Das Care Limited

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Reviews of care were not always taking place. The provider’s policies were not always complete or being followed. Pre-assessment checks were completed prior to a person’s package of care starting to ensure the service could deliver the care required and confirm what care and support was required. The provider observed staff to ensure the care provided was in line with good practice standards. An external healthcare professional provided positive feedback about joint working.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Whilst people and relatives did not raise any concerns about the initial assessment of their care needs, we found people did not always receive regular reviews of their care and treatment. People had their needs assessed and risks identified prior to them receiving support, this information had been incorporated into their care plan. A person said, “They assessed the house and asked lots of questions.”

The provider completed an assessment of people’s care and treatment. The provider said, “We always do a ‘needs assessment’ for people, we will ask about their communication needs, likes and dislikes and other information to support matching people with appropriate care staff. We will review people’s ‘needs assessment’ every 6 months, or sooner if this is required.” The provider advised families are invited to participate in care plan reviews to ensure their input is included. However, we did not receive any documentary evidence of this.

People’s needs and risk were identified prior to them commencing with the agency. However, the provider was unable to submit any evidence of care reviews taking place in line with their person-centred care and care planning policy. This meant systems to review if people were receiving the right care were not always effective.

People, relatives, and friends had no concerns with staff’s ability to provide care and treatment. A person said, “The staff do everything and would do more. The washing and drying, the beds, they cream my legs, exercises, nothing is too much trouble for them and that is amazing.”

Staff told us people had their needs assessed prior to them delivering care. A care plan was implemented and the information on how staff should support people correctly would be incorporated within this plan. Staff confirmed if there was a change in legislation the provider would inform them. A staff member said, “I always make sure people are happy with their care and support and if things need adapting, I will speak with the registered manager for advice.” Other staff said the provider would conduct spot checks to ensure people are receiving dignified care.

The provider used policies from 2 different ‘policy providers.’ However, not all policies were complete, and were not always being followed. For example, policies on person-centred care, support planning and the use of bed rails in domiciliary care. All staff had completed the Care Certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. The provider conducted spot checks on staff’s practice including safe working, attitude and behaviour, records, medication, service users feedback whilst providing care and support to people. Dignity checks were also conducted separately. The provider attended regular local authority meetings where good practice guidelines and advice was shared.

People and relatives spoke positively about the service and said the provider and staff worked well with other healthcare professionals, including the district nurse team and people’s GP.

The provider confirmed they collaborated with external professionals to ensure people’s care is coordinated well and is at the right level to meet peoples’ needs. Staff confirmed family mainly liaise with external professionals, however, staff said they worked closely with the district nurse team and would contact them directly for advice on people’s healthcare needs.

A care professional was complimentary about the service. They told us care was not rushed and often their call times would exceed what was commissioned. All staff worked in a positive way and had good rapport and communication skills with both the person they were caring for and their family.

The provider confirmed they had previously attended a multi-disciplinary professional team meeting to discuss people’s care needs. However, a record of this meeting was not provided upon request. The provider ensured a list of medication is in people’s homes just in case other healthcare professionals require this information in an emergency. Staff in the past had also completed paper medicines administration records (MAR) and daily notes at the request of external professionals.

People, relatives, and friends we spoke with all confirmed they organised their own healthcare appointments.

Staff were monitoring people through observation during each care call. These included general observations, mood, food and fluid intake, physical health, continence, and mental health. However, it was unclear whether staff responded to people’s changing needs as there was no record of this. Staff told us they would support people to live healthier lives when they think this is possible and safe to do so. For example, 1 person had exercises provided by the physiotherapy team, and staff supported the person with their exercise regime. Staff spoke about helping people to access the community to support their well-being. The provider told us staff would support people to attend health appointments if their family were unable to do so.

Staff were supporting people with basic exercises to support their health. A copy of a physical exercise sheet was received for 1 person, however, basic information was missing, such as the person’s name and it was not dated, written text was not legible; and it was not clear as to whether the exercises were still relevant to the person in achieving a positive outcome. Staff were supporting other people with basic exercises, but there was also no record of these. The daily notes written by staff at the end of each visit were not audited, so it was unclear whether any changes in people’s presentation were identified by the provider and promptly acted upon.

Whilst people, relatives and friends gave us positive feedback about the care people received we found shortfalls in the providers systems to continuously monitor people’s care and treatment.

The provider told us they monitored people’s care and treatment continuously to improve it, the processes we reviewed during our assessment were unsatisfactory. Staff told us how they worked alongside other healthcare professionals to ensure positive outcomes for all.

The provider told us they monitored people’s care and treatment in several ways, which included spot checks, reviewing daily logs, and conducting dignity checks during staff support visits. However, these processes were not effective. There were no records of actions captured from the daily observations conducted by staff during people’s calls and the records of staff practice in relation to dignity; were focused on staff and not people receiving care. The provider confirmed they conducted courtesy calls to people, but only 1 call had been recorded across the 4 care records we reviewed.

People were asked for consent prior to receiving care from staff. Although a person, who was happy said, “No, staff don’t ask me for consent, because the staff that come are regular, they know exactly what I want doing. They are very competent. They always ask if I need anything doing prior to leaving.” Several relatives told us staff always ask their loved ones for agreement before providing care.

Staff were able to share their understanding of the Mental Capacity Act (MCA) 2005, and how this could affect the support they provided to people. A staff member said, “It is important to look at people’s facial expressions when trying to engage with people about choices in their care, for example, choices around food, clothing, personal care and using hand gestures to also support communication.” The provider was not aware of the Court of Protection safeguards to deprive someone of their liberty, whilst living in their own home.

The provider had completed an assessment with people to determine whether they had the capacity to make decisions about their care and treatment. All MCA decisions made were documented appropriately. Documentary evidence of people’s consent to care was also provided.