Das Care Limited

Updated 22 July 2022

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 was carried out by one 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 houses and flats.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

We gave the service a short period of 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 20 June 2022 and ended on 29 June 2022. We visited the location’s office on 20 June 2022.

What we did before inspection

We reviewed information we had received about the service since the last inspection. 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 four people who used the service and five relatives about their experience of the care provided. We spoke with two care staff by telephone, and the registered manager and nominated individual in person when we visited the office. The nominated individual is responsible for supervising the management of the service on behalf of the provider. We received feedback from a local authority professional who works with the service. We reviewed a range of records relating to the management of the service, including care plans and risk assessments, staff recruitment and training records, evidence of monitoring staff practice and quality.

Updated 22 July 2022

About the service

DAS Care Limited is a domiciliary care service that provides personal care and support to people living in their own homes. The service was supporting 11 people with personal care at the time of our inspection.

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 this inspection, everyone who used the service received personal care.

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

People were at risk of harm because care plans lacked sufficient detail to care for people safely and assessments did not identify risk and action required to minimise this. For example, where one person required support to keep their limbs mobile to reduce pain and stiffness, there was no guidance in place as to how to do this safely. The lack of detailed care documentation also had an impact on people receiving care that met their individual needs, preferences and characteristics.

Staff understood how to support people to take their medicines safely and how to reduce the risks associated with the spread of infection. They understood how to identify and report incidents of potential avoidable harm. Where people were supported with food and drink, they said this was done well. Staff worked well with other health and social care professionals to make sure people received the care they needed.

The provider had safe recruitment processes in place and there were enough staff to care for people. Staff had received training in relation to their role. People confirmed staff were usually on time and stayed for the expected amount of time for their care calls. They told us they did not feel rushed and that staff and the registered manager were kind and listened to their views. Staff and the registered manager spoke with respect and compassion for the people they supported.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff had completed training in the Mental Capacity Act. However, the registered manager did not have good understanding of their responsibilities in relation to this legislation. Where people might have lacked capacity to make specific decisions about their care, assessments of their capacity had not been completed. Where decisions were made in their best interests, a record of the process used and who was involved was not made.

Although the provider had developed some quality monitoring systems, these were not effective at identifying issues and did not cover all aspects of the service. Significant shortfalls in care documentation had not been sufficiently addressed. This put people at risk of harm because guidance on how to meet their needs and maintain their safety was insufficient. Quality monitoring systems had not identified this.

The registered manager’s skills and understanding of key aspects of managing a care service and providing safe high-quality care required development. The registered manager acknowledged this and was taking steps to enrol on training to develop their skills. People, their relatives and staff were complimentary about the registered manager and said they were supportive, fair and approachable.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service at the previous premises was inadequate (published 20 January 2022) and there were multiple breaches of regulations. Following the inspection we imposed conditions on the provider’s registration to restrict new and increased care packages, and to require a regular report on improvements made. 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 in some areas but not in others and the provider remained in breach of regulations . The conditions imposed on the provider’s registration will remain in place following this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate 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, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to care planning and risk assessment, the Mental Capacity Act and the quality assurance and management of the service at this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.