Das Care Limited

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

We identified 1 breach of legal regulations in relation to safe care and treatment. The provider did not promote a consistent learning culture. There was no management oversight of safeguarding concerns or incidents and accidents. Risks to people’s health and safety were not always assessed or mitigated. The provider had not ensured safe recruitment practices were being followed. Staff were not sufficiently trained. Safety checks of people’s equipment was not managed well. People did not receive their medicines in a safe way and as prescribed for them. Enough staff were planned and deployed, who worked well with health and social care professionals. Staff had access to personal protective equipment (PPE) and understood its usage. People did not raise any concerns in relation to safety.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt safe with the care they received. When asked whether the service engaged with people to share learning, a relative said, “The service does ask about [Name], and we work together, if they have spoken to [Name] about something, they will ask me to speak with them too.”

Mixed feedback was received from staff relating to lessons learned. Some staff confirmed learning for the future when incidents had occurred would be communicated to them face to face, via a secure online messaging group, in their supervision or during team meetings. However, other staff confirmed this had not happened. They said the provider did not communicate lessons learnt following incidents and accidents to improve practice. The provider confirmed they were open and transparent with all and would communicate everything to people and relatives and inform the appropriate professionals. Discussions of lessons learned would take place with all staff and if necessary, they would complete unannounced spot checks with staff to ensure good working practices. The provider had implemented a new care management system within the service which meant it was easier for the provider to track the care people were getting at the time it was delivered.

There was no oversight of lessons learned. Safeguarding concerns, incidents and accidents had been reviewed by the provider at the time they occurred, and relevant professionals had been informed. However, there was no record of any lessons learnt following the incidents. The safeguarding log which had been implemented was blank and there was no incident and accident log. This meant the provider did not adequately review patterns and trends relating to incidents, to protect people from the risk of experiencing repeat incidents.

Discussions with people and relatives was limited under this quality statement. A friend of one person using the service told us, “Professionals, including the GP practice come to see [Name].”

Staff were able to describe how they worked with other health and social care professionals to support people’s care pathways, including occupational therapists, GPs, and physiotherapists. Staff told us, when they referred people to paramedics, they supported people to pack an overnight bag for hospital admissions and remained as a point of contact for ambulance staff. The provider advised they would stay in touch with the local hospital to gather feedback on people’s care requirements upon discharge, often consulting with the social workers within the hospital to ensure safe discharges.

Professionals told us the provider had demonstrated effective partnership working. Care visits were never rushed and often their call times would exceed what was commissioned. The provider consulted with the GP to request a new assessment when there was a decline in nutritional intake.

The provider was only able to provide us with 1 record confirming they had been involved in joint working with healthcare professionals, and this was in the form of an email from a family member. Other evidence received was provided directly by external professionals at our request. A copy of the providers policy relating to referral, admission and new packages of care was requested from the provider, but they failed to meet our request. Furthermore, we could not be assured of people’s continuity of safe care during their care journeys. We found shortfalls in the provider’s system always being established or effective to adequately assess and monitor the risks to people’s health and safety.

People and relatives did not raise any concerns in relation to safeguarding. They told us they felt safe and happy with the quality of staff support.

Staff had a good understanding of how to keep people safe from harm and how to report concerns. They felt confident to do so and knew what to look out for which might suggest someone was being abused. The provider confirmed they had raised awareness to some of the people they care for about ‘doorstep scammers’ and to be vigilant when opening the door to strangers. The provider confirmed safeguarding was a regular agenda item at staff meetings and supervisions.

There was no management oversight of safeguarding concerns. The provider had implemented a safeguarding log following advice from the local authority. However, during our first onsite visit we discovered the log had not been populated with details of any safeguarding concerns, actions, referrals, or lessons learned. The provider had notified the CQC and local authority of safeguarding concerns. The provider responded to our feedback and provided an updated safeguarding log, however, there were still two known safeguarding concerns missing from this record.

Whilst people and relatives did not raise any concerns about the management of risk in the service. We found people had been placed at risk of harm by a failure to fully assess, monitor and have suitable plans in place to manage known risks to individuals. People we spoke to told us they felt safe. A person said, “Staff use a standing hoist which has a strap that lifts me up. I am completely safe. They know what they are doing and use the hoist well.”

Staff we spoke to told us they had access to people’s risk assessments on the care planning system, however, following our review it became clear there were very few risk assessment records in place. People were at risk as staff did not have all the information they needed to provide safe care. Staff were able to describe the process for reporting incidents and accidents and demonstrated an understanding of the process they needed to follow to ensure people’s safety in an emergency. This included seeking appropriate medical assistance. Staff knew people well and worked with people in a positive way to support them and reduce risks to their safety. The provider confirmed there were detailed risk assessments records in place for people’s known risks. However, we found during our review this was incorrect. During our second site visit the provider demonstrated during our second site visit they had started to implement some new risk assessment records within their care management system. The provider confirmed people’s risks were discussed during team meetings.

We requested risk assessment records for 4 people using the service. There were a small number of risk assessments in place to assess and minimise the impact of known risks. However, it became evident there were several risk assessments missing, including those related to personal care, skin integrity, medication, continence, bed care, choking, psychological, exercises, wheelchair, smoking, commode/transfer, and Covid. Furthermore, a comprehensive bed rails assessment had not been completed for those people using hospital beds with rails, bumpers and grab handles as per the provider’s policy. Pressure area care risk assessments had not been completed correctly. There was no incident and accident log. This meant the provider could not review patterns and trends relating to people’s individual risks. Additional risk assessment documentation was provided during our assessment. However, there were still several risk assessments missing, and until we assessed and identified these shortfalls, people were at risk of potential harm.

Whilst the people we spoke with expressed they were generally happy with their care, our assessment found that some people had been placed at risk of harm by a failure to ensure all equipment was safe to use. People who were in receipt of care in their own homes did not raise any concerns about the safety of their environments. People and relatives told us the provider had completed a check of the environment when their care package commenced.

We did not identify any concerns during our initial discussions with the provider or staff about safety of their working environments. The provider confirmed there was no equipment in the office that required servicing. The provider conducted staff competency checks within people’s homes, during their planned calls using people’s own equipment. During an interview with the provider, they confirmed annual checks of equipment were organised by families. However, upon review of the providers policy this stated it was the responsibility of the provider to ensure all equipment was safe to use and appropriately maintained and serviced.

The provider did not have an established system to check and record if all the equipment people were using to support them to keep safe, was serviced, as per their Health & Safety policy. Evidence of 1 equipment safety check was received, but the make and model of the standing hoist and sling had not been completed, and it was unclear what the outcome of the check was, as the form was blank.

People and relatives gave us positive feedback about staffing, they told us staff generally arrived on time and would stay for the full duration of their allocated care call. People had no concerns with staff’s ability to carry out their role. A person said, “I have no concerns with staff and their abilities.” A relative said, “Staff come on time unless there is lots of traffic, they stay the correct amount of time, and they do have time to talk to me and [Name].”

Staff told us they went through a recruitment process when they joined the service. However, we found the staff recruitment practices were not always consistent. The provider had failed to ensure robust pre-employment checks were always completed. Staff told us they felt well supported by the provider, that they had regular supervision meetings and opportunities to complete specific training courses to enhance their knowledge on certain health conditions. They felt the service had enough staff and were happy with the staff rotas. Staff told us care visits were not rushed and they had sufficient time to provide care and support to people. People received care from a regular team of staff.

There were enough staff to meet people’s care and support requirements. A full employment history for 2 members of staff had not been fully explored by the provider prior to our assessment. A Disclosure and Barring Service (DBS) check for 1 staff member was obtained during our assessment despite them commencing employment at the end of 2023. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The provider had no oversight of staff training. Staff had not always completed the training they needed to give them the skills they required to effectively meet the needs of people they were caring for. For example, several staff started completing training in diabetes, catheter care, multiple sclerosis, stroke awareness, and manual handling when our assessment commenced. The dates on the providers staff supervision matrix did not align with the supervision records we reviewed. On bringing this to the providers attention a 3rd supervision matrix was provided with the correct dates. The staff medication training competency records did not align to the electronic system the provider was using to manage people’s medicines. Manual handling staff competency assessment records were not always completed in full. The provider took immediate action and provided us with a full career history for 2 staff along with an explanation of gaps in employment. The most up to date training matrix was never received, so it was unclear whether staff training was fully up to date.

People and relatives told us staff used personal protective equipment (PPE) during their care calls, including items such as gloves and aprons. A person said, “Staff will always dispose of their PPE in the designated bin outside the home. They always keep the home tidy.”

Staff supported people to keep their homes clean and tidy and free from infection. Staff were able to describe how they prevented the risk of infection by using appropriate PPE. The provider told us any guidance received from external authorities relating to infection prevention control would always be shared with care staff and discussed during staff meetings to ensure people were protected from the risk of cross contamination.

Most staff had completed training in infection prevention and control. Audits completed by the provider in relation to infection prevention control and PPE had not been fully completed.

Whilst the people we spoke with expressed they were happy with the medicines support provided by staff, our assessment found people did not always receive their medicines safely as prescribed for them. People and relatives told us staff discussed their medicines with them. A relative said, “Yes, the staff are very good.”

Staff we spoke to told us they felt well supported with administering medicines. A staff member could not describe what ‘time specific’ medicines were, and other staff advised there were issues when recording administration of people’s medicines due to network connectivity concerns when using their mobile APP. Most staff had received medicines training, and competency checks to ensure they administered people’s medicines safely. They were knowledgeable about people’s medicines and were able to describe the protocol for administering medicines that were prescribed to be given ‘when required.”

Records showed people mostly received their medicines safely as prescribed. However, there was not always suitable arrangements in place for the receiving, administration, and disposal of medicines. There was no evidence the timing of medicines in relation to food had been considered. When medicines were prescribed to be taken ‘when required’ there were no detailed and person-centred protocols in place to guide staff when these might be needed. Risk assessments were in place for high-risk flammable external preparations (emollient medicines), but they did not contain sufficient information about how to reduce risk.