Daryel Care Greenwich

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

At the last inspection In June 2023 we found the provider did not have a robust process for assessing people’s needs. The provider was also not working in line with the Mental Capacity Act 2005. At this assessment, we found some improvements had been made. The provider had made improvements to their assessment processes, however further improvements were needed to ensure people were consenting to their care and treatment. The provider had also improved the detail recorded about people’s health needs. Staff worked in partnership with other health and social care professionals to share information about risks and support continuity of care.

This service scored 58 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people about being consulted about their care needs and being part of the ongoing review of their care plan. We received comments such as, “I did speak with them ages ago about what care [family member] needs and I believe there is a care plan but I have never seen it” and “I don’t think the care plan officially gets reviewed or updated, or at least I haven’t seen it.” More positive comments included, “We do have a care plan and this was updated sometime last year” and “I am happy that the needs identified in his plan are being met.”

Staff told us people’s needs had been assessed and care plans accurately reflected people’s needs. Comments from staff included, “Yes, I do get time to read both the care plan and risk assessment. I also believe they reflect the clients’ care needs and risks” and “The care plans and risk assessments offer detailed information and guidance on the service user's care requirements.”

At the last inspection in June 2023 we found the provider’s process for assessing people’s needs was not robust. At this assessment we found the provider had made improvements. Initial assessments were now in place which covered a wide range of health needs. The provider was using a range of assessment tools to gather information about people’s health and social care needs. People’s communication needs were assessed and guidelines put in place to help staff understand people’s preferred communication styles. Despite improvements the process did not show when people had agreed to their care plan which corresponded with the feedback from people we received.

At the last inspection in June 2023 people were not always happy with how staff supported their nutrition and hydration needs. At this assessment, most people told us improvements had been made. Positive comments from people included, “They do make me a drink and bring it to me which is a help” and “There are a lot of things that I don't eat for example I don't eat rice and they respect that and they try to look out for more foods that they know I will eat.”

Staff received relevant training to ensure they were competent to support people with fluids and nutrition. The registered manager showed us the systems they had in place to identify and monitor people who required support with eating and drinking.

Care plans contained prompts for staff to ensure they left adequate snacks and drinks for people who were unable to do this for themselves. Care plans contained information about people’s likes and dislikes and food preferences.

People generally thought staff worked with external partners as required. Positive comments included, “They do seem to liaise with the district nurses as necessary” and “The GP has prescribed some build up drinks and the carers let me know what she's been eating or not eating.”

Staff told us they worked well with other health and social care professionals such as the district nurse, GP and social workers when needed. Comments from staff included, “We flag information about emerging risks to the local authority as they arise” and “We often liaise with the pharmacist or people’s GP when we identify issues with medicines.”

We received positive feedback from professionals about how the provider worked with external partners to ensure people’s needs were met. Positive comments included, “I am aware that Daryel Care makes appropriate referrals to other professionals when needed, including speech and language therapists, incontinence team and district nurses” and “Daryel Care informs me promptly when patients' needs change. They update me about medication needs and issues, enabling timely intervention and preventing patient relapse.”

The provider made referrals to and worked in partnership with a wide range of other external health and social care professionals. Referrals and information about emerging risk were being sent to the local authority. The provider also liaised with GPs, district nurses and community pharmacists.

People had mixed views about whether the provider was fully supporting them with their healthcare needs. Some people did not feel staff had a good awareness of conditions such as dementia. Negative comments included, “They don’t seem to be very experienced and I wouldn’t be sure how good they would be if I were really ill” and “The staff don’t have an understanding about dementia.” More positive comments included, “Yes I do think they understand about my pain and they're quite light to their touch when they are applying the creams and gels and “They sometimes will advise me which creams to get and I will go and fetch these for them” and “If they notice any new skin areas, they will let me know so that I can contact the District Nurse.”

The provider told us how they had made changes to the care plans and risk assessments to provide more information about people’s health needs and medical conditions. Staff also told us they were in regular contact with healthcare professionals. One member of staff said, “We liaise with people’s GP when needed or communicate with other healthcare professionals.”

The provider had put in place a range of risk assessments and care plans for specific medical conditions such as dementia risk assessments which considered a wide range of risks associated with dementia. There were information fact sheets in place for staff about a wide range of other medical conditions and health needs. However, as these were generic information sheets we found they were not person-centred and did not provide information about how the medical conditions affected individuals. We raised this with the provider and they have agreed to make improvements.

We received mixed feedback from people about how the provider was monitoring and improving outcomes. Some people felt the provider had not made sufficient improvements and they did not feel the provider was monitoring effectively. We received comments such as, “They have never contacted me to audit or ask me what I think about the service” and “Someone does occasionally call me from the office to see if everything is okay and ask a few questions.”

Staff told us they felt the provider was monitoring people’s experience of care and staff performance. One member of staff told us, “We go out in the field to get feedback from people ensuring their needs are met.”

There were a range of processes in place to monitor people’s experience of care and staff performance. The provider was carrying out spot checks and conducting telephone calls to people. However, due to the ongoing shortfalls with the monitoring of the ECM system and the mixed feedback from people and their relatives we were not assured the provider had made sufficient progress in this area.

People told us staff asked permission when carrying out care tasks. Comments included, “They are mostly respectful and ask [family member] before doing anything” and “They just tend to ask me what I want doing each visit”. People’s choice of staff was also upheld. One person told us, “We only have female carers and I would object if a male carer was sent.” In general people were positive about how staff adapted their communication, “Staff are attentive and try to communicate with [family member] despite language difficulties, they will use sign language and facial gestures.” However, many people had not signed to indicate their consent of their care plan so we could not be assured their views and wishes and been taken into account in all aspects of their care.

Staff received Mental Capacity Act (MCA) training and showed a good understanding of how this was put into practice. We received comments such as, “We always assume people have capacity to make decisions about their care unless there is anything to suggest otherwise. If people are not able to make decisions we follow best interests processes and include people’s next of kin where possible.”

The provider was following the principles of the MCA. As part of the initial assessment of needs senior staff carried out capacity assessments when there was evidence to suggest people could not make certain decisions for themselves. They also recorded best interests’ decisions made about people’s care and support. However, the provider's process for recording people's consent was not robust. Most people had not signed their care plan to indicate they had agreed with it and this corresponded with the feedback we received.