Daryel Care Greenwich

On this page

• 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

At the last inspection in June 2023 we found breaches in relation to risk assessments, medicines and staff training. The provider has made improvements in these areas but due to ongoing concerns with staff timekeeping, late and missed calls and the provider’s monitoring processes further improvements are needed. Most people told us they received a safe service, however, the issues with consistency of staff and timekeeping meant some people did not feel entirely safe especially when they received care from different staff. Some people and relatives were also not confident in the skills of some staff around caring for people with dementia. The provider acknowledged however, that further improvements were needed to ensure everyone received a consistently safe and effective service.

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.

Although many people told us the provider had made improvements, there was a mixed response about how the provider was learning lessons and resolving issues that had previously been raised. One person told us, “Someone does occasionally call me from the office to see if everything is okay and ask a few questions, but they never come back to me regarding any comments I make” and “I would say they are just about scraping by at the moment, doing a fair job but there is a lot of room for improvement.” Positive comments on improvements included, “The people in the office used to be dreadful but they have improved. If I ring up now, they do seem to listen and actually do something about my complaints” and “The care company has not been very good over the past 12 months but it has started to improve.”

Staff told us there had been many improvements made since the last inspection in June 2023. One member of staff told us, “Communication between the office and care staff has improved and more spot checks are taking place.” Staff also told us the registered manager listened to them and gave them opportunities during staff meetings to discuss their issues and concerns. One member of staff told us, “The staff meeting was extremely useful. We were able to discuss the problems we face with the [registered] manager and other members of staff in the organisation.”

Staff recorded accidents and incidents when these occurred. The registered manager reviewed incidents to ensure appropriate actions were taken. The registered manager also used team meetings to discuss emerging themes with the quality of care. They also collated information raised during staff supervisions to identify trends and themes. Due to ongoing issues with the monitoring processes and staff timekeeping we could not be assured the provider was effectively learning lessons.

We received mixed feedback from people about the processes in place to manage safety. Some people told us they felt care staff were managing risks related to skin integrity when required. Positive comments included, “They do check that [family member] is not getting a sore or has any skin issues” and “If they notice any new skin areas, they will let me know.” However, other people were not so confident the provider had made sufficient improvement. One person told us, “They are supposed to be checking family member’s skin but I am not confident they are doing it.”

Staff told us the safety of people was managed and monitored effectively. We received comments such as, “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.”

We received positive feedback from external professionals who worked with staff to manage risks to people’s health and well-being. One professional told us, “I believe risks are managed appropriately. I jointly conduct mental capacity assessments, risk assessments, and advise implementation of risk management plans, which are evaluated within specified time-frames.”

At the last inspection in June 2023 people were not always protected from the risk of harm as we identified several risks that had not been assessed and/or mitigated by the provider. The provider had made improvements to their systems and processes. There were a wide range of risk assessments in place with clear guidelines for staff. The registered manager was monitoring the improvements and had plans in place to ensure all risk assessments would be reviewed and checked for accuracy.

People understood how to raise concerns about their safety. One person told us, “I know exactly how to complain to them and wouldn’t hesitate to do so.” Despite this some people were not confident their concerns would be listened to and acted on. One person told us, “I have raised issues before but nothing seems to get resolved.” People told us they felt safe when they received care visits from regular staff. However, the inconsistency of staff made them feel less safe.

Staff told us they received relevant training around safeguarding and showed a good understanding of whistleblowing and safeguarding procedures. They knew who to inform if they had any concerns about abuse or safety. Comments from staff included, “I have had training in safeguarding and understand this means protecting adults from the risk of abuse and neglect” and “If I had concerns that someone was at risk of abuse or neglect, I would report these to my manager immediately.”

Prior to the last inspection in June 2023 the service was generating a high number of safeguarding and quality alerts due to people receiving poor, unsafe care. At this assessment we found there had been a significant reduction in the frequency of safeguarding alerts and quality alerts being raised. The registered manager carried out investigations into allegations of abuse or neglect and provided feedback to relevant agencies. The registered manager understood their responsibility under the duty of candour and took responsibility when things went wrong.

Not all people felt they were getting safe care especially when they received care visits from different staff. One person told us, “I only feel safe with those particular carers as there are some good carers but some who are not good.” People were more positive about safety when they were receiving care from regular staff who knew them well. Positive comments included, “I now feel confident for the weekday carer to help me get downstairs as I trust him to make sure I am safe and not going to fall” and “I do feel very safe with all the carers and find them all quite pleasant. The staff are helpful and stay with me to make sure I don’t fall.”

Most staff felt there were robust procedures in place to ensure people were involved in the management of risks. However, some staff felt further improvements were needed to ensure care plans and risk assessments were up to date and accurate. One member of staff told us, “Some of our clients' needs have changed a lot. The supervisor is trying her best to get these done but hasn't been able to cover all clients yet.”

At the last inspection in June 2023 we found people were not always protected from the risk of harm as risk assessments contained conflicting and contradictory information. The provider had many improvements to the range of assessments and the quality of information recorded. Most risk assessments accurately captured all necessary information about risks to people’s health and guidelines for staff were much clearer. However, further improvements were needed as we found some assessments lacked sufficient detail about the steps staff should take to reduce the risk of people becoming distressed.

People were confident staff understood how to ensure the environment and equipment were safe and free form hazards. We received comments such as, “[Family member] does use a frame and a wheelchair and staff seem competent to make sure he is safe and does not fall” and “The environment is always left safely to avoid trips and falls.”

Staff told us they assessed the risks associated with people’s living environments during the assessment and review of people’s care needs. One staff told us, “We carry out an assessment of people’s homes when we do the initial assessment to identify any hazards or risks. This is done again when we do the annual review.”

At the last inspection in June 2023 we found the provider was not assessing the risks of fire effectively. Improvements had been made and the provider was assessing all fire risks using a recognised fire risk assessment tool. However, we found the provider had not made any referrals to the London Fire Brigade when they identified risk factors such as the use of air flow mattresses and the use of flammable emollient creams. We raised our concerns about the lack of referrals and the provider has agreed to review the fire risk assessments and make referrals for people where necessary. Moving and handling equipment was listed with a record of the maintenance history to provide assurance that the equipment was safe to use.

Despite improvements, many people were still experiencing issues with times of care visits, missed visits and staff not staying for the full allocated time. We received comments such as, “I have never had a missed visit just some very late ones!” and “I don't think they stay for the full time” and “Staff are often very late and we have to ring up to find out what is happening.” Another issue that caused people anxiety was not receiving care from regular staff. One person told us, “The problem is there is no continuity of care and I have lots of different carers.” Some people were more positive about staff attendance times and the skills of the staff. Positive comments included, “We are happy with the care we get from the regular staff and they generally arrive on time” and “Communication is much better and they now contact us if they are running late.”

Staff were positive around the improvements made to the staff rota. However, some staff felt further improvements were needed. One member of staff told us, “The [office staff] needs to work more on the rota to ensure carers are placed in one location especially for carers that are using public transport.” However, the majority of staff told us the rotas had improved. Positive comments included, “Yes, my rota is organised effectively” and “There is enough travel time between clients enabling us to get to our respective clients relatively on time.” Staff were happy with the training and support they received. Positive comments included, “I have proper support and training to meet people’s needs” and “Yes, I do get supervision from my manager regularly so as to review my work and render support where needed.” At the last inspection the provider was not ensuring staff received the relevant training in learning disability and Autism. The provider had made improvements and was now ensuring staff received Autism and learning disability training.

At the last inspection in June 2023 we found widespread issues with the scheduling and monitoring of care visits which resulted in many missed and late care visits. Despite some general improvements at this assessment we found the systems for monitoring visits was still not effective. The electronic call monitoring data showed persistent issues with late and unlogged calls. A member of staff was now following up on un-logged calls to seek assurance people had received their visit, however, not all calls had been checked which meant the provider could not be assured people were getting their care visits as planned. The provider had acknowledged that their current system was not effective and they were the process of replacing this with a more robust system which will enable them to monitor staff timekeeping more effectively. At the last inspection we found the provider did not always provide necessary training for staff. The provider had made improvements and staff received a wide range of training to ensure they could meet the needs of people receiving care. Staff did not received training in some areas such as stroke, cerebral palsy despite some people having these care needs. We raised this with the provider and they have agreed to put the required training in place.

Most people told us staff wore the correct personal protective equipment (PPE) and maintained good standards of hygiene to reduce the risks of infections. Despite generally positive feedback several people told us staff did not always wear a uniform in line with the provider’s policy. One person told us, “They do wear gloves and aprons for personal care but I have never seen the carers wearing a uniform.” Some people told us there had been recent improvements. We received comments such as, “They always put on aprons and gloves.”

Staff told us they had access to sufficient supplies of PPE. We received comments such as, “We are provided with adequate PPE” and “Even when they run out, supplies are made as soon as possible.”

Care plans contained person-centred information to ensure staff understood how to maintain people’s personal hygiene safely and in line with their personal preferences. The provider had identified that staff did not always wear the uniform in line with their policy and they had made changes to their quality assurance processes to ensure they were monitoring staff compliance with the uniform policy.

At the last inspection in June 2023 many people told us they did not feel the provider was managing their medicines safely. At this assessment, although most people told us the provider had made improvements, further improvements were needed as not everyone was confident sufficient improvement had been made. We received comments such as, “I don’t think they are competent with medicine giving” and “We have had issues with the medication and I feel I need to keep checking.” Positive feedback included, “They do have to give him his medication and I understand that there are never any issues with this” and “They do help her with her tablets and get them out of the blister pack for her and as far as I know they stay with her while she takes them.”

Staff told us they received ongoing training to ensure they had the right skills to manage people’s medicines safely. One member of staff told us, “The most useful training I have had recently is on how to properly administer people’s medicines” and “I have received training on medication which consists of administering the right medication at the right time as prescribed by the doctor and filling the medicine administration record (MAR) correctly.”

At the last inspection in June 2023 the provider was not managing people’s medicines safely. At this assessment we found the provider had made improvements. Medicine administration was now being recorded electronically which meant if staff failed to sign after administration this could be picked up more quickly. A member of staff monitored the electronic system to alert staff if they failed to record medicine administration correctly. The same member of staff was responsible for reviewing medicine support plans and MARs and followed up issues or concerns with the pharmacy or GP. Medicine audits showed issues with administration were followed up when these occurred.