Archived: Dee's Domiciliary Care Services Limited

Dee’s Domiciliary Care Services provides personal care, respite and domestic services to people in their own homes, some of whom are living with dementia or have complex health needs. The service operates mainly in the eastern part of the City of Southampton, where it is a preferred provider under the local authorities domiciliary care framework. The service also provides care to some people living in Hedge End, and the Bursledon, Netley and Hamble areas of Hampshire. There were 80 people using the service at the time of our inspection.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

People did not always have a care plan which provided detailed information about their needs and supported staff to deliver responsive care. The legal requirements of the Mental Capacity Act (MCA) 2005 were not being fully met. The provider had been asked to make improvements with regards to both these areas at our last inspection in July 2015. The required improvements had not been made.

Some risk assessments needed to be more robust and include more detailed guidance about how the identified risks were to be managed. More robust systems were needed to ensure that medicines were managed safely.

The provider had not notified CQC about significant events that had occurred within the service.

People told us the reliability of the service, particularly at weekends, needed to improve. Communication was sometimes poor. This impacted upon the confidence people had in the service and its leadership.

Staff had received training in safeguarding adults and had an understanding of the signs of abuse and neglect. Where concerns had been expressed about the care provided by Dee’s Domiciliary, their senior staff were working effectively with the local authority to investigate and learn from these.

The induction for new staff was limited and was not mapped to nationally recognised standards. Staff did not receive regular supervision. This is important as it helps to ensure staff receive the guidance required to develop their skills and understand their role and responsibilities.

Improvements were being made to ensure that there were sufficient numbers of staff deployed to meet people’s needs. Recruitment practices were safe and the required checks had been completed before new staff members started work.

People were happy with the support they received to eat and drink and staff were able to describe to us the importance of protecting people from the risk of poor nutrition or hydration. Most people felt staff helped them to stay healthy and monitored their wellbeing.

People were treated with kindness. They felt that their privacy and dignity was respected. People felt at ease with their regular care workers who had developed positive caring relationships with them.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have asked the provider to take at the back of this report.

On this occasion we found the agency had taken steps to obtain the full work histories of their existing care workers and introduced new application forms to ensure this information would be obtained from new applicants.

We gathered evidence against the outcome we inspected to help answer our one key question. Is the service safe?

Below is a summary of what we found. The summary is based on our speaking with two care workers, three of the agency's management staff and looking at relevant records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The service is safe because the agency's recruitment procedures had been strengthened to ensure only staff suitable to work with vulnerable people were employed to provide the help and support they required.

Our inspection took place over two and a half days. On the first day we visited the agency's office and looked at documentation such as care plans, visit schedules, policies and procedures, training records, staff records, surveys and audit material. We also met with three care workers and discussed the training and support they received.

On our second day we met with four people and/or their relatives in their homes. They told us about the service they received. We also spoke with four more care workers.

On the third day we spoke on the telephone with ten people and/or their relatives who used the services of the agency in order to obtain their views.

We gathered evidence against the outcomes we inspected to help answer our five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and/or their relatives, the care workers supporting people, management staff and from looking at relevant records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

People told us they felt safe. The service had robust safeguarding procedures in place and staff had received appropriate training and understood how to safeguard people they supported.

The agency used a satisfaction survey and arranged 'client forum meetings', recorded accidents and incidents and complaints all in order to learn from events. This reduced the risks to people and helped the service to improve.

Risks to people's safety and welfare were identified and plans had been put in place to manage them.

The registered manager took people's care needs into account and ensured that care workers with the relevant knowledge, skills and experience were scheduled to carry out visits. This helped to ensure that people's needs were met.

Eleven of the fourteen people we spoke with told us that care workers usually carried out their visits when they were expected. Three people, however, told us that the visiting times of care workers were inconsistent and this had caused difficulties for them. For example because they had to take medication at a certain time or an extended length of time in bed caused discomfort.

Recruitment practice was not sufficiently robust because full work histories had not always been obtained from people who had been employed.

Is the service effective?

People's health and care needs were assessed with them before they received a service. Specialist dietary needs had been identified where required. People told us they received the help and support they required.

Senior personnel from a local authority adults' services department expressed positive views about the agency and described it as 'flexible' and said that many people it provided a service to had complex needs, such as dementia.

Is the service caring?

We met with four people and/or their relatives and spoke with them. We also telephoned another ten other people who were supported by the service. We asked them for their opinions and all the people we spoke with, without exception, spoke positively about the approach and attitude of care workers. They described them as 'lovely', 'caring', 'wonderful' and 'brilliant' They said that care workers were polite and treated them with respect and promoted their dignity. They told us their independence was promoted and they made decisions about the support they received.

When observing care workers and talking with them it was clear that they genuinely cared for the people they supported.

People using the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Two of the fourteen people we spoke with told us they thought their complaints were not taken seriously. However all the other people were confident the agency would treat complaints seriously and three people said that when they had raised concerns with care workers or the agency's management team they were quickly resolved. This meant that people were assured their complaints were investigated and action had been taken as necessary.

Is the service well-led?

The agency had a quality assurance system in place and records showed that staff performance was monitored and people were asked for their views about the standard of service they received. This showed the provider was committed to improving their service.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the service. This helped to ensure that people received a good quality service at all times.

We spoke with 17 people out of 119 who used the service, and three family members who were closely involved with their relative's care. They told us they were satisfied with the care and support provided. Three of them considered there had been recent improvements in the responsiveness and quality of the service. Comments included 'It's quite good, everything is fine', 'I'm quite satisfied, it's all done properly' and 'They are excellent, very helpful.' People said that care and support, including assistance with medication, were provided with their consent.

We found people's care and support were based on detailed plans and assessments. The provider had systems in place to ensure care was provided according to people's agreed plans. Staff who provided care in people's homes were knowledgeable about the need for consent and about issues of mental capacity. Appropriate arrangements and records were in place where people were assisted with medication. The provider had systems to monitor and assess the quality of service provided. People's personal information and other management records were suitably protected and fit for purpose.

The provider had taken steps to ensure people's views and experiences were taken into account in the way the service was provided and delivered.

We reviewed records and care plans for people using the service and found they were inaccurate, incomplete and not fit for purpose. This meant that people were not adequately protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

Staff were positive about the support they received from managers. Inductions were to recognised standards, and staff had sufficient training to carry out their roles effectively. Effective recruitment and selection processes were in place, and appropriate checks were undertaken before staff began work.

People had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint. The service had effective procedures in place for safeguarding vulnerable adults and staff followed the appropriate local safeguarding process.