Archived: Direct Line Consultancy Services

We asked the provider to take action to address our concerns about fit and proper persons employed, receiving and acting on complaints and safeguarding service users. We took enforcement action and issued warning notices requiring the provider to meet regulations regarding good governance, safe care and treatment, staffing and person-centred care.

The provider had taken very limited steps and had only addressed our concerns about complaints. Following this inspection in July 2018 we continue to have significant concerns about person centred care, safe care and treatment, good governance, staffing, and fit and proper persons employed.

Direct Line Consultancy Services is a domiciliary care agency. It provides personal care to children living in their family homes in the community. Although registered to provide a service to older adults, younger disabled adults and children, the service was only providing care to children at the time of our inspection. Not everyone using Direct Line Consultancy Services receives regulated activity; CQC only inspects the service being received by people provided with 'personal care'; help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided. At the time of the inspection the provider told us they were supporting three children with personal care. After the inspection the local authority told us an additional four packages had been commissioned to include personal care.

There was a registered manager in post, although he was not present during the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider had failed to address our previous concerns about the lack of detail in care plans and risk assessments. There was insufficient information to ensure care workers could provide safe care and treatment to children in a way that reflected their preferences. Children receiving care had complex healthcare needs including physical and neurological disabilities but there was no recorded joint working with other professionals. There was also a lack of information about how to respond to health related emergencies which meant children were at risk of harm. It was not always clear whether the provider had taken appropriate action to safeguard children from harm.

Parents told us they were unhappy with staff who had only received online training working with their children. Staff had not received the training they needed to meet children’s needs. Recruitment records were not complete and did not show robust recruitment processes had been followed.

The provider collected information about children’s religious beliefs and cultural background but did not consider if this affected how children wished to receive care. Care workers did not feel the provider was sensitive to the religious and cultural background of families they supported.

Care plans were reviewed regularly, and families were asked to provide feedback on their experience. However, key information was not recorded and changes in circumstances were not captured in the care plans.

Families told us they had developed trusting and positive relationships with named care workers, but they did not trust the provider to supply consistently skilled care workers. Families chose to go without care when their regular care workers were not available.

The audit and quality assurance systems in place had failed to identify and address issues with the quality and safety of the service. The response of the provider did not demonstrate they understood the seriousness of the issues or that the lack of information within files put children at risk of harm.

Families told us staff arrived on time and stayed the full duration of scheduled visits. The provider had taken action to ensure complaints were responded to appropriately. Families told us they knew how to make complaints.

During this inspection we identified continued breaches of five regulations regarding person-centred care, safe care and treatment, staffing, fit and proper persons employed and good governance. Full information about our regulatory response is added to reports once all appeals and representations have been exhausted.

The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘special measures.’

Services in special measures will be kept under review, and if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe, so there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review, and if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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 improvement 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.

Direct Line Consultancy Services is a domiciliary care agency. It provides personal care to people living in their own homes. Direct Line Consultancy Services had previously provided care to both older adults and children. However, since our last inspection in April 2016 they had stopped delivering services to older adults from this location, and only provided care to children living in their own homes.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At the last inspection in April 2016 we served the provider with two warning notices as they had been in breach of regulations regarding the safety of medicines management and staff supervision. The provider had taken action to address these concerns.

Care plans and risk assessments lacked detail and were not personalised to each child. The care required had not been described in detail and the provider relied on family members and the individual skills of care workers to meet the children’s needs. Care plans did not tell staff about children’s care preferences, dietary needs, or religious and cultural background. Risks faced had not been appropriately identified and records lacked detail about the nature of children’s mobility needs.

Staff recruitment processes had not operated robustly and the provider did not record the interview process. The provider carried out reference checks and checks on staff criminal histories. Although staff now received supervision, they had not received the training they needed to perform their roles.

Although families felt their children were safe with care workers, the provider did not have robust systems in place to safeguard people from harm.

Families told us staff did not always use personal protective equipment to control the risk of infection.

The provider did not complete analysis of incidents to ensure lessons were learnt and improvements made. Likewise they were not appropriately identifying complaints, although family members told us they were satisfied with how their complaints were resolved.

The provider’s quality assurance and audit systems had not identified issues with the quality and safety of the service, and there were no plans in place to improve the service.

Some families told us they were asked for feedback and were involved in reviewing their care. Other families told us they had not been asked for feedback.

Families told us care workers demonstrating a caring attitude. Care workers described how they got to know the children they supported and how they promoted their dignity and independence.

The Mental Capacity Act (2005) only applies to people aged over 16. The provider sought appropriate consent from parents who must consent to care and treatment provided to their children.

During this inspection we identified breaches of seven regulations regarding person centred care, safe care and treatment, safeguarding, complaints, staff training, staff recruitment and display of ratings. We have also made a recommendation about meeting cultural and religious needs. Full information about our regulatory response is added to response once all appeals and representations have been exhausted.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

The service is a domiciliary care agency that provides support with personal care to adults and children living in their own homes. At the time of our inspection they were providing support with personal care to 40 people.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Medicines were not always managed in a safe manner. Staff did not receive regular one to one supervision from a senior member of staff in line with the provider’s supervision policy. Quality assurance and monitoring systems were not always effective.

We found three breaches of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this

Report.

People told us they felt safe using the service. Risk assessments were in place which included information about how to mitigate the risks people faced. The service had suitable systems in place for safeguarding people and staff understood their responsibility with regard to safeguarding. There were enough staff to meet people’s needs and checks were carried out on new staff to check their suitability.

Staff undertook an induction training programme on commencing work at the service and received on-going training after that. People were able to make choices for themselves where they had the capacity to do so and the service operated within the Mental Capacity Act 2005. Where people were supported with food preparation they were able to choose what they ate and drank. The service worked with other agencies to promote people’s health and wellbeing.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place for people which set out their needs and the support they required. People told us they were happy with the support provided and staff had a good understanding of people’s individual needs. The service had a complaints procedure in place and people told us they knew how to make a complaint if needed.

People and staff spoke positively of the management at the service and of the working atmosphere.