Dailycare4U Telford Ltd

Dailycare4U is a domiciliary care agency providing personal care to 35 people at the time of the inspection.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

The registered office was located on the high street of a small market town.

People’s experience of using this service and what we found

At our last inspection we found that Dailycare4U had made significant improvements. However these improvements had not been fully embedded. At this inspection we found the service had continued to improve and many of the systems and processes they had introduced, were now embedded.

We identified two areas at this inspection which required some additional improvement, and discussed these with the provider. We did not find that anyone was at risk of harm.

People and staff were generally complimentary about the training staff had received. However, we were unable to fully assess the level of training new staff received before being able to lone work. The provider maintained two different systems for recording training data, which when combined did not provide a clear picture of what training new staff had received.

Risks to people safety had been considered but records relating to the maintenance of equipment were minimal. The provider immediately made the necessary improvements. However, the governance systems in place had not highlighted the need for more robust oversight.

People were protected from abuse by staff who understood safeguarding procedures. People were supported by sufficient numbers of staff and call times were actively monitored. People received their medicine as prescribed and were protected from the risk of infection.

The provider could evidence that lessons had been learnt when things went wrong and were aware of their duty of candour.

People’s care needs were assessed, and detailed care plans were developed. These provided staff with the information they needed to offer support, although, one person did tell us they had to request a review after their needs had changed. People were supported to maintain healthy lives and encouraged to eat and drink a balanced diet, as agreed in their care plan.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were treated well and involved in decisions about their care. Staff knew how to respect people’s privacy and dignity. Staff supported people’s independence by only completing the tasks people needed assistance with.

Care plans were personalised to each person’s needs and information was made accessible for people when required. Staff supported people to maintain relationships and supported social activities when requested.

People had access to a complaint’s procedure, but any concerns had been resolved before they became a formal complaint. The provider was not supporting anyone with end of life care at the time of inspection.

People were complimentary about the care received and staff felt well supported by the provider. People were engaged with the service and we saw evidence of continuous learning and improvement.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 14 February 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Daily Care 4 U is a domiciliary care agency. It provides personal care to people living in their own homes. It provides a service to older people, younger adults, people with mental health needs and people who have a physical disability and/or sensory impairment. Not everyone using the service received a regulated activity; CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. At the time of this inspection 25 people were receiving assistance with their personal care needs.

At our inspection in June 2018 the service was in breach of eight of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated inadequate and was placed into special measures. We also used our urgent enforcement powers to impose conditions on the provider’s registration. These included not taking on any new packages of care and ensuring safe staff recruitment procedures. Following that inspection, the provider was required to write to us detailing the action they would take to address the shortfalls and breaches of our regulations. We carried out a further inspection in July 2018 where we focused on the key questions of safe and well-led. We again found breaches of the regulations and following that inspection, the provider wrote to us detailing the improvements they had made. We made the decision to carry out a further comprehensive inspection in January 2019 as the provider had provided reassurances that improvements had been made.

Daily Care 4 U had a registered manager in post who was present throughout this inspection. The registered manager was also the registered provider. 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.

Whilst the provider had taken some action to address the immediate concerns we raised at our previous inspections, further time is needed to ensure improvements are embedded and can be sustained. The service is no longer in special measures.

The provider had taken steps to mitigate risks to the people who used the service. Staff had received training about how to recognise and report abuse. Staff felt confident about the action to take and all felt confident action would be taken to investigate any concerns. People were now protected by the provider’s staff recruitment procedures because checks were carried out before staff commenced employment to make sure they were suitable to work with people. Risks to people were assessed and plans were developed to manage known risks. These included environmental risks, fire safety, reducing the risk of falls and pressure damage to the skin. Staff had received additional training about the management and administration of people’s medicines. The provider was in the process of introducing competency assessments to monitor staffs’ skills and knowledge. People told us they received their medicines when they needed them. Systems had been introduced to ensure staff were allocated to visit people at the agreed times. People told us they were provided with information which told them which staff member would be visiting them. People were protected from the risks associated with the control and spread of infection. Individual assessments had been completed and people told us staff wore appropriate personal protective equipment when they assisted them with their personal care needs. The provider told us there had not been any accidents involving the people who used the service. However, they told us they would use any learning from any incidents to reduce the risk of reoccurrence.

The provider had liaised with other agencies to ensure staff were provided with the training they needed to meet the needs of the people who used the service. People were confident staff had the skills to meet their needs. Newly appointed staff completed an induction programme and were provided with opportunities to shadow more experienced staff before they supported people. Staff were provided with opportunities to discuss their role with senior staff. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to eat and drink in accordance with their needs and preferences. People’s health care needs were monitored and understood by staff. Staff liaised with other professionals to ensure people’s environment helped to maximise their independence.

People were supported by kind and caring staff who took time to get to know people and what was important to them. Staff treated people with respect and respected their right to privacy. Staff understood the need to respect people’s confidentiality.

Systems to ensure people were involved in planning and reviewing the care and support they received had been introduced. Care records had been updated to include information about the number and duration of visits people required. People received a service which responded to changes in their needs. Records could be produced in a format to meet people’s needs. Systems were in place to ensure people’s needs were fully assessed before a service was provided. People knew how to make a complaint and the provider’s procedures ensured complaints were investigated and responded to. Training was in the process of being provided to ensure staff had the skills to care for people during their final days.

The provider had taken steps to improve their knowledge and meet their legal responsibilities as a registered person however, further improvements were required. Systems had been introduced to monitor the quality of the service provided and to identify areas for improvement. These had not yet been embedded, so progress will be followed up at the next inspection. People found the provider approachable and supportive and there was an on-call system which people found effective.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. At this inspection they were providing personal care for 49 people.

Daily Care 4 U had a registered manager in post who was present throughout this inspection. The registered manager was also the registered provider. 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.

We carried out an announced comprehensive inspection of this service on 13 June 2018. Breaches of legal requirements were found. These included, failure to protect people from abuse, failure to ensure fit and proper persons were employed, failure to ensure safe care and treatment, failure to deploy suitably qualified, competent and experienced staff, failure to provide person centred care, failure to act on complaints, failure to make appropriate notifications and failure to have systems and processes in place that ensure that they assessed, monitored and drove improvement in the quality and safety of the services provided. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Glebe Centre on our website at www.cqc.org.uk

At this inspection we focused on the key questions ‘Safe’ and ‘well-led’. We found the provider was still in breach of regulations regarding the safe treatment of people, protecting people from harm and abuse, fit and proper persons employed and ineffective quality assurance systems. In addition, we found them to be in breach of their duty of candour. This means that they were not open and honest with people when things had gone wrong.

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.

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.

People were not safe from the risks of ill-treatment and abuse as the provider failed to recognise and respond to allegations which could potentially harm people. The provider failed to follow safe recruitment practices when employing staff members and failed to complete robust risk assessments regarding staff members. People were at risk of harm when receiving assistance with their medicines as the provider did not have the systems to assess whether or not people received their medicines as prescribed. People were at risk of harm in relation to their care and support needs as there was insufficient assessment or guidance provided to staff on how to safely support someone with their identified risks. The provider had not embedded effective infection prevention and control practices. People were at risk of missed calls as the provider had insufficient systems in place to monitor staff member’s attendance.

The provider failed to keep themselves up to date with current practices in health and social care. There were insufficient quality monitoring checks completed to identify or respond to poor care practices. The provider did not act in an open and transparent manner when things went wrong. The provider did not safely secure people’s personal information. Policies and procedures were in place but these were not followed. The provider did not follow their own policies and procedures when unsafe and abusive staff practice was raised with them. The provider failed to make the required notifications regarding significant events occurring in their service.

You can see what action we told the provider to take at the back of the full version of the report.

This service is a domiciliary care agency. It provides personal care to people living in their own houses and flats. It provides a service to older adults and younger disabled adults. At this inspection they were providing personal care for 53 people.

Daily Care 4 U had a registered manager in post who was present throughout this inspection. The registered manager was also the registered provider. 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.

This service has not been previously inspected.

During this inspection we identified seven breaches of regulations. These were in relation to, not protecting people from the risk of abuse and ill-treatment, unsafe care and treatment of people, staff members not having the appropriate skills and support to meet people’s needs, complaints not being recorded or responded to, people not having personalised care based on their individual needs, failure to make notifications of significant events occurring within the service and ineffective quality assurance systems to identify or drive improvements.

People were not safe from the risks of ill-treatment and abuse as the provider failed to recognise and respond to allegations which could potentially harm people. The provider failed to follow safe recruitment practices when employing staff members. People were at risk of harm when receiving assistance with their medicines as the provider had failed to train and subsequently assess staff members as competent when supporting people. People were at risk of harm in relation to their care and support needs as there was insufficient assessment or guidance provided to staff on how to safely support someone with their identified risks. Staff members did not always follow safe and effective infection prevention and control practices. People could not be assured staff would arrive on time as the provider had insufficient systems in place to monitor staff member’s attendance.

People did not receive care that was effective and personalised to their individual needs and preferences. People were supported by staff members who did not have the appropriate training and assessment of their skills and abilities. Staff members did not receive appropriate support and guidance from the provider. New members of staff were not supported through a structured induction programme and were not equipped with the necessary skills to support people in their own homes. People could not be assured that their rights would be protected as the provider did not have effective systems in place or knowledge to meet the requirements of the Mental Capacity Act 2005. People were not supported to have maximum choice and control of their lives. The policies and systems of support in Daily Care 4 U did not promote the involvement of people in decisions about their care needs. People received assistance with eating and drinking although staff members had not been informed of, or promoted, people’s individual likes or dislikes.

People received an inconsistent experience regarding the approach from the staff who supported them. Some reported good and kind care whilst others did not. People did not have their protected characteristics recognised or respected by the provider. People were not always supported in a way that eased their anxiety or distress. People did have their privacy and dignity respected by staff members.

People were not consistently involved in developing their own care and support plans. People’s care and support plans did not contain the necessary information to direct the assistance they needed. When changes occurred in people’s personal and medical circumstances these plans were not reviewed to reflect these changes. People’s individual preferences were not known by staff members who supported them. People were able to raise concerns but the provider did not follow their own policies for recording or investigating complaints. People could not be assured their concerns would be effectively addressed. People did not receive information regarding their care and support in a way they could access or understand as the provider failed to recognise people’s individual communication needs.

The provider failed to keep themselves up to date with current practices in health and social care. There were insufficient quality monitoring checks completed to identify or respond to poor care practices. Policies and procedures were in place but these were not followed. People did not receive information regarding their care and treatment in a timely way. The provider did not follow their own policies and procedures when unsafe and abusive staff practice was raised with them. The provider failed to make the required notifications regarding significant events occurring in their service.