The Care Quality Commission
  • Services in your home
  • Homecare service

Archived: Direct Health (Nottingham)

Overall: Good read more about inspection ratings

6th Floor, Pearl Assurance House, Friar Lane, Nottingham, Nottinghamshire, NG1 6BT (0115) 896 4005

Provided and run by:
Direct Health (UK) Limited

Important: The provider of this service changed. See new profile

All Inspections

28 November 2016

During a routine inspection

This inspection took place on 28 November 2016. Direct Health Nottingham is a domiciliary care service which provides personal care and support to people in their own home in Eastwood, Beeston, Stapleford and Kimberley in Nottinghamshire. There were 170 people using the service at the time of the inspection.

There is a registered manager and she was available 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of avoidable harm. Risks to people’s health and safety were managed and plans were in place to enable staff to support people safely. Missed calls had greatly improved since our last inspection and where these had occurred; appropriate action had been taken to reduce further risks.

People were not routinely informed in advance of the staff that would be visiting them and this was important to them. Not all people were informed if calls were going to be late but people said communication with the office had much improved since our last inspection.

There were sufficient numbers of staff to meet people’s care needs and safe recruitment practices meant as far as possible only staff suitable to work for the service were employed. People received the level of support they required to safely manage their medicines.

Staff received appropriate induction, training and supervision. People’s rights were protected under the Mental Capacity Act 2005. People received the assistance they required to have enough to eat and drink. External professionals were involved in people’s care as appropriate.

Positive and caring relationships had been developed between staff and people who used the service. People were involved in the planning of their care and making decisions about what care they wanted. People were treated with dignity and respect by staff who understood the importance of this.

People received the care they needed and staff were aware of people’s support needs. Care records had improved and information for staff was easy to follow. Support plans showed personalised care was provided but the level of detail and quality of information recorded was dependent on what care coordinator had completed the record. People felt able to make a complaint and knew how to do so.

The provider had checks in place that monitored the quality and safety of the service. This included opportunities for people who used the service to share their experience of the service they received. The provider had notified us of important events registered providers are required to do.

19 October 2015

During an inspection looking at part of the service

This inspection took place on 19 October 2015 and was announced. This meant we informed the provider at short notice of our visit.

When we last inspected the service in January 2015 we found the provider was in breach of three Regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. At this inspection we found the provider had taken action to meet these breaches. Further improvements were required to ensure continued sustainability, new systems and processes needed time to fully embed.

Direct Health provides care to people in their own homes. Since our last inspection the provider had made some changes to their registration. This meant there were less people that used the service managed from this branch. At the time of this inspection there were 515 people who used the service.

Direct Health is required to have 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 (Regulated Activity) Regulations 2014 about how the service is run. At the time of our inspection there was not a registered manager in place, but the branch manager was in the process of submitting their application to us to apply to become the registered manager. We will monitor this.

People that used the service did not always receive care and support from regular care workers. They said this impacted on how well their needs, routines and what was important to them was known and understood by care workers.

Whilst care workers stayed for the duration of the call and people said they received a safe service, most people said they had experienced late calls. Additionally, there were inconsistencies of people being informed in advance about late calls or which care workers were due to visit. Missed calls had improved due to better monitoring systems in place.

People that used the service and care workers said they found contacting the office was difficult. Additionally, messages left were not always responded to in a timely manner.

Care workers had a good understanding of the various types of abuse and their roles and

responsibilities in reporting any safeguarding concerns. Safe recruitment checks were in place that ensured people were cared for by suitable care workers.

People’s needs were assessed and planned for when they first started using the service. This information was then developed into a plan of care and other documentation such as risk assessments were completed. The provider had an ongoing plan to review people’s care packages. On the whole people said they felt involved in the development and review of their care package.

The communication system used to share information with care workers had been improved upon but most care workers said they had experienced some difficulties receiving and accessing this information.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA and to report on what we find. This is legislation that protects people who are unable to make specific decisions about their care and treatment. It ensures best interest decisions are made correctly. Where people lacked mental capacity appropriate assessments and best interest decisions had been made in line with this legislation.

On the whole people that used the service spoke highly of the care workers and complemented them on their approach. They referred to them as kind and caring. Additionally, people said that the service had started to show improvements.

People were supported appropriately with their food and drinks. Support was provided with people’s healthcare needs and action was taken when changes occurred.

Care workers received an induction before they provided care and support. The provider was in the process of ensuring all care workers were up to date with refresher training. Support to care workers required improvements to ensure care workers received appropriate opportunities to discuss and review their role and responsibilities.

The provider had improved the checks in place that monitored the quality and safety of the service. The provider had notified us of important events registered providers are required to do.

14 January 2015

During a routine inspection

This inspection took place on 14 January 2015 and was announced. This meant we informed the provider at short notice of our visit. When we last inspected the service in January 2014 the provider was meeting all the required standards.

Direct Health provides care to people in their own homes. There were 1000 people who used the service at the time of our visit.

There was a registered manager in post at the time of our visit. A manager is required to register with us by law. 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 (Regulated Activity) Regulations 2014 about how the service is run.

The service was not providing consistently safe care.

Not all risks were identified and managed. People’s care plans did not always reflect their care needs and risk assessments were not always in place.

Staffing levels appeared good, but there were a high proportion of missed late and irregular calls which meant people’s safety was compromised.

Where the service was responsible for people’s medicines, people were at risk, as they did not always receive their medicines in a timely manner.

Most people told us they were well cared for, but some people and their relatives expressed concerns about staff skills and knowledge. Inductions had taken place, but staff supervision was not up to date. There were gaps in staffs on-going training. People’s on-going health needs were not always met.

People’s nutritional needs were met, but some people had varied experiences, when the service was responsible for supporting people.

Some people were happy with the care provided by the service. They told us the staff were kind and respectful at all times. Staff we spoke with told us they had clear values to ensure people were treated with dignity and respect.

Some people were able to express their views by completing a service questionnaire about how the service was run, but this did not reflect all the views of people who use the service. Some felt their views were not always taken on board.

People did not have access to an advocacy service, or appropriate information to support them make informed choices

Systems in place to monitor and improve the quality of the service provided were not robust enough to highlight concerns.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which, corresponds to the Health and Social care Act (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 did not receive planned care and support that was relevant to their needs and delivered in a safe way. People’s needs were not always identified, assessed and managed according to risk. Complaints were not always investigated or resolved to the satisfaction of the person who used the service, or people acting on their behalf.

17 January 2014

During a routine inspection

The people we spoke with who used the service all said that they were happy with the care and support they received. One person said, 'I am very satisfied with Direct Health. I have nothing to complain about'. Another person we spoke with said, 'They (the carers) are all fantastic. Everyone is very kind and very helpful'. A relative of someone who used the service said, 'I am well satisfied with the service and the carers. I couldn't have managed caring for (my relative) without them'.

We sent out 61 questionnaires and had 37 returned in total. 24 of these were from people who used the service, and 13 from their relative/friend/advocate. Overall, people were very satisfied with the service being provided by Direct Health. All of the people who used the service said that they thought the care staff had the right skills needed to give them the care and support they needed.

People's care records showed that they had been fully involved in making decisions about what care and support they needed. All of the people we spoke with told us that the team leaders regularly reviewed their care needs with them. People told us that they felt treated with respect and dignity, and that the carers were always kind to them.

Care plans were detailed, up to date and person-centred. Appropriate risks assessments had been completed and reviewed on a regular basis. There was a secure system for the passing of information from the care coordinators based in the office to the carer workers visiting people in their homes. We saw evidence that this system was effective and helped ensure people's needs were met.

People who used the service told us that they felt safe and did not have any concerns. The provider had appropriate arrangements in place to reduce the risk of abuse to people. The care staff understood their responsibilities to report any suspicion or allegation of abuse.

At the time of this inspection there were enough suitably trained and experienced staff to meet the needs of the people who used the service. People were very complimentary about the staff. We noted that the provider had a system in place to alert the care coordinators when a care worker was late to visit someone in their home. The provider had a system in place to telephone people if their care worker was going to be late.

The provider had a complaints policy and procedure. This was readily available to people who used the service. All of the people we spoke with said that they knew how to raise a complaint if they needed to.