District Care improved from Requires Improvement to Good overall following a comprehensive inspection on 31 May 2023, with all previous regulatory breaches resolved. Well-led remains Requires Improvement as governance systems, while strengthened, have yet to demonstrate sustained effectiveness, and people were not provided feedback on quality assurance survey results.
Concerns (3)
moderate
Governance
: “The service now needs to demonstrate that these systems are working effectively, and appropriate action is taken when shortfalls are identified.”
minorRecord keeping: “This now identified areas which needed attention. For example, some care plans were overdue for review.”
minorCommunication with families: “People told us they received quality assurance surveys from the service. However, some stated they would have liked some feedback regarding the results.”
Strengths
· People and relatives were complimentary about the service and would recommend it; staff described as friendly, efficient and kind.
· Risk assessments were carried out with appropriate actions, and care plans were personalised and person-centred.
· Staff were safely recruited, received appropriate training including MCA, safeguarding, infection control and medicines administration.
· People received care visits at expected times for the agreed duration from staff they knew.
· People were supported to maintain dignity, independence and involvement in care planning decisions.
Quality-Statement breakdown (20)
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
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: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
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: 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
District Care, a domiciliary care agency in Lowestoft serving 47 people, was rated Requires Improvement overall following an unannounced inspection in November 2022, with Well-led rated Inadequate — a significant decline from its previous Good rating in 2019. Three regulatory breaches were found: failure to complete risk assessments (Regulation 12), failure to apply the Mental Capacity Act (Regulation 11), and ineffective governance including systematic visit-shortening that went undetected (Regulation 17).
Concerns (7)
criticalCare planning: “one person had a history of falls which resulted in serious injury before District Care started providing support to them. Despite this, the service had not carried out falls risk assessment, nor was there any care planning around reducing the risk of further falls.”
criticalConsent / capacity: “The service was providing care to a number of people living with dementia whose capacity to make decisions had not been assessed. The registered manager demonstrated a lack of knowledge around the Mental Capacity Act.”
criticalGovernance: “the majority of people's visits were cut short. This was frequently by ten minutes but in some cases, calls were cut short by 20 to 30 minutes. There was no explanation in the records of why this was the case.”
criticalLeadership: “The registered manager did not demonstrate an appropriate knowledge or understanding in key subjects... They also demonstrated a poor knowledge of risk management and monitoring processes.”
moderateMissed or late visits: “Records completed by staff demonstrated that people's visits were being regularly cut short and this had not been identified by the service.”
moderateIncident learning: “The registered manager and provider failed to operate systems capable of identifying the shortfalls we found. Therefore, we were not assured they were able to continuously learn and improve care independently.”
moderateRecord keeping: “There was a quality assurance system in place which included checks on care plans. However, this had not identified the shortfalls we found with regard to a lack of risk assessment and risk management care planning.”
Strengths
· People told us they felt safe when carers visited them and that staff were kind, caring and thoughtful.
· Staff were recruited safely with robust DBS checks and references, and had appropriate training for the role.
· Medicines were administered, managed and monitored safely with correctly completed MAR records.
· Staff had regular appraisal and supervision sessions and competency assessments were carried out.
· The service had good links with healthcare professionals such as district nursing teams and GP surgeries.
Quality-Statement breakdown (15)
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: Using medicines safelyGood
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 standards, guidance and the law
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
well-led: Promoting a positive culture; duty of candour; understanding quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving careInadequate
well-led: Working in partnership with othersGood
well-led: Engaging and involving people using the service, the public and staffGood