Derbyshire Care Services HQ is a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community in a supported living setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Previously the provider had two services registered with CQC: Derbyshire Care Services and Derbyshire Care Services Central and West. The last inspection of both services took place in June 2017. We rated both services overall as ‘requires improvement’. We found two breaches of the regulations because both services were not always safe or well-led. We issued requirement notices in response to these. Both these services have been cancelled by the provider.
In April 2018 the provider registered a new service, known as Derbyshire Care Services HQ at a new address located in Derby city. The staff employed at this service have been transferred from Derbyshire Care Services and Derbyshire Care Services Central and West.
This inspection took place between 21 to 23 August 2018 and was announced.
At the time of our inspection visit 363 people were using the service and received a regulated activity; personal care.
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.
System, processes and procedures were in place to promote people’s safety. People were mostly protected from the risk of avoidable harm and abuse. Staff had been trained in safeguarding people and understood how to keep people safe. Staff followed the infection control procedures
The risks to people’s health and wellbeing had been assessed. We found further improvement were needed to ensure specific risks to manage people’s health conditions had been identified. Clearer guidance in the care would enable staff to follow the measures put in place to meet people’s needs and to promote their safety and independence.
Staff recruitment procedures reduced the risks of employing staff unsuitable to work in care. There were enough staff to meet people's needs. People expressed concerns about poor time-keeping and lack of communication that increased the risk of people not receiving the care they needed at the agreed times. The registered manager had taken action and put systems and processes in place. The computerised system used to plan rotas estimated the travel times between each visits and changes in management staff roles enabled them to monitor and improve communication with the care staff team and people using the service.
Staff were trained in safeguarding and other safety procedures to ensure people were safe and protected from avoidable harm. Staff understood their responsibilities to report concerns.
People were supported with their medicines in a safe way. People’s nutritional needs were met and they were supported with their health care needs when required. The service worked with other organisations to ensure that people received coordinated care and support.
Care staff had not always been supported in their role. Supervisions and their observed practices were overdue. The registered manager had put systems in place to address this. The registered manager and the provider continue to monitor this.
The provider, registered manager and staff demonstrated their understanding of the Mental Capacity Act, 2005 (MCA) and gained people's consent before they were supported. 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 and their family were involved in the development of their care and staff had a good understanding of people's needs. Care plans were different written in formats and required more details to reflect people’s preferences, culture needs and lifestyles choices. People’s care plans and risks had not been kept under review and the guidance for staff to follow varied. These had been identified by the registered manager and action taken. New risk assessments and care plans developed were more personalised and reflected people’s preferences, daily routines, cultural needs and what was important to them. A system had been put in place to review people’s care needs and transfer information to the new care plans. The registered manager and the provider continue to monitor this.
People and their relatives were happy with their regular care staff and had developed positive trusting relationships. People were treated with dignity and respect, and their rights to privacy were upheld. Staff respected people’s backgrounds, faith and choice of lifestyle and promoted their impendence. People had the opportunity make decisions about their end of life care.
People, relatives and staff were encouraged to provide feedback about the service. People knew how to make a complaint. The provider had a process in place that ensure complaints and concerns were addressed in a timely manner.
The registered manager and provider were aware of their legal responsibilities and provided good leadership. The registered manager, management and staff team were committed to the provider’s vision and values of providing good quality care.
People and relative’s views about how well the service was manage were mixed however, all acknowledged there had been some improvements. Staff spoke positively about the registered manager and the changes that had been made to the service.
The provider’s policies and procedures had been reviewed and updated. The provider had governance systems and processes but these were not used effectively, which meant some aspects were fragmented. The registered manager made changes within the service in relation to the management, changes in staff roles and responsibilities, and introduced new systems and processes to improve the running of the service. There were arrangements in place for the service to make sure that action was taken and lessons learned when things went wrong, to improve safety across the service. The provider worked in partnership with other agencies and made improvement where required to meet people’s needs.