South East and South Derbyshire Home Care improved significantly from its previous Inadequate rating, exiting Special Measures with Good ratings across Safe, Effective and Caring domains following resolution of multiple regulatory breaches. Requires Improvement ratings remain for Responsive and Well-Led due to underdeveloped end-of-life care planning and newly introduced governance systems not yet fully embedded.
Concerns (4)
moderate
End-of-life care
: “Information relating to people's care during this stage of life had not always been explored...people's care plans did not record people's wishes or views.”
moderateGovernance: “These systems need to be embedded within the service and staff to receive on-going training and support to ensure continued effective outcomes.”
minorCare planning: “End of life care...staff confirmed this was not always discussed and people's care plans did not record people's wishes or views.”
minorStaff training: “The provider was offering care and support for people when they were discharged from hospital and some staff had not received the training to support people with reablement.”
Strengths
· People felt safe when receiving care and risks were now assessed with management plans guiding staff.
· Medicines management had improved with staff receiving training and competency checks for safe administration.
· Safeguarding processes were now in place; staff understood their role and reported concerns appropriately.
· Care plans were developed with people before the service started and reviewed when needs changed.
· People received kind, compassionate, dignified care from consistent, familiar staff teams.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and management; using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: End of life care and supportRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture; managers and staff clear about roles; continuous learning; duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
DCC Amber Valley Home Care received a focused inspection of the Responsive and Well-Led key questions, both rated Good, improving from Requires Improvement at the previous inspection in January 2020. The service demonstrated strong person-centred care planning, effective governance and audit systems, and a positive open culture with no failure themes identified.
Strengths
· People were involved in creating their care plans and supported as individuals in line with their needs and preferences.
· The provider met the Accessible Information Standard and supported people's communication needs.
· No complaints received in the past 12 months; people and relatives knew how to raise concerns.
· Staff received end of life care training and were able to support people in partnership with external professionals.
· Quality assurance systems ensured regular auditing; medication recording errors were promptly followed up with training and supervision.
Quality-Statement breakdown (9)
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood
South East and South Derbyshire Home Care was rated Inadequate overall following a February 2019 inspection of 219 people receiving domiciliary care, with enforcement conditions imposed for breaches of Regulations 11, 12, and 17 relating to consent, safe care and treatment, and governance. Critical failures included unsafe medicines management, unreported safeguarding concerns, missed calls not identified until the following day, incomplete risk assessments, and ineffective quality monitoring systems.
Concerns (10)
criticalMedication management: “Systems were not always in place to ensure people had their medicines when needed. People's care records did not include all the information about what medicines people had prescribed.”
criticalSafeguarding: “When their concerns had been reported to the office staff, this information was not reported to the safeguarding team. Breach of Regulation 13.”
criticalMissed or late visits: “One person needed support with their meals and had diabetes. It had not been identified that the call had been missed until the following day.”
criticalCare planning: “Care plans and risk assessments were not always completed before people started using the service and they had limited information about how people needed to be supported safely.”
criticalGovernance: “Quality monitoring systems were not effective to ensure people received safe care. Breach of Regulation 17 of the Health and Social Care Act 2008.”
criticalConsent / capacity: “Where people no longer had capacity to make decisions, assessments of capacity had not been completed and decisions were being made by family members without considering best interests.”
moderateIncident learning: “There was no formal analysis to help identify any themes or trends and people's care was not always reviewed to reflect any significant events.”
moderateRecord keeping: “Care plans in the home were not always the most recent documents. Where changes were made in the care records, these were often posted to people with no checks to ensure receipt.”
moderatePerson-centred care: “Some morning calls were around lunch time and people told us that they felt uncomfortable staying in their night clothes all morning. Breach of Regulation 9.”
moderateCommunication with families: “Where people had a hearing impairment and used sign language, there was no information available to support them to communicate and express themselves.”
Strengths
· Sufficient numbers of staff on duty with safe and effective recruitment practices including satisfactory references and DBS checks.
· Staff maintained good infection control standards; PPE provided and assessed during spot checks.
· People were supported to access healthcare services and staff monitored health needs, staying with people during medical emergencies.
· Staff completed a six-week induction programme and shadowed experienced staff before working independently.
· People felt staff were kind, caring and respectful, maintaining dignity during personal care.
Quality-Statement breakdown (19)
safe: Assessing risk, safety monitoring and management / Using medicines safelyInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced diet
Erewash DCC Home Care Services received a Good rating across all five key questions at its first inspection since registering in October 2014, with 146 people supported in the Erewash region. The service demonstrated safe staffing, robust recruitment, effective training, dignified care, responsive care planning, and well-functioning governance and audit systems.
Strengths
· People felt safe and reported trust in regular, familiar staff; key safe systems protected security of entry.
· Thorough recruitment checks including DBS and references before staff commenced employment.
· Structured induction using the national Care Certificate with shadowing, observations and mentoring for new staff.
· Staff trained in Mental Capacity Act and observed seeking consent before care; choices offered even for small decisions.
· People had positive, respectful caring relationships with staff; service achieved the local authority dignity award.
Good
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Staff support: induction, training, skills and experienceGood
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Planning and promoting person-centred, high-quality care; governance and continuous learningInadequate
well-led: Engaging and involving people using the service, the public and staffGood