We carried out this inspection to see if improvements had been made. This service was last inspected in September 2023 and was rated inadequate. The local authority informed us that they believed improvements had been made and they wished to consider commissioning the service. At the time of this inspection, only two people were using the service and only one of those received support with the regulated activity of personal care. This was a comprehensive inspection of the service and we found improvements had been made since the previous inspection and we have now rated them as good. We found them to be providing care and support that was safe, effective, caring, responsive and well-led.
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Disablement Association of Barking and Dagenham was rated Inadequate overall following an unannounced inspection in September 2023, with substantiated safeguarding concerns including staff shouting at and roughly handling people, critical gaps in risk assessments, insufficient staffing, absent MCA compliance, and quality assurance failures since 2022. The service was placed in special measures with Warning Notices served for breaches of Regulations 9, 12, and 17, and further regulatory action taken for breaches of Regulations 10, 11, 13, and 18.
Concerns (13)
criticalSafeguarding: “Multiple safeguarding concerns raised by a whistle blower which when assessed by the local authority were substantiated. These included examples of poor care, out of date care plans and risk assessments.”
criticalSafeguarding: “Staff shouting at people and leaving them in bed 24 hours...staff handle [person] roughly when putting on their clothes, pulling them around in bed and shouting at them.”
criticalCare planning: “Risk assessments had not been completed in relation to people's health conditions. 5 out of 6 care plans stated a person was either at risk of choking or required modified texture food. There were no risk assessments.”
criticalStaffing levels: “Only 2 staff were on duty to support 8 people who lived in a supported living scheme. Six people required the support of 2 staff for personal care and moving safely.”
criticalConsent / capacity: “Care plans and risk assessments did not contain information that people had consented to their care and that where they could not give consent, a mental capacity assessment had been carried out.”
criticalGovernance: “There had been a lack of quality assurance checks since 2022. MAR chart audits and spot checks had not taken place since 2022.”
criticalPerson-centred care: “People were supported with personal care at times that suited staff as opposed to when they needed personal care to be delivered...without their agreement, so the day staff would have less work to do.”
criticalLeadership: “There was a high turnover of staff within the management team which lead to inconsistencies in leadership. At the time of the inspection the service did not have a registered manager.”
moderateRecord keeping: “Care plans had not been completed or reviewed with people's involvement or that of their relatives. Care plans had not been signed by people or their relatives.”
moderateStaff competency: “One staff member we spoke to was unable to tell us what types of abuse to look out for and who to report them to. Another member of staff told us they were unaware of the whistleblowing policy.”
moderateCommunication with families: “There were no communication plans or guidance to support staff to understand people's communication and sensory needs. One person had a speech impairment, and another was hard of hearing.”
minorMedication management: “The provider had not regularly assessed staff competency to support people with their medicines.”
minorCultural competency: “Care records did not also address people's diverse and cultural backgrounds. This meant staff might not have all the necessary information to care for people appropriately.”
Strengths
· Staff were safely recruited with pre-employment checks including DBS, references and employment history reviews.
· Staff completed an induction comprising e-learning and shadowing, and received specific training including mental health awareness, learning disabilities and dysphagia.
· People were supported to eat and drink enough, with nutritional needs assessed and meal choices offered.
· People were supported to access healthcare services; staff acted appropriately when people became unwell and liaised with medical professionals and relatives.
· Staff had access to and wore full PPE, and infection prevention and control practices were followed.
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Staffing and recruitmentInadequate
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely care; supporting people to live healthier livesGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Supporting people to develop and maintain relationships to avoid social isolation; support to follow interests and activitiesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; continuous learning and improving careInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement
This focused inspection of Disablement Association of Barking and Dagenham found improvements had been made following a previous 'Requires improvement' rating, with breaches of Regulations 12 and 17 remediated. The service was rated Good overall, with safe and well-led both achieving Good ratings based on strengthened risk assessments, medicines management, and governance systems.
Concerns (2)
minorRecord keeping: “Where the service spent money on behalf of people, records and receipts were kept of this. However, these were not audited or checked by a senior member of staff.”
minorPerson-centred care: “One person told us some staff rushed them. We discussed this with the registered manager who said they would investigate the matter.”
Strengths
· Risk assessments were in place covering moving and handling, medicines, health conditions and personal care, subject to regular review.
· Medicine administration records (MAR) were in place and audited to check correct completion and medicines given as prescribed.
· Sufficient staffing levels with no missed calls reported in the past 12 months.
· Robust pre-employment checks carried out including DBS, identification, right to work and references.
· Effective infection prevention and control measures in place including PPE, testing and up-to-date policy.
Disablement Association of Barking and Dagenham was rated Requires Improvement overall at its November 2019 inspection, down from Good in 2017, due to breaches of Regulation 12 (unsafe risk assessments and medicine management) and Regulation 17 (inadequate governance and failure to learn from incidents). Caring, effective and responsive domains remained Good, with staff praised for their compassion, person-centred care planning and support for independence.
Concerns (5)
criticalMedication management: “staff 'Should pop out medicines and place in pot and to ensure [person] takes medicine in front of carers' ...MARs were not kept of the administration.”
criticalCare planning: “risk assessments had not been completed in relation to people's health conditions and circumstances...no information on the signs and symptoms of breathing difficulties or high blood pressure.”
criticalGovernance: “Robust systems would need to be put in place to ensure these shortfalls were identified and prompt action taken to ensure people received high quality care at all times.”
moderateIncident learning: “body maps had been completed when people had small bruises or small cuts...this was not being analysed or investigated so action could be taken to minimise any risk of re-occurrence.”
moderateStaff competency: “Some people had cerebral palsy...Some staff we spoke to were not aware of cerebral palsy and the risks that may be associated with this.”
Strengths
· Staff were kind, compassionate and had developed positive relationships with people they supported, treating them with dignity and respect.
· Care plans were person-centred and detailed people's support needs including preferences and areas of independence.
· Staff received mandatory training and refresher courses; supervisions were carried out to support staff in their roles.
· Systems were in place to ensure timely staffing, with rotas sent in advance and spot checks carried out.
· Robust pre-employment checks including DBS, references and identity verification were completed for all staff.
Quality-Statement breakdown (23)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Staff support: induction, training, skills and experienceGood
Disablement Association of Barking and Dagenham was rated Good across all five key questions at its January 2017 inspection, with 35 people receiving personal care supported by well-trained, compassionate staff and personalised care plans. A minor gap was noted in that two criminal records checks out of 40 had not been completed in a timely manner, and the service was operating without a registered manager at the time of inspection.
Concerns (1)
minorRecord keeping: “We did note two criminal records checks out of 40 had not been done for some time and we informed the service of this.”
Strengths
· Staff trained in safeguarding adults and children and knew escalation procedures including whistleblowing to external agencies
· Medicines managed safely with staff trained in medication administration and MAR records maintained
· Safe recruitment practices including application forms, interviews, references, and criminal records checks
· Staff received regular supervision every three months, spot checks every six months, and an annual appraisal
· Care plans were personalised, reviewed regularly, and involved people and their families in the planning process
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives and access healthcare servicesGood
caring: Ensuring people are well treated and supported; 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 meet people's needs, preferences, interests and give them choice and controlGood
responsive: Supporting people to develop and maintain relationships and avoid social isolationGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Continuous learning and improving careGood