Das Care Limited

DAS Care Limited is a domiciliary care service that provides personal care and support to people living in their own homes. The service was supporting 11 people with personal care at the time of our inspection.

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. At the time of this inspection, everyone who used the service received personal care.

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

People were at risk of harm because care plans lacked sufficient detail to care for people safely and assessments did not identify risk and action required to minimise this. For example, where one person required support to keep their limbs mobile to reduce pain and stiffness, there was no guidance in place as to how to do this safely. The lack of detailed care documentation also had an impact on people receiving care that met their individual needs, preferences and characteristics.

Staff understood how to support people to take their medicines safely and how to reduce the risks associated with the spread of infection. They understood how to identify and report incidents of potential avoidable harm. Where people were supported with food and drink, they said this was done well. Staff worked well with other health and social care professionals to make sure people received the care they needed.

The provider had safe recruitment processes in place and there were enough staff to care for people. Staff had received training in relation to their role. People confirmed staff were usually on time and stayed for the expected amount of time for their care calls. They told us they did not feel rushed and that staff and the registered manager were kind and listened to their views. Staff and the registered manager spoke with respect and compassion for the people they supported.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Staff had completed training in the Mental Capacity Act. However, the registered manager did not have good understanding of their responsibilities in relation to this legislation. Where people might have lacked capacity to make specific decisions about their care, assessments of their capacity had not been completed. Where decisions were made in their best interests, a record of the process used and who was involved was not made.

Although the provider had developed some quality monitoring systems, these were not effective at identifying issues and did not cover all aspects of the service. Significant shortfalls in care documentation had not been sufficiently addressed. This put people at risk of harm because guidance on how to meet their needs and maintain their safety was insufficient. Quality monitoring systems had not identified this.

The registered manager’s skills and understanding of key aspects of managing a care service and providing safe high-quality care required development. The registered manager acknowledged this and was taking steps to enrol on training to develop their skills. People, their relatives and staff were complimentary about the registered manager and said they were supportive, fair and approachable.

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

Rating at last inspection and update

The last rating for this service at the previous premises was inadequate (published 20 January 2022) and there were multiple breaches of regulations. Following the inspection we imposed conditions on the provider’s registration to restrict new and increased care packages, and to require a regular report on improvements made. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made in some areas but not in others and the provider remained in breach of regulations . The conditions imposed on the provider’s registration will remain in place following this inspection.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified continued breaches in relation to care planning and risk assessment, the Mental Capacity Act and the quality assurance and management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

DAS Care Limited is a domiciliary care service that provides personal care and support to people living in their own homes. The service was supporting 17 people with personal care at the time of our inspection.

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

At the beginning of our inspection activity the provider provided us with inconsistent information. This related to the amount of people receiving personal care and the amount of staff who were actively working for the service. This was difficult for the provider to verify.

We had to liaise with the local authority to determine the amount of people that were receiving commissioned care.

People were at risk of poor care and support because there were no governance systems in place to monitor the quality of the service. No audits were being carried out. This meant that the provider had failed to identify and address the issues we found during our inspection of the service.

Although there were enough staff employed to care for people, the provider was unable to demonstrate that staff had been recruited safely. Relatives said their loved ones felt safe with staff and advised that a regular team of staff would visit who knew them well.

No induction for new employees was taking place and not all staff had received essential training. Staff had not received competency assessments or supervisions to ensure they had the required skills to provide safe care and support to people. In most cases staff’s previous work experience in other care settings had been relied upon.

People’s medicines were not managed safely. Some people did not have medicines records even though staff were prompting their medication and no medication risk assessments were in place. The provider was unaware that this paperwork needed to be completed.

Risk management of people’s care required improvement. Not all risks were assessed and those that were did not contain the information staff needed to provide safe care.

Staff were not taking part in the governments COVID-19 testing programme for domiciliary care workers.

A safeguarding concern relating to a person living with dementia had not been reported to the relevant authorities without delay and the provider had limited knowledge of safeguarding processes. A review of this person’s care had not taken place to ensure that it was suitable and safe.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. There were no mental capacity assessments or best interest decisions in place, and staff and management had limited knowledge of the principles of the Mental Capacity Act 2005 (MCA).

Despite our finding’s relatives felt listened to and were involved in decisions about their family members care and support. Relatives confirmed their loved one’s dignity was maintained, and staff were able to describe how they promoted people’s independence and respected their right to privacy. However, we found that care plans were not person-centred and did not outline individual preferences and wishes on how people would like to be supported or any information about their life history.

Relatives felt able to raise concerns with the management team if they had any and were positive about the care their loved ones received. However, the provider had not set up a system to identify, record and respond to any concerns or complaints.

Staff told us that they enjoyed working for the company and that they felt supported by the manager. The service worked with other professionals to support people with complex health needs to remain living in the community. Feedback received about the provider’s professional manner was positive.

The provider responded positively to our findings, welcomed our inspection and planned to make improvements in the future.

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

Rating at last inspection

This service was registered with us on 29/01/2020 and this is the first inspection.

Why we inspected

This was a planned inspection based on the date of registration.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe recruitment of staff, safeguarding service users from abuse, staff competency and training, safe care and treatment people receive, care that is not person-centred, consent to care, no system in place to identify and manage complaints and the overall management oversight of the service at this inspection.

We took action to impose conditions on the providers registration to prevent them taking on new or increases in care packages until improvements have been made. The provider is also required to give regular updates on progress towards these improvements.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions 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.