Archived: Direct Carers Ltd

Updated 8 March 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The site visit to the agency office took place on 12 January 2017 and was announced. The registered provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the agency office who could assist us with the inspection. The inspection was carried out by two adult social care inspectors and an expert by experience. An expert by experience is someone who has personal experience of using or caring for someone who uses / has used this type of service. The expert by experience made telephone calls to people who used the service on 16 January 2017 and an inspector visited people who lived in their own home on 30 January 2017.

Before this inspection we reviewed the information we held about the agency, such as information we had received from the local authority who commissioned a service from the registered provider and feedback from people who used the service.

The registered provider was asked to submit a provider information return (PIR) before this inspection. This is a form that asks the registered provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR was submitted within the required timescale.

On the day of the inspection we spoke with the registered provider, the registered manager and agency office staff. We also spent time looking at records, which included the care records for seven people who used the service, the recruitment records for five care workers and other records relating to the management of the service, including quality assurance, staff training, health and safety and medication. Following the inspection we spoke with eleven people who used the service, three relatives of people who used the service and seven members of staff. We also visited four people in their own home.

Updated 8 March 2017

This inspection took place on 12 January 2017, 16 January 2017 and 30 January 2017 and the first inspection day was announced. The registered provider was given 48 hours' notice because the location provides a domiciliary care service and we needed to be sure that someone would be at the agency office who could assist us with the inspection.

The service is a domiciliary care agency that is registered to provide the regulated activity personal care. This includes support with activities such as washing and dressing, the provision of meals and the administration of medication for people living in their own home. On the day of the inspection 127 people were receiving assistance with personal care. The agency office is situated in Beverley, in the East Riding of Yorkshire, and there is parking available for people who wish to visit the office by car.

The registered provider is required to have a registered manager in post and on the day of the inspection the manager was not registered with the Care Quality Commission (CQC). However, they had submitted an application to become registered as the manager and had an interview with the Commission the day before this inspection. We were later informed that their application to be registered as the manager was successful. 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 found that the agency had not followed their own policies and procedures when recruiting new staff and that this could have resulted in people receiving care from staff who were not suitable to work with vulnerable people.

This was a breach of Regulation 19 (1)(a)(b)(2) of the Health and Social Care Act (Regulated Activities) Regulations 2014: Fit and proper persons employed.

Some concerns were expressed about the management of the service. People were concerned about the consistency of the service in that they did not always know who would be visiting them, and they did not always receive their agreed time because staff were not allowed travelling time between calls. Care records were inconsistent and this could have led to people not receiving appropriate care. Quality audits had not identified some of the shortfalls we found during the inspection.

This was a breach of Regulation 17 (1)(2)(a)(c) of the Health and Social Care Act (Regulated Activities) Regulations 2014: Good governance.

We saw there were sufficient numbers of staff employed to meet people's individual needs, although we felt that staff deployment needed to be reconsidered so that people received their agreed package of care.

We found that people were protected from the risk of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

People expressed satisfaction with the support they received with the administration of medication. However, we found some omissions in recording that meant it was not clear whether people had received their prescribed medication.

Staff confirmed they received induction training when they were new in post and told us that they were happy with the training provided for them. The training records showed that staff had completed induction training and the training that was considered to be essential by the agency, although some refresher training was overdue.

The feedback we received confirmed that people had positive relationships with care workers and it was apparent that care workers genuinely cared about the people they supported.

There was a record of any accidents or incidents involving people who received a service from the agency although the analysis of these records had only just commenced. It was anticipated that this would enable the registered provider to monitor whether any patterns were emerging or if any improvements to staff practice were required.

There was a complaints policy and procedure and this had been made available to people who received a service and their relatives. Some people told us they were satisfied with how their complaint had been responded to.

There were systems in place to seek feedback from people who received a service and we saw that most of this feedback was positive. There were minimal systems in place to request feedback from staff.

We found the registered provider was in breach of two of our regulations under the 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 the report.