Archived: De Vere Care

Not everyone using De Vere Care receives regulated activity; the 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 our inspection, 62 people were using the service, who received personal care. The provider employed 70 care staff, who visited people living in the local community.

We last inspected this service on 7 December 2017 and we rated the service as Requires Improvement. This was because we found concerns in all five key questions that we ask; is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led? There were four breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to providing safe care and treatment, providing staff with training and support and receiving consent to care from people. Following the last inspection, we asked the provider to complete an action plan to show how they would make improvements. We also sent the provider a Warning Notice for the breach of regulation 17, good governance because the provider was failing to maintain the quality of the service and there was a lack of robust management. We asked for them to be compliant with legal requirements by April 2018.

At this announced inspection, we checked that they had followed their plan and to confirm that they now met legal requirements. During this inspection, the service demonstrated to us that improvements have been made and we have now rated the service Good.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered care homes, 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 last inspection, the provider had made internal structural changes to help make the necessary improvements and carried out a review of processes. They had assessed and monitored the quality of the service to ensure people received safe care.

We saw that improvements had been made in ensuring people received care that was safe and that care was provided to people at the correct times. Care staff had enough time to travel in between care visits to people and the number of missed visits had reduced. Risks to people were assessed and monitored so that these risks were mitigated against.

The provider had sufficient numbers of staff available to provide care and support to people. Staff were recruited appropriately and the necessary pre-employment background checks were undertaken to ensure they were suitable for the role and were safe to provide care to people. Staff received support from the management team with regular supervision meetings to discuss any concerns or issues. They were sufficiently trained and we saw that their training was now up to date. This meant the care and support they provided to people was effective.

When required, staff administered people’s medicines and recorded medicines that they administered on people's Medicine Administration Records (MAR). They had received training on how to do this. Staff had received training in infection control and followed procedures when providing personal care.

The provider was now compliant with the principles of the Mental Capacity Act 2005 (MCA). Assessments were carried out for people who did not have capacity to make decisions, using MCA principles.

Staff told us that they received support and encouragement from the new management team and told us they had made improvements to the service. Staff were able to raise any concerns and were confident that they would be addressed by the management team.

The management team carried out regular spot checks on staff providing care in people’s homes to ensure they followed the correct procedures and people always received safe care. Senior managers took action where necessary to improve staff performance.

The registered manager reviewed serious incidents to reduce reoccurrence of similar incidents in future.

People's care and support needs were assessed and reviewed regularly.

People were registered with health care professionals, such as GPs and staff contacted them in emergencies or if there were concerns about people's health.

Staff provided people with meals and drinks when they requested to maintain their health and nutrition.

People were treated with respect by staff and their privacy and dignity were maintained. They were listened to by staff and were involved in making decisions about their care and support.

Care plans were person centred. They provided staff with suitable and relevant information about each person’s individual preferences in order to obtain positive outcomes for each person. People's care and support needs were assessed and reviewed regularly.

A complaints procedure was in place. People and their relatives knew how to complain and give feedback about their care. Formal complaints about the service were responded to appropriately and within the provider’s timescales as set out in their complaints procedures.

The registered manager completed audits and inspections of the service to maintain quality standards and to ensure people were safe at all times.

Feedback was received from people and relatives to check they were satisfied with the service and to help make improvements.

De Vere Care is based in Redbridge, Essex. This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults.

Not everyone using De Vere Care receives regulated activity; the 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 our inspection, 80 people were using the service, who received personal care. The provider employed 75 care staff, who visited people living in the London Borough of Redbridge and other local boroughs.

The service did not have a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered care homes, 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. The previous registered manager had cancelled their registration prior to our inspection. The current service manager was in the process of applying to register as manager.

Prior to our inspection, we received some concerns about the management of the service from the local authority because the provider had recently cancelled people’s care packages and the local authority had to find alternative care providers for those packages. This was because there were internal issues within the service which meant the provider was unable to fulfil their role fully.

Staff told us that they received support and encouragement from the manager. Most staff were happy with the overall management of the service but some staff were not happy and had decided to leave.

During this inspection, we found that people did not always receive safe care because visits from care staff were missed and some people went without a service for a number of days.

People had their individual risks assessed and staff were aware of how to manage these risks. However, specific risk factors were not always fully stated in risk assessments to help staff identify and mitigate the risks to ensure the safety of the person and the staff.

Staff had not received recent supervision and training to ensure the service they provided to people was effective.

The provider was not always compliant with the principles of the Mental Capacity Act 2005 (MCA) because people who did not have capacity to make decisions for themselves had not provided their consent to care through a best interest decision process.

This meant that the provider did not always assess, monitor and mitigate risks associated with the service to ensure people received safe care and keep accurate records of decisions taken.

People were not always treated with respect because care visits to them were not completed without explanation. We have made a recommendation for the provider to ensure staff are mindful of their responsibilities to people who used the service.

The provider had made improvements to make sure people were kept updated about changes to their regular care staff. However, some people told us the provider did not always communicate any changes to them.

Formal complaints about the service were not always responded to appropriately and within the provider’s timescales as set out in their complaints procedures. We have made a recommendation about this.

The provider had sufficient numbers of staff available to provide care and support to people. Staff had been recruited following pre-employment checks such as criminal background checks, to ensure staff were safe and of good character.

Once recruited, new staff received an induction, relevant training and were able to shadow experienced staff in order for them to carry out their roles effectively.

When required, staff administered people’s medicines and recorded medicines that they administered on people's Medicine Administration Records (MAR). They had received training on how to do this.

People's care and support needs were assessed and reviewed regularly.

The provider worked with health professionals if there were concerns about people's health. People were registered with health care professionals, such as GPs and staff contacted them in emergencies.

People were supported to have their nutritional and hydration requirements met by staff, who provided them with meals and drinks of their choice, when they requested.

People were listened to by staff and were involved in their care and support planning. They were treated with dignity when personal care was provided to them.

Care plans were person centred. They provided staff with sufficient information about each person’s individual preferences and how staff should meet these in order to obtain positive outcomes for each person.

People were able to access information they were able to understand to help keep them informed and safe.

The provider was in the process of introducing new technologies to help manage the service.

The management team carried out regular monitoring checks on staff providing care in people’s homes. This ensured they followed the correct procedures and people received safe care.

Feedback was received from people and relatives to check they were satisfied with the service. The management team ensured lessons were learned following serious incidents.

There was a culture of working together with staff to help improve the service.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any presentations and appeals have been concluded.