good.

People continued to experience care that was caring and compassionate. Staff were trusted and well thought of by the people using the service.

People continued to have their needs assessed and their care was planned to maintain their safety, health and wellbeing.

Risks were assessed and recorded by staff to protect people. There were systems in place to monitor incidents and accidents.

Staff had received training about protecting people from abuse and showed a good understanding of what their responsibilities were in preventing abuse.

The provider had updated their policies since we last inspected in line with published guidance and practice in social care.

Procedures for reporting any concerns were in place. The registered managers knew how and when they should escalate concerns following the local authorities safeguarding protocols.

Staff training covered both core training like first aid and more specialised training like catheter care. They also understood the Mental Capacity Act 2005 and how to support people’s best interest if they lacked capacity.

Staff continued to have good levels of support and supervision to enable them to carry out their roles.

Staff continued to be recruited safely and had been through a selection process that ensured they were fit to work with people who needed safeguarding.

Staff had been trained to administer medicines safely and staff spoke confidently about their skills and abilities to do this well.

People were pleased that staff encouraged them to keep healthy through eating a balanced diet and drinking enough fluids. Care plans were kept reviewed and updated.

There were policies in place that ensured people would be listened to and treated fairly if they complained.

The management team and staff were committed to the values of the organisation and ensured they took these into account when delivering care and support.

People were happy with the leadership and approachability of the service’s registered managers.

People we spoke with told us they were happy with the care they received. People made comments such as "They're very good", "They always come on time and never let me down" and "They are very good at what they do".

We looked at staff training records and saw that all staff had received training in subjects including health and safety, medication and infection control. We also saw that staff received regular supervision with a more senior member of staff and annual appraisals.

We saw that people and their relatives were sent questionnaires to check the quality of the service they received. People we spoke with told us that they were asked for their opinion on the service.

We looked at the complaints policy and procedure for the service. People we spoke with told us that they were given a copy when they started using the service and knew how to contact the service if they needed to make a complaint.

We looked at care records and staff files and saw that all were kept accurate and updated regularly.

People we spoke with told us that they were very pleased with the service they received. Relatives of people who used the service told us that they were able to be involved in planning their relatives' care and were kept informed if there were any changes to their health. They told us their views were taken into consideration and one person said 'They are very approachable, and they take me seriously'.

Staff said they liked working at the service and were given the training they needed to perform their roles safely. One member of staff said 'This is the first job I've had that I've really enjoyed and felt supported'.