Dana Home Care was rated Requires Improvement overall following a November 2017 inspection, with five regulatory breaches identified covering medicines management, recruitment, complaints handling, governance, and failure to notify CQC of incidents. Strengths were noted in caring practices, multi-agency working, and personalised support, but the service was found to rely excessively on CQC intervention to drive improvements.
Concerns (8)
criticalMedication management: “The MAR for one person showed staff had signed for supporting them to take their medicines five times across 20 days when care records showed the person was visiting family.”
criticalRecord keeping: “One incident report stated the person was 'taken to room' and 'contained.' Their daily record stated 'physical restraint' was used...the incident summary stated the person was 'prompted' and 'invited'.”
criticalGovernance: “Quality and risk audits were not consistently effective as they had not identified the concerns and service shortfalls that we found.”
criticalIncident learning: “Three police incidents and a safeguarding matter were not notified to us, as required by legislation, until we pointed this out to the management team.”
criticalSafeguarding: “The service relied too much on our interventions to support continuous learning and improvement...a safeguarding matter were not notified to us, as required by legislation.”
moderateStaff competency: “One staff member told us they had started giving medicines to people through on-site support and checks, but not yet completed online training.”
moderateComplaints handling: “It took over two months before a further response to the complaint was received...the explanation meant the response would still have taken 50 days.”
minorStaff training: “The induction process was not in line with the national Care Certificate which is seen as best practice for ensuring each new staff member has demonstrated sufficient knowledge.”
Strengths
· People were treated with kindness, respect and compassion, and staff demonstrated good knowledge of individual needs and preferences.
· The service cooperated effectively with external organisations, healthcare professionals and local authorities to deliver care.
· Personalised care plans and positive behaviour support plans were in place and kept under regular review.
· Staff supported people to engage in community activities, employment, and to develop independence skills.
· Attention was paid to communication needs, including use of Makaton and 'social stories' for autistic individuals.
Quality-Statement breakdown (20)
safe: Staffing and recruitmentRequires improvement
safe: Medicines managementRequires improvement
safe: Risk assessment and managementGood
safe: SafeguardingGood
safe: Infection controlGood
effective: Assessment of needs and care planningGood
Dana Home Care was rated Good overall at its first inspection in January 2016, with staff providing individualised, relationship-based care underpinned by effective safeguarding and staffing practices. The single Requires Improvement rating in Effective reflected incomplete Mental Capacity Act compliance, including absent capacity assessments and outstanding Deprivation of Liberty Safeguards applications for supported living residents.
Concerns (5)
criticalConsent / capacity: “People's care records did not include assessment of their capacity to consent to receiving care and support from the service.”
criticalConsent / capacity: “applications to the Court of Protection, as required for people in supported living schemes, had not yet occurred.”
moderateMedication management: “their medicine profile did not have a guidance sheet for circumstances on when and how much of the medicine to offer...it was not administered as prescribed.”
minorRecord keeping: “in one case the reviews were four months out of date.”
minorComplaints handling: “at the time of the inspection, the complaint was six weeks old without being resolved.”
Strengths
· Positive feedback from people, relatives and community professionals about care quality and staff knowledge.
· Sufficient staffing levels with consistent staff teams enabling individualised, relationship-based care.
· Effective safeguarding procedures understood and followed by staff with no current safeguarding activity.
· People's positive behaviour guidelines provided clear, individualised guidance to staff on managing risks.
· Robust staff recruitment process including scenario-based interviews and criminal record checks.
Dana Home Care improved from Requires Improvement to Good across all five key questions following remediation of medicines management, recruitment, complaints handling and governance shortfalls identified at the November 2017 inspection. The service demonstrated consistent person-centred care for 13 adults with learning disabilities across five supported living locations, with strong staff support and effective partnership working.
Strengths
· Medicines management significantly improved since previous inspection: stocks balanced, MAR charts accurate, clear protocols for 'as needed' medicines, and staff competencies assessed.
· Robust staff recruitment checks embedded, including DBS, employment history, right to work, and references.
· People and relatives consistently praised the kindness, dedication and skill of staff.
· Comprehensive, person-centred risk assessments updated regularly covering community, mental health and health conditions.
· Complaints process improved: one complaint investigated and resolved since last inspection; staff and people confident concerns would be acted upon.